The term
overactive bladder (OAB) is used to describe the symptoms of urinary frequency and urgency with or without
urge incontinence. Commonly reported symptoms are
nocturia, urgency, frequency, and
urge incontinence. However, some of these symptoms may be because of other lower urinary tract conditions or may simply represent a variant of normal physiologic function. Consequently, special considerations need to be made when diagnosing OAB in women. In women of all ages, lower
urinary tract infection is the most common cause of irritative urinary symptoms, and midstream urine microscopy and culture should be performed. A chronic urinary residual secondary to voiding difficulties may also result in symptoms of frequency and overflow incontinence and may be diagnosed using a postmicturition ultrasound scan. In premenopausal women, pregnancy should also be excluded. In postmenopausal women, urogenital
atrophy can cause irritative symptoms that may be improved with
hormone replacement therapy.
Vaginal administration has been shown to be most effective and may be used to supplement systemic replacement
therapy. In addition,
estrogen replacement may be beneficial in the management of OAB as an adjunct to
anticholinergic therapy. When investigating elderly women with OAB, special consideration should be given to comorbidities, such as
constipation and
fecal impaction, mobility problems, and the loss of independence. Concomitant medication, such as
diuretics and
alpha-adrenergic blockers, should also be noted and the need for
therapy reviewed. In conclusion, OAB is a subjective diagnosis that should only be made when other lower urinary tract conditions have been excluded.