Symptoms & diagnosis^2,3

Symptoms

If you have an overactive bladder (OAB) you may experience a frequent, intense and urgent need to urinate. In some cases, it’s so sudden that you have trouble making it to the bathroom in time.

OAB is caused by involuntary bladder contractions and is characterised by a group of four symptoms:

Urgency

Frequency

Nocturia

Urge incontinence

The most common symptom of overactive bladder is urinary urgency, which is a sudden and compelling desire to pass urine, which is difficult to hold in. Urgency may occur with accidental leakages, often referred to as “wet OAB” or without accidental leakage, often referred to as “dry OAB”.

Ideally you should be able to go for 3-4 hours between needing to pass urine.⁷ However, if you find yourself going to the toilet more often than that, you may have OAB. Your bladder may feel extremely full but you only pass a little urine. Sometimes, it may feel that your bladder has not completely emptied. It is possible to monitor the frequency of your toilet trips by keeping a bladder diary where you can record urination episodes.

People with bladder problems may have night-time symptoms, which could indicate nocturia. Nocturia is defined as waking up two or more times a night to urinate. Most people can sleep for 6-8 hours without having to urinate. Nocturia can be very disruptive and lead to poor sleep quality, which can have a knock-on effect during the day.

OAB can have symptoms of urinary urge incontinence. This happens because the sense of needing to empty your bladder is so overwhelming that there may be some accidental loss of urine before you reach the toilet. In urge incontinence, small or large quantities of urine can be lost involuntarily. Wearing pads is often not enough to cope with the large amounts of urine and frequent changes of clothes may be required. Activities are often planned around the availability of toilets and some people may restrict social activity outside the home for fear of leaking urine.

Getting help

OAB can turn your world upside down but can be managed with the appropriate treatment. You should take the first step of approaching your GP to determine whether the symptoms you are experiencing are due to overactive bladder or another condition, and to decide which treatment is the best.

Diagnosis

You might feel embarrassed discussing such a private matter with your doctor, but it's worthwhile to take that step and seek help, particularly if your symptoms are disrupting your daily activities. The diagnosis of overactive bladder (OAB) is made primarily on the person's signs and symptoms and by ruling out other possible causes such as an infection. The more information you have for the doctor about your symptoms, the more straightforward it will be to make a diagnosis.

You may be asked to answer questions about patterns of passing urine; daily fluid intake; if you are taking any medications and/or supplements that might be contributing to your problem and to discuss any significant medical conditions you may have. Your doctor may also talk to you about the severity of the problem, if it causes you any inconvenience or embarrassment, and possibly suggest that you keep a bladder diary recording your bathroom trips. A bladder diary is available to download in our downloadables section.

The doctor may also perform a urinalysis, which is a simple test that can help find the cause of symptoms by checking a sample of urine for glucose, blood or infection.

A minority of people may require referral to a specialist for further tests. These may include urodynamic testing, which is usually carried out as an outpatient procedure in a hospital. Urodynamic⁸ testing may involve measuring the pressure inside the bladder while the bladder is being filled. It can assess the bladder’s ability to hold urine and empty steadily and completely, and also whether the bladder is having involuntary contractions that cause urine leakage.