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Overactive%20bladder Diagnosis
Diagnosis
- Bladder symptoms should be carefully elicited
- Presence of storage symptoms associated with overactive bladder (OAB) [eg urgency, urgency incontinence, frequency, nocturia]
- Storage problems (stress incontinence episodes)
- Bladder emptying problems (hesitancy, straining to void, prior history of urinary retention, force of stream, intermittency of stream)
- Bladder function related to the amount and type of fluid intake with or without caffeine
- Patients should be asked how much fluid and what type they drink each day, how many times they void each day and how many times they void at night
- If unable to provide accurate intake of fluids, then a diary should be filled out
- Current medications should reviewed to ensure that voiding symptoms are not adverse effects of the prescribed medications such as anticholinergics or antimuscarinics, antidepressants, antipsychotics, sedatives or hypnotics, diuretics, narcotics, alpha-adrenergic blockers, alpha-adrenergic agonists, beta-adrenergic agonists, and calcium channel blockers
- Degree of bother from bladder symptoms
- Can affect daily activities related to work and leisure
- Patients are advised to avoid certain activities like travel or in situation that will not allow an easy access to a toilet
- Assess for co-morbid conditions
- Neurologic diseases (eg, stroke, multiple sclerosis, spinal cord injury)
- Mobility deficits
- Medically complicated/uncontrolled diabetes
- Fecal motility disorders (fecal incontinence or constipation)
- Chronic pelvic pain
- History of recurrent urinary tract infections (UTIs) and gross hematuria
- Prior pelvic surgeries (incontinence/prolapse surgeries)
- Pelvic cancer (bladder, colon, prostate) and pelvic radiation
Physical Examination
- Comprehensive physical examination would determine the nature, severity, and impact of the symptoms in patients with overactive bladder (OAB)
- Pulmonary and cardiovascular evaluation
- Assess control of cough or the need for medications such as diuretics
- Abdominal examination
- Assess and check for presence of diastasis recti, scars, masses, ascites, organomegaly, hernias and areas of tenderness as well as for suprapubic distension that may suggest urinary retention
- Palpable bladder may imply overflow incontinence or obstructive problem
- Lower extremities
- Check if there is edema (potential for fluid shifts during periods of postural changes)
- Bimanual examination
- Should include rectal examination to check the anal sphincter tone, fecal impaction, presence of rectal lesions
- Rectal examination should also be focused on the prostate to rule out benign prostatic hypertrophy (BPH) or prostate cancer
- Pelvic examination
- Evaluate for inflammation, infection and atrophy
- Above-mentioned conditions can increase afferent sensation leading to urinary urgency, frequency, dysuria, and OAB
- Neurological examination
- Related to the severity of symptoms and therapeutic implications (Mini-Mental State Examination-MMSE)
- Assessment of the lumbosacral nerve roots and evaluation of the deep-tendon reflexes, lower-extremity strength and sharp/dull sensation
- Abnormal findings such as deep tendon hyperreflexia or absent bulbocavernosus reflex are possible underlying neurologic lesions contributing to urinary incontinence
Laboratory Tests
Urinalysis
Cystoscopy
- Used to rule out microhematuria, pyuria, urinary tract infection (UTI) and glucosuria
- Indicated for patients with irritative voiding symptoms in the absence of signs of infection and this may completely exclude the presence of clinically significant bacteriuria
- Assessed in patients with obstructive symptoms, history of incontinence or prostatic surgery, neurologic diagnoses and when PVR assessment is deemed necessary to optimize care and minimize potential risks
- Baseline PVRs should be performed in men who have overlap of symptoms between storage, emptying and voiding prior to initiation of antimuscarinic therapy
- Antimuscarinics should be used with caution in patients with PVR of >250-300 mL
Cystoscopy
- Used to look for presence of tumors in the bladder
- Measures the anatomic and functional status of the bladder and urethra
- Used when there is suspicion of neurologic etiology
- Multiple components:
- Cystometrography (CMG): assesses the storage phase of bladder function and looks at bladder capacity, compliance, detrusor overactivity, sensation of filling
- Uroflow/electromyelography: assesses the detrusor pressure during voiding, relaxation of pelvic floor muscles during voiding, and nature of the flow pattern
- Intravesical pressure: determines the detrusor pressure
- Documents the intake, voiding behaviour and baseline symptom levels to assess treatment efficacy
Screening
Symptom questionnaires
- Used in overactive (OAB) clinical trials to quantitate symptoms and changes with OAB therapies such as Urogenital Distress Inventory (UDI), UDI-6 Short Form, Incontinence Impact Questionnaire (IIQ) and Overactive Bladder Questionnaire (OAB-q)
