Differential Diagnosis for a 67-year-old Female with Urinary Frequency, Urgency, and Normal UA
- Single most likely diagnosis
- Overactive Bladder (OAB): This condition is characterized by urinary urgency, usually accompanied by frequency and nocturia, in the absence of a urinary tract infection (UTI) or other pathology. The normal UA and absence of pain or burning support this diagnosis, as OAB does not typically cause these symptoms.
- Other Likely diagnoses
- Stress Urinary Incontinence: Although the primary complaint is frequency and urgency, stress incontinence can sometimes present with urgency due to the fear of leakage, leading to more frequent voiding.
- Mixed Urinary Incontinence: This combines symptoms of stress incontinence and OAB, which could explain the frequency and urgency.
- Benign Prostatic Hyperplasia (BPH) in Men is a common cause, but in women, similar symptoms can be due to urethral stricture or other obstructive causes, though less common.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Diabetes Mellitus: Uncontrolled diabetes can lead to polyuria (frequent urination), which might be mistaken for urinary frequency due to other causes. The absence of burning or pain does not rule out diabetes, as these symptoms are more commonly associated with UTIs.
- Neurogenic Bladder: Conditions affecting the brain, spinal cord, or nerves can lead to abnormal bladder function, presenting with urgency and frequency. This could be due to a variety of causes, including stroke, multiple sclerosis, or spinal cord injury.
- Bladder Cancer: Although less likely, bladder cancer can cause irritative voiding symptoms like frequency and urgency, especially in older adults. A normal UA does not rule out this diagnosis, as hematuria (blood in the urine) may not always be present.
- Rare diagnoses
- Interstitial Cystitis/Bladder Pain Syndrome: This condition is characterized by chronic pain perceived to be from the bladder, often accompanied by frequency and urgency. However, the absence of pain in this case makes it less likely.
- Urethral Diverticulum: A condition where a pouch or pocket forms in the wall of the urethra, which can cause urinary frequency, urgency, and sometimes incontinence. It's less common and might not be initially suspected without specific diagnostic tests.
- Sphincter Dyssynergia: A condition where the external urethral sphincter does not relax properly during voiding, leading to obstructive and irritative voiding symptoms. This is more commonly seen in the context of neurogenic bladder.