Thursday, August 31, 2006
overactive bladder
Evaluation and Diagnosis
OAB is a syndrome which is diagnosed on the basis of history, examination, and urinalysis. The history should focus on the patient's bladder complaints. Does the patient have the symptoms described in the definition of OAB; namely urinary urgency, frequency, nocturia, and UUI? For patients with incontinence it is important to distinguish leakage associated with UUI compared with leakage associated with SUI (Table 1).
Table 1. Differentiating OAB From Stress Incontinence
| Symptoms | OAB | Stress Incontinence |
|---|---|---|
| Urgency (strong, sudden desire to void) | Yes | No |
| Frequency with urgency | Yes | Rarely |
| Leaking during physical activity (eg, coughing, sneezing, lifting, etc) | No | Yes |
| Amount of urinary leakage with each episode of incontinence | Large if present | Usually small |
| Ability to reach the toilet in time following an urge to void | No or just barely | Yes |
| Nocturnal incontinence | Yes | Rare |
| Nocturia (waking to pass urine at night) | Usually | Seldom |
From: Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003;62:28-32.
Past history should focus on any medications that can exacerbate urinary complaints (Table 2) as well as other medical issues which can cause or exacerbate lower urinary tract symptoms. Any symptoms suggestive of an undiagnosed neuropathic condition should be noted and evaluated; many neurologic diseases (eg, multiple sclerosis, spinal cord injury, stroke, Parkinson's) can result in neurogenic OAB.
Table 2. Potential Adverse Bladder Effect From Medicines
| Medication | Adverse Effect |
|---|---|
| Sedatives | Confusion, secondary incontinence |
| Alcohol, caffeine | Diuresis |
| Anticholinergics | Impair detrusor contractility |
| Voiding difficulty | |
| Overflow incontinence | |
| α-Agonists | Increase outlet resistance, voiding difficulty |
| β-Blockers | Decrease urethral closure |
| Stress incontinence | |
| Calcium-channel blockers | Reduce bladder smooth muscle contractility |
| ACE inhibitors | Induce cough, stress urinary incontinence |
From: Berek J. Novak's Gynecology. 13th ed. Philadelphia: Lippincott Williams and Wilkins. 2002:1037.
