Symptoms of Overactive Bladder
Overactive bladder is characterized by urinary urgency (a sudden, compelling desire to urinate that is difficult to defer) as the hallmark symptom, usually accompanied by urinary frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology. 1
Core Symptom: Urgency
Urgency is the defining and required symptom for diagnosing OAB. The International Continence Society defines urgency as "a sudden, compelling desire to pass urine which is difficult to defer." 1 This is the only mandatory symptom—all other symptoms are commonly associated but not required for diagnosis.
Associated Symptoms
Urinary Frequency
- Daytime frequency: Traditionally defined as more than 7 voids during waking hours, though this varies based on sleep duration, fluid intake, and comorbidities 1
- Characterized by many small-volume voids (this distinguishes OAB from polydipsia) 1
- More commonly reported in males (63.6% vs 38.1% in females) 2
Nocturia
- Waking one or more times during sleep to void 1
- Three or more episodes typically constitute moderate to major bother 1
- In OAB, nocturnal voids are typically small-volume (versus the normal or large-volume voids seen in nocturnal polyuria) 1
Urgency Urinary Incontinence (UUI)
- Involuntary urine leakage associated with the sudden compelling desire to void 1
- Present in approximately 72.6% of OAB patients 2
- More commonly reported in females (76.7% vs 66.7% in males) 2
- When present, the condition is termed "OAB-wet"; when absent, "OAB-dry"
Important Clinical Distinctions
What OAB Is NOT:
- Nocturnal polyuria: Production of >20-33% of 24-hour urine output during sleep (age-dependent), characterized by normal or large-volume nocturnal voids rather than the small-volume voids of OAB 1
- Polydipsia: OAB involves many small-volume voids, not the pattern seen with excessive fluid intake 1
- Neurogenic bladder: This guideline specifically addresses non-neurogenic OAB 1
Key Diagnostic Feature:
Symptoms must be self-reported as bothersome to warrant diagnosis and treatment. 1 Alternatively, a caregiver or partner may perceive these symptoms as bothersome and prompt the patient to seek care. Patients commonly suffer for extended periods before seeking medical advice.
Clinical Pearls
- 91% of children with urgency also report either frequency or daytime incontinence, indicating urgency alone is relatively uncommon 2
- OAB is a clinical diagnosis that does not require urodynamic studies for confirmation 3
- The symptom complex must occur in the absence of urinary tract infection or other obvious pathology 1