While overactive bladder is more common as we age, it is not a normal part of aging and can affect anyone at any age. A complete medical history, including a voiding diary; a physical examination; and possibly one or more diagnostic procedures help the physician determine an appropriate treatment plan for overactive bladder.

Other tests may be ordered if your doctor thinks your symptoms could be caused by other problems, such as diabetes or prostate disease.

Medical History
The medical history includes information about bowel habits, patterns of urination and leakage (when, how often, how severe), and whether there is pain, discomfort, or straining when voiding. The patient's history of illnesses, pelvic surgeries, pregnancies, and medications currently used also supply the physician with information relevant to making a diagnosis. In the elderly, a mental status evaluation and assessment of social and environmental factors may be performed.

Physical Examination
A physical examination includes a neurologic status evaluation and examination of the abdomen, rectum, genitals, and pelvis. The cough stress test, in which the patient coughs forcefully while the physician observes the urethra, allows observation of urine loss. Instantaneous leakage with coughing indicates a diagnosis of stress incontinence. Leakage that is delayed or persistent after the cough indicates urge incontinence.

The physical examination also helps the physician identify medical conditions that may be the cause of overactive bladder. For instance, poor reflexes or sensory responses may indicate a neurological disorder.

Urinalysis
Examination of the urine may identify medical conditions associated with overactive bladder, such as the following:

• Bacteriuria-presence of bacteria in urine; indicates infection
• Glycosuria-excess glucose in urine; may indicate diabetes
• Hematuria-blood in urine; may indicate kidney disease, stone disease or bladder cancer
• Proteinuria-excess protein in urine; may indicate kidney disease, cardiac disease, blood disease
• Pyuria-presence of pus in urine; indicates infection or inflammation

Other Testing

Cystometrogram
This simultaneously measures intra-abdominal, total bladder, and true detrusor (bladder muscle) pressures. This allows involuntary detrusor contractions to be distinguished from increased intra-abdominal pressure. The voiding cystometrogram detects outlet obstruction in patients who are able to void.

Uroflowmetry
Identifies abnormal voiding patterns. In a simple uroflowmetry, typically a stop watch is used to measure the amount of time a patient needs to urinate into a calibrated vessel. The doctor then assesses the ratio. In a complex uroflowmetry, electronic equipment is used to record the volume of urine and elapsed time. The physician then assesses the ratio.

Bladder Stess Test
To see whether you're leaking urine, your doctor might do a bladder stress test, which consists of filling your bladder with fluid and then asking you to cough.

Cystoscopy
If your urinalysis reveals blood in your urine, if you have frequent urinary tract infections or if your doctor is contemplating surgery for you,a cystoscopy might be scheduled. In this procedure a thin, lighted instrument called a cystoscope is used to evaluate the lining of the urethra, bladder and prostate (in men). The cystoscope is inserted into your urethra and slowly advanced into the bladder, allowing the doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be inserted through the cystoscope that allow the doctor to remove samples of tissue (biopsy) or samples of urine. Small bladder stones and some small growths can be removed during cystoscopy. This may eliminate the need for more extensive surgery.

Urodynamic Testing
Cystometry may be used to measure the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle (the muscle surrounding the bladder).

Imaging Tests
X-rays, CAT scans and ultrasound may be used to evaluate anatomic conditions associated with overactive bladder. Imaging of the lower urinary tract before, during, and after voiding is helpful in examining the anatomy of the urinary bladder and urethra. A CAT scan is available in our Poughkeepsie office for the convenience of our patients.