One of the greatest barriers to treatment of overactive bladder (OAB) is the fear people have of what will happen when they seek treatment. Part of that fear is concern about expensive or invasive tests that may be needed to diagnose OAB. We explore today some of the very simple tools that we use in evaluating patients at The OAB Clinic.
1. Symptom and Medical History
It may seem obvious that evaluation of incontinence should be begin by listening to the patient. Unfortunately, this is not always what patients experience. Listening to the patient’s description of her symptoms is extremely useful first in determining what type of incontinence she may be experiencing. Patients with urgency incontinence will often report their frequent voids, awakening at night to void, or rushing to reach the bathroom before leaking urine. Patients with stress incontinence, instead, will describe actions that increase their abdominal pressure (such as exercise or sneezing) that precede incontinence. In addition, information about medications tried, previous pelvic surgeries, or medical issues are very important in planning treatment. Diagnosis of OAB should always begin by carefully listening to what the patient has to tell us.
2. Physical Exam
No one likes it, but a good physical exam is a key component to properly evaluating urinary incontinence in a patient. This usually includes an exam of the pelvis that can guide us to potential causes of incontinence. It is also possible to discover other problems that may complicate planned treatments. In patients with previous surgical incontinence treatments, for instance, it is particularly important to examine for any possible problems that may have come about as a result of that surgery.
3. Bladder Diary
One of the most effective (and inexpensive) tools we have for evaluating OAB is a diary maintained at home by the patient. We typically prefer that this diary is kept for 3 days (though it does not need to be 3 consecutive days). By keeping track of how often you urinate and the volume of each void, we can evaluate whether your bladder is holding enough urine, whether you are urinating too frequently, whether you are making too much urine at night, and even what type of activities are leading to incontinence. In many patients, review of this diary alone is enough to diagnose the type of incontinence a patient may be experiencing.
4. Bladder Symptom Questionnaires
It is very difficult to solve a problem unless you have a proper understanding of the nature of the problem. With OAB, bladder symptom questionnaires help us to determine if the symptoms are consistent with overactive bladder. These tools are essential in measuring how bothersome the symptoms may be, helping to guide treatment. Most important, they can allow us to track a patient’s symptoms over time to see if treatments are having their intended effect.
For most patients with OAB, the evaluation does not need to include numerous invasive and expensive tests. We begin by listening to the patient, then looking for clues as to what may be contributing to the symptoms. A bladder diary and symptom questionnaire are simple, inexpensive tools that help to define and then track incontinence symptoms. Don’t let the fear of the unknown prevent you from seeking help for your bladder problems. Knowing these 4 simple test will help get you the relief you need.
At The OAB Clinic at Erlanger East in Chattanooga, Tennessee, we specialize in the evaluation and treatment of all forms of urinary incontinence. For more information, contact us at 423-778-4OAB (4622).
Colin M. Goudelocke, MD, FPMRS