Diagnostic Considerations

The term overactive bladder (OAB) refers to a symptom complex. Therefore, the first part of the evaluation of OAB is to review the patient’s lower urinary tract symptoms to ensure that the symptoms are consistent with OAB.

A diagnosis of OAB depends on the presence of urgency, which differs from a simple urge to void. A typical urge to void is a normal sensation that progressively strengthens when deferred. In contrast, urgency is an abnormal condition that is characterized by a sudden onset of a desire to void that is difficult to defer.

Nocturia is often confused with lower urinary tract symptoms (LUTS) and assumed to be a symptom of OAB or, in men, of benign prostatic hyperplasia (BPH). Not all patients with nocturia have OAB or BPH, and the relationship between nocturia and OAB is not well understood. A 2011 consensus statement on the evaluation and treatment of nocturia concluded that most patients with nocturia do not have OAB but most patients with OAB do have nocturia.^[27]

Other causes of urinary frequency, urgency, and urinary incontinence must be excluded. Urinary incontinence has several subtypes: stress, urge, mixed, overflow, and transient. Transient incontinence may be related to any of a number of conditions, easily recalled by means of the following mnemonic, DIAPPERS:

Delirium
Infection
Atrophy
Pharmaceuticals
Psychological factors
Excess urine output
Restricted mobility
Stool impaction

Other conditions to consider include the following:

Urinary stone disease
Bladder cancer (must be ruled out if the patient has microscopic or gross hematuria)
Gastrointestinal (GI) pathology
Gynecologic pathology

Differential Diagnoses

Workup

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Media Gallery

Communication between urothelium and suburothelium. ACh—acetylcholine; ATP—adenosine triphosphate; M2—muscarinic receptor subtype 2; M3—muscarinic receptor subtype 3; NO—nitric oxide; P2X1—purinergic receptor P2X, ligand-gated ion channel 1; P2X3—purinergic receptor P2X, ligand-gated ion channel 3; sGC—soluble guanyl cyclase; VR1—vanilloid receptor 1.
Overactive bladder (OAB) and quality of life (QoL). Short Form-36 (SF-36). Reprinted with permission from Blackwell.
Total community and institutional costs of overactive bladder (OAB) (in millions of dollars). UTI—urinary tract infection (UTI). Reprinted with permission from Elsevier.

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Author

Pamela I Ellsworth, MD Chief, Division of Pediatric Urology, Nemours Children's Hospital; Professor of Urology, University of Central Florida College of Medicine

Pamela I Ellsworth, MD is a member of the following medical societies: American Urological Association, Massachusetts Medical Society, Society for Fetal Urology, Society of Women in Urology

Disclosure: Nothing to disclose.

Coauthor(s)

Wellman W Cheung, MD, FACS Clinical Professor, Department of Urology and Department of Obstetrics and Gynecology, State University of New York Downstate Medical School

Wellman W Cheung, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Chinese American Medical Society, Endourological Society, American Urogynecologic Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

Disclosure: Received grant/research funds from Astallas for pi.

Aneela Naureen Hussain, MD, MBBS, FAAFM Consulting Staff, Department of Family Medicine, South Texas Veterans Health Care System in San Antonio

Aneela Naureen Hussain, MD, MBBS, FAAFM is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Medical Women's Association, Medical Society of the State of New York, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Nadia Hasan Khan, MD Family Medicine Physician, Dartmouth Hitchcock Clinics Milford

Nadia Hasan Khan, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Miriam T Vincent, MD, PhD, JD Professor and Chair, Department of Family Practice, State University of New York Downstate Medical Center

Miriam T Vincent, MD, PhD, JD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Bar Association, American Bar Association, American Academy of Family Physicians, Sigma Xi, The Scientific Research Honor Society, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoscopic and Robotic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

LiAnn N Handel, MD Resident Physician, Department of Urology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University

LiAnn N Handel, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Overactive Bladder Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

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