Overactive Bladder Differential Diagnoses

Updated: Dec 09, 2016
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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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 benign prostatic obstruction (BPO). 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 and that most patients with OAB do have nocturia. [26]

Other causes of urinary frequency, urgency, and urinary incontinence must be excluded. Incontinence has several subtypes: stress incontinence, mixed urinary incontinence, overflow incontinence, and transient incontinence. 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) or colonic pathology
  • Gynecologic pathology

Differential Diagnoses