Diagnosis of Overactive Bladder



Overactive bladder (OAB) is a highly prevalent disorder impacting millions of people’s lives throughout the world. Our goal in this chapter is to define the condition as it has evolved over the past few decades. We will then review the basis for establishing a diagnosis, which includes a thorough symptom assessment as well as physical exam and urine studies. The use of adjunctive tests will also be reviewed, although their utility is limited in the diagnosis of an index patient with OAB.


OAB diagnosis OAB prevalence Urodynamics Voiding diary 


  1. 1.
    Milsom I, Abrams P, Cardozo L, Roberts RG, Thoroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based study. BJU Int. 2001;87(7):760–6.PubMedGoogle Scholar
  2. 2.
    Marinkovic S, Rovner E, Moldwin R, Stanton S, Gillen L, Marinkovic C. The management of overactive bladder syndrome. BMJ. 2012;344:e2365.CrossRefGoogle Scholar
  3. 3.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.CrossRefGoogle Scholar
  4. 4.
    Abrams P, Wein AJ. The overactive bladder and incontinence: definitions and a plea for discussion. Neurourol Urodyn. 1999;18(4):413–6.CrossRefGoogle Scholar
  5. 5.
    Abrams P, Blaivas JG, Stanton SL, Andersen JT. The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol. 1988;114(Suppl):5–19.Google Scholar
  6. 6.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An international Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMedGoogle Scholar
  7. 7.
    Wein AJ, Rackley R. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. J Urol. 2006;175(3 Pt w):S5–S10. Review.CrossRefGoogle Scholar
  8. 8.
    Abrams P, Chapple C, Juneemann KP, Sharpe S. Urinary urgency: a review of its assessment as the key symptoms of the overactive bladder syndrome. World J Urol. 2012;30(3):385–92.CrossRefGoogle Scholar
  9. 9.
    Stav K, Dwyer PL, Rosamilia A. Women overestimate daytime urinary frequency: the importance of the bladder diary. J Urol. 2009;181(5):2176–80.CrossRefGoogle Scholar
  10. 10.
    Cardozo L, Coyne KS, Versi E. Validation of the urgency perception scale. BJU Int. 2005;95(4):591–6.CrossRefGoogle Scholar
  11. 11.
    Freeman R, Hill S, Millard R, Slack M, Sutherst J; Tolterodine Study Group. Reduced perception of urgency in treatment of overactive bladder with extended-release tolterodine. Obstet Gynecol. 2003;102(3):605–11.Google Scholar
  12. 12.
    Zinner N, Harnett M, Sabounjian L, Sandage B Jr, Dmochowski R, Staskin D. The overactive bladder-symptom composite score: a composite symptom score of toilet voids, urgency severity and urge urinary incontinence in patients with overactive bladder. J Urol. 2005;173(5):1639–43.CrossRefGoogle Scholar
  13. 13.
    Thurmon KL, Breyer BN, Erickson BA. Association of bowel habits with lower urinary tract symptoms in men: findings from the 2005–2006 and 2007–2008 National Health and Nutrition Examination Survey. J Urol. 2013;189(4):1409–14.CrossRefGoogle Scholar
  14. 14.
    Rovner ES, Wein AJ. Today’s treatment of overactive bladder and urge incontinence. Women’s Health in Prim Care. 2000;3(3):179–92.Google Scholar
  15. 15.
    Nambiar A, Lucas M. Chapter 4: guidelines for the diagnosis and treatment of overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). Neurourol Urodyn. 2014;33(Suppl):S21–5.CrossRefGoogle Scholar
  16. 16.
    Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al; American Urological Association; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. 2012; amended 2014. Accessed 27 Apr 2018.
  17. 17.
    Thuroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Drake MJ, et al. EUA guidelines on urinary incontinence. Eur Urol. 2011;59(3):387–400.CrossRefGoogle Scholar
  18. 18.
    National Institute of Clinical Excellence (NICE). CG171 urinary incontinence in women: full guideline. 2013.Google Scholar
  19. 19.
    Colhoun A, Goudelocke C, Rovner ES. Reproduction of female lower urinary tract symptoms on urodynamics. Low Urin Tract Symptoms. 2012;4(2):59–62.CrossRefGoogle Scholar
  20. 20.
    Rovner E, Goudeloke C. Urodynamics in the evaluation of overactive bladder. Curr Urol Rep. 2010;11(5):343–7.CrossRefGoogle Scholar
  21. 21.
    Gowda M, Danford JM, Slaughter JC, Zimmerman CW, Ward RM. Clinical findings associated with bladder trabeculations in women. Int Urogynecol J. 2013;24(7):1167–71.CrossRefGoogle Scholar
  22. 22.
    Cartwright R, Afshan I, Derpapas A, Vijaya G, Khullar V. Novel biomarkers for overactive bladder. Nat Rev Urol. 2011;8(3):139–45.CrossRefGoogle Scholar
  23. 23.
    Klarskov P, Gerstenberg T, Ramirez D, Christenson P, Hald P. Prostaglandin type E activity dominates in urinary tract smooth muscle in vitro. J Urol. 1983;129(5):1071–4.CrossRefGoogle Scholar
  24. 24.
    Bradley CS, Brown JS, Van Den Eeden SK, Schembri M, Ragins A, Thom DH. Urinary incontinence self-report questions: reproducibility and agreement with bladder diary. Int Urogynecol J. 2011;22(12):1565–71.CrossRefGoogle Scholar
  25. 25.
    Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, Chapple CR, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(3):352–60.CrossRefGoogle Scholar
  26. 26.
    Kupelian V, Wei JT, O’Leary MP, Norgaard JP, Rosen RC, McKinlay JB. Nocturia and quality of life: results from the Boston area community health survey. Eur Urol. 2012;61(1):78–84.CrossRefGoogle Scholar
  27. 27.
    Appell RA, Sand P, Dmochowski R, Anderson R, Zinner N, Lama D, et al. Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT study. Mayo Clin Proc. 2001;76(4):358–63.CrossRefGoogle Scholar
  28. 28.
    Burgio KL. Influence of behavior modification on overactive bladder. Urology. 2002;60(5 Suppl 1):72–6.CrossRefGoogle Scholar
  29. 29.
    Chapple CR, Rechberger T, Al Shukri S, Meffan P, Everaert K, Huang M, et al. Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder. BJU Int. 2004;93(3):303–10.CrossRefGoogle Scholar
  30. 30.
    Diokno AC, Appell RA, Sand PK, Dmochowski RR, Gburek BM, Klimberg IW, et al. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. Mayo Clin Proc. 2003;78(6):687–95.CrossRefGoogle Scholar
  31. 31.
    Dmochowski RR, Sand PK, Zinner NR, Gittelman MC, Davila GW, Sanders SW, et al. Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine versus placebo in previously treated patients with urge and mixed urinary incontinence. Urology. 2003;62(2):237–42.CrossRefGoogle Scholar
  32. 32.
    Haab F, Stewart L, Dwyer P. Darifenacin, an M3 selective receptor antagonist, is an effective and well tolerated once-daily treatment for overactive bladder. Eur Urol. 2004;45(4):420–9. discussion 429CrossRefGoogle Scholar
  33. 33.
    Van Kerrebroeck P, Kreder K, Jonas U, Zinner N, Wein A; Tolterodine Study Group. Tolterodine once-daily: superior efficacy and tolerability in the treatment of the overactive bladder. Urology. 2001;57(3):414–21.CrossRefGoogle Scholar
  34. 34.
    Mazurick CA, Landis JR. Evaluation of repeat daily voiding measures in the national interstitial cystitis data base study. J Urol. 2000;163(4):1208–11.CrossRefGoogle Scholar
  35. 35.
    Brown JS, McNaughton KS, Wyman JF, Burgio KL, Harkaway R, Bergner D, et al. Measurement characteristics of a voiding diary for use by men and women with overactive bladder. Urology. 2003;61(4):802–9.CrossRefGoogle Scholar
  36. 36.
    Sussman RD, Richter L, Tefera E, Park A, Sokol A, Gutman R, Iglesia C. Utilizing technology in assessment of lower urinary tract symptoms: a randomized trial of electronic versus paper voiding diaries. Female Pelvic Med Reconstr Surg. 2016;22(4):224–8.CrossRefGoogle Scholar
  37. 37.
    Homma Y, Batista JE, Bauer SB, Griffiths DJ, Hilton P, Kramer G, et al. Urodynamics. In: Abrams P, Wein A, Schussler B, Kawabi K, Bump R, Melchior H, et al., editors. Incontinence. First international consultation on incontinence. Recommendations of the International Scientific Committee: the evaluation and treatment of urinary incontinence. Plymouth: Health Publication Ltd; 1999. p. 317–72.Google Scholar
  38. 38.
    Masunaga K, Yoshida M, Inadome A, Iwashita H, Miyamae K, Ueda S. Prostaglandin E2 release from isolated bladder strips in rats with spinal cord injury. In J Urol. 2006;13(3):271–6.Google Scholar
  39. 39.
    Liu H, Tyagi p CMB, Kuo HC. Urinary nerve growth factor but not prostaglandin E2 increases in patients with interstitial cystitis/bladder pain syndrome and detrusor overactivity. BJU Int. 2010;106(11):1681–5.CrossRefGoogle Scholar
  40. 40.
    Fry CH, Sahai A, Vahabi B, Kanai A, Birder L. What is the role for biomarkers for lower urinary tract disorders? ICI-RS 2013. Neurourol Urodyn. 2017;33(5):602–5.CrossRefGoogle Scholar
  41. 41.
    Oddiah D, Anand P, McMahon SB, Rattray M. Rapid increase of NGF, BDNF and NT-3 mRNAs in inflamed bladder. Neuroreport. 1998;9(7):1455–8.CrossRefGoogle Scholar
  42. 42.
    Yokoyama T, Kumon H, Nagai A. Correlation of urinary nerve growth factor level with pathogenesis of overactive bladder. Neurourol Urodyn. 2008;27(5):417–20.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of UrologyMedical University of South CarolinaCharlestonUSA

Personalised recommendations