How is Overactive Bladder Diagnosed?
The American Urological Association Guidelines suggest that a diagnosis of OAB be made carefully and thoughtfully, based not only on the symptoms present but also the patients history and physical examination.(1) Other conditions which cause frequency and urgency must be excluded.
#1 – Symptoms – Does the patient present with typical OAB symptoms: Urgency, frequency, nocturia or incontinence. How long have they been present? Is the patient avoiding certain activities because of worry about restroom access? How much water and/or fluids does the patient drink? Is the patient taking any medication, such as diuretics?
#2 – Co-morbid conditions – Does the patient have any other medical conditions which could be contributing to bladder function, such as neurological diseases (stroke, multiple sclerosis, spinal injury), mobility deficits, diabetes, bowel disorders, chronic pelvic pain, a history of UTI, blood in the urine, prior pelvic surgeries, pelvic cancer and/or a history of radiation, pelvic organ prolapse. If present, these represent more “complicated OAB” cases and are usually referred to a specialist.
#3 – Physical Examination – A careful physical examination should be performed. An abdominal exam will look for scars, masses, hernia and areas of tenderness. physicians will look at the lower legs to determine if edema is present. A rectal/ genitourinary exam should be performed to rule out pelvic floor muscle disorders. In women, a brief gynecological examination should occur to assess the skin quality of the vulva and vagina to determine if estrogen deficiency is present. Men require a rectal examination to assess the prostate and pelvic musculature.
#4 – Urinalysis – A urinalysis should be performed to rule out microhematuria (microscopic blood), UTI, pyuria (pus in your urine) and glucosuria (glucose in the urine). If infection is found, the infection should be treated appropriate and symptoms should be reassessed once the infection has cleared.
#5 – Post Void Residual Test – For more complex cases or if the diagnosis is in doubt, physicians may perform a post void residual test to determine if the patient is emptying their bladder fully. After the patient has urinated, the physician may perform a simple ultrasound to determine if the bladder has emptied. If this is vague, they may also use a catheter to determine if any urine is left in the bladder.
#6 – Bladder Diaries – Diaries that document the intake and voiding of patients can be helpful, particularly if the patient cannot describe their symptoms well. The AUA suggests that patients make a voiding diary for three to seven days, documenting the times that they void and/or experience incontinence. They should also rate the degree of urgency that occurs with each. Bladder & voiding diaries are useful tools that can also be used by the patient and physician to monitor progress with treatment. Bladder diaries placed in medical records over time also make for compelling evidence should the patient be applying for disability benefits.
#7 – Urodynamics – The AUA does not recommend using urodynamics, cystoscopy and renal/bladder ultrasound in uncomplicated patients. However, for those patients with more complicated cases and/or who fail to respond to multiple OAB treatments, additional testing may be suggested.
- (3) Gormley, at al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. May 2012