Overactive Bladder Differential Diagnoses

Updated: Dec 20, 2022
  • 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, 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