Because the symptoms of OAB mimic those of other urological conditions, patience may be needed while multiple tests and procedures are performed. Even so, bladder conditions are frequently misdiagnosed due to their nonspecificity, and it can take time before the right treatment is found.
Self-Checks
Most people will seek the diagnosis of OAB when the symptoms are causing embarrassment or are interfering with their quality of life. Because the causes of OAB are widespread, recognition of the four characteristic symptoms is key to reaching a correct diagnosis.
These include:
Urinary frequency: The need to urinate more than seven times within a 24-hour period Urinary urgency: The sudden urge to urinate that’s difficult to control Nocturia: The need to urinate more than once nightly Urge incontinence: The unintentional loss of urine after the sudden urge to urinate
Not everyone experiences OAB in the same way. Although urinary frequency and urgency are considered hallmarks of the disorder, some people may experience nocturia more profoundly than others, for example.
Some may experience urinary incontinence (referred to as “wet OAB”) either mildly or severely, while others may have no incontinence at all (referred to as “dry OAB”).
Understanding these distinctions can help you better describe your symptoms when you see a healthcare provider.
Bladder Diary
To aid in the diagnosis, you can keep a record of your daily and nightly urinations using a bladder diary. The aim of the diary is not only to record the timing of your urinations but also what happened prior to and at the time of the event.
A bladder diary should keep a record of:
When you consume liquids each day, including how much and what you drink (e. g. , soda, coffee, water)Your bathroom trips, including an estimate of how much urine you voidWhen you have accidental leakage and how much is involvedWhether the accidental leakage was preceded by the sudden urge to urinateWhat you are doing at the time of the event (such as laughing, sneezing, running, or simply sitting at your desk)
With an accurate record, your healthcare provider may be able to pinpoint the cause of your symptoms quicker.
Physical Examination
OAB is a complex disorder best evaluated by a specialist in urinary tract disorders, called a urologist. Urologists are skilled in differentiating the conditions that cause urinary frequency and incontinence, thereby reducing the risk of misdiagnosis.
The first step in the diagnosis is the physical exam. As part of the evaluation, your healthcare provider will review your symptoms and medical history and ask questions about your lifestyle, behaviors, diet, and medication use.
Each of these areas can provide clues as to the underlying cause of your symptoms and help your healthcare provider select the appropriate tests and procedures to pursue.
As for the exam itself, you may be asked to undress and put on a hospital gown. The exam will try to eliminate other possible causes of your symptoms and may involve:
Abdominal exam: To look for evidence of a hernia, abdominal masses, organ enlargement (organomegaly), surgical scars, or bladder distention Pelvic exam: To look for signs of uterine prolapse, prolapsed bladder (cystocele), the thinning of the vaginal wall (atrophic vaginitis), and the outgrowth of the urethra (urethral caruncle) caused by things like pregnancy and menopause, or other anatomical changes Digital rectal exam: To look for abnormal growths or the loss of sphincter tone in all patients, and an enlarged prostate (benign prostatic hyperplasia) in people with a prostate
Labs and Tests
There are no laboratory tests that can definitively diagnose OAB. More often than not, urine tests and blood tests are performed to exclude other possible causes of your symptoms.
Urinalysis
During your initial evaluation, you will be asked to provide a urine sample for the lab. The main purpose of the urinalysis is to check for any abnormalities in your urine, such as:
Excessive white blood cells: A sign of a urinary tract infection (UTI) Bacteria and mucus: Commonly seen with cystitis and certain sexually transmitted diseases (STDs) affecting the urethra Red blood cells: A sign of a kidney infection, enlarged prostate, kidney or bladder stones, or cancers of the urinary tract, all of which can require a full workup, including cystoscopy (camera to look inside the bladder), if red blood cells of three or more are noted in urinalysis or blood is seen in the urine Excessive protein: A sign of kidney disease or kidney cancer Excessive glucose: A sign of type 2 diabetes
Blood Tests
In some cases, a urinalysis, physical exam, and comprehensive review of a person’s symptoms and medical history are all that are needed to diagnose OAB. At other times, additional tests may be necessary to validate the diagnosis.
Blood tests serve much the same purpose as a urinalysis. They are generally pursued if you are at an increased risk of a urological condition or are suspected of having one.
These blood tests may include:
Complete blood count (CBC): Used to look for abnormalities in the composition, number, and proportion of blood cells C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Used to detect generalized inflammation associated with many diseases Hemoglobin A1C: Used to help diagnose diabetes Prostate-specific antigen (PSA): Used to detect prostrate enlargement, or benign prostatic hyperplasia (BPH) STD screening: Used to detect bacterial STDs like chlamydia and gonorrhea that commonly cause urinary urgency
Imaging
Imaging studies are less commonly used in the initial diagnosis of OAB. More often, they may be called for when symptoms are severe or there are other concerns related to the proper functioning of the bladder.
Bladder ultrasonography, or bladder ultrasound, a noninvasive procedure that uses high-frequency sound waves to create images of the bladder and surrounding structures, is the most common imaging test.
An ultrasound can reveal abnormalities suggestive of OAB or point the healthcare provider in the direction of other bladder-related conditions. Two reasons for ultrasound include:
Bladder wall hypertrophy: The thickening of the bladder wall is commonly associated with an overactive detrusor muscle (the muscle that contracts and relaxes the bladder) and OAB. Post-void residual (PVR): PVR evaluates the amount of urine left in the bladder after urination, a condition commonly experienced in people with an enlarged prostate, neurogenic bladder (bladder dysfunction caused by neurological damage), traumatic bladder injury, or urinary tract obstruction
Other, more invasive imaging techniques may be used if the urinary incontinence is severe or if there is evidence of bladder damage, urinary reflux, or neurogenic bladder. These may include bladder fluoroscopy or urodynamics (used to measure abnormal contractions and spasms while the bladder is filled and emptied).
Other Procedures
Other procedures may be performed if the causes of your urological symptoms remain unclear or if you fail to respond to the prescribed treatment for OAB.
These typically in-office procedures include:
Cystometry: Warm fluid is fed into the bladder with a urinary catheter while another catheter with a pressure-sensitive probe is fed into the rectum or vagina to measure the pressure needed to void the bladderUroflowmetry: While you urinate into a device called a uroflowmeter, a measurement is taken of the rate of urine flow and any changes in the flow pattern
These tests are often most beneficial to people with intractable (treatment-resistant) incontinence, who may need surgery.
Differential Diagnosis
The challenge of diagnosing OAB is that it can mimic many other conditions, including those not directly involving the bladder. Expert consultation is needed to reach a correct diagnosis and ensure that all other likely causes have been reasonably explored.
Among the conditions commonly included in the differential diagnosis are:
Diagnosing OAB can take time, but by identifying the factors that contribute to it, many people can learn to manage the symptoms with not only medications but also lifestyle changes (such as fluid restriction and caffeine avoidance), pelvic floor exercises, and bladder training.
With the proper diagnosis and treatment, around 60% of people will achieve complete remission within a year, while others will experience a significant reduction in the frequency, discomfort, and stress associated with OAB.
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