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Assessment of overactive bladder (OAB)

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 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.

Download Bladder Diary