The assessment of the overactive bladder (OAB) is similar to the general assessment performed for urinary incontinence (even though about 2/3 of patients with OAB will not have urinary incontinence or leakage with their urgency).
The assessment consists of a history, examination and basic investigations including a bladder diary.
History
History taking includes:
- Details of bladder habits e.g. how many times in a 24-hour period toileting occurs
- Details of incontinence such as triggers, frequency, severity
- Other medical history e.g. of conditions that can affect bladder control such as diabetes, heart failure
- Medications – both prescribed and over the counter
- Fluid intake – especially that of bladder irritants such as coffee, tea, cola drinks, alcohol
- Smoking history- as smoking (even when it has been discontinued) is a risk factor for urinary system cancer
- In women- obstetric history
- Past history – of pelvic surgery (e.g. in women – hysterectomy, prolapse or other incontinence surgery) or other urological surgery (e.g. prostate surgery in men)
Physical Examination
The examination aims to look for something that may be causing the symptoms.
- It includes an examination of the abdomen looking for a distended or enlarged bladder.
- In women the examination includes a pelvic (also known as an internal or vaginal examination) to assess the pelvic organs and pelvic floor.
- In men the examination includes a prostate assessment (also known as digital rectal examination).
Basic Investigations
- Testing of the urine for infection and blood or pus cells is important to exclude other conditions that can mimic the overactive bladder.
- Assessment of bladder emptying (usually with an ultrasound of the bladder) is useful in some patients
- The Bladder Diary is a very useful tool in both the assessment and treatment of urinary incontinence
- The bladder diary documents frequency of urination and volumes of urine passed over three 24-hour periods (not necessarily consecutive). It is an important tool in quantifying urinary symptoms, helping establish a baseline of symptoms and assessing the effectiveness of treatments.
- In some people additional investigations may be necessary to confirm the diagnosis of OAB, to exclude other conditions and to help determine the treatment plan.
- More complex testing such as the urodynamic study and cystoscopy is NOT required before starting treatment in straightforward cases of overactive bladder.
