Use of validated questionnaires – such as the OAB questionnaire (OAB-q) to assess patient quality of life with urge incontinence, or the International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ–OAB) to assess severity and burden – assist in providing a baseline from which treatment efficacy can be determined. Specific details of incontinence should be interrogated to exclude other types of incontinence. It is important to complete comprehensive history-taking, assessing pertinent past medical history, quantification of local symptoms, urge incontinence and obstetric history. OAB is a diagnosis of exclusion beginning with a targeted history and examination of the urogenital system with an aim to assess the burden of disease facing the patient and affecting their quality of life (refer to Table 2). Foreign body in lower urinary tract (eg eroded synthetic mesh).Bladder outlet obstruction (including benign prostatic hyperplasia, urethral stricture).Urothelial carcinoma (including carcinoma in situ).Neurological (neurogenic detrusor overactivity) Caffeine intake (coffee, tea, energy drinks).Risk factors and contributory factors for OAB Risk factors and differential diagnosis for overactive bladder (OAB) A more comprehensive differential diagnosis for OAB is listed in Table 2. Similarly, urothelial carcinoma of the bladder can result in irritative voiding and patients presenting with voiding dysfunction therefore, symptoms similar to OAB may be the first signs of high-grade bladder cancer. 6 Specifically, a neuropathic bladder from diseases of the central nervous system may result in neurogenic detrusor overactivity, a disease process that is high risk and requires complex urological input. Pertinent key differential diagnoses must be considered and excluded prior to the diagnosis of OAB being confirmed. 5 Identification of these is critical as reduction of exposure represents a pertinent facet of the initial treatment of OAB. 5 Such risk factors may be modifiable or non-modifiable. By definition, OAB is idiopathic – although multiple risk factors have been identified. The symptoms of OAB are typically associated with detrusor overactivity. The aim of this article is to summarise these updated strategies. 3–5 Since a previous review published in 2012, 6 considerable changes have occurred in recent years with respect to management regimens for patients with OAB and urge urinary incontinence. 1 While OAB may be difficult to completely cure, symptoms can be effectively reduced, and quality of life can be improved without excessive cost or morbidity. Many patients downplay their symptoms of OAB and do not raise the issue with health practitioners. Urgency causing non-voluntary urinary incontinence Definition of symptoms of overactive bladder Further, untreated urinary incontinence may increase the risk of urinary tract infection (UTI) and may cause significant surrounding inflammatory changes. Increased burden may be felt by the caregiver, thereby affecting the caregiver’s relationship with the patient. 2 The effects of urinary incontinence are not isolated to the patient. 1 The associated sequelae of OAB, including urinary incontinence, have a negative impact on the quality of life of affected individuals. Associated urge urinary incontinence is common, with large American and European studies suggesting that >10% of the general population is symptomatic, with those aged >65 years being twice as likely to be affected. OAB is frequently associated with urge incontinence. Classically, patients with OAB report difficulty suppressing the urge to urinate. Overactive bladder (OAB) is a common syndrome characterised by unstable bladder contractions, resulting in urinary urgency, frequency and nocturia (defined in Table 1).
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