How can I differentiate between overactive bladder and other causes of urinary urgency in a primary care setting?

In primary care, differentiating overactive bladder (OAB) from other causes of urinary urgency involves a detailed clinical assessment focusing on symptom patterns, exclusion of other pathologies, and targeted investigations. OAB is characterised by urinary urgency, usually with increased frequency and nocturia, with or without urge incontinence, in the absence of infection or other obvious pathology ¹.

Initial evaluation should include a thorough history to identify the nature of urgency, voiding frequency, nocturia, and presence of incontinence, as well as any red flags such as haematuria, recurrent urinary tract infections, or neurological symptoms which may suggest alternative diagnoses or the need for referral ¹,³.

Physical examination and urinalysis are essential to exclude urinary tract infection or haematuria, which may indicate malignancy or other causes ¹,³. In men, assessment for bladder outlet obstruction (e.g., benign prostatic hyperplasia) is important, including digital rectal examination and consideration of PSA testing ¹,³.

Bladder diaries can help quantify frequency and volume, aiding differentiation between OAB and other conditions such as polyuria or nocturnal polyuria (Nitti and Taneja, 2005). Additionally, neurological causes should be considered if there are signs of neurogenic bladder dysfunction, requiring further specialist assessment ².

When symptoms are typical and no red flags are present, a diagnosis of OAB can be made clinically in primary care, and initial management with lifestyle advice, bladder training, and possibly pharmacotherapy can be initiated ¹.

Referral for urodynamic studies or specialist assessment is reserved for cases where diagnosis is uncertain, symptoms are refractory to treatment, or there are atypical features such as persistent haematuria, recurrent infections, or neurological signs ¹,².

In summary, differentiation relies on careful history, exclusion of infection and malignancy, assessment for obstruction or neurological disease, and use of bladder diaries, with OAB diagnosed primarily by symptom pattern and exclusion of other causes in primary care ¹,²,³ (Nitti and Taneja, 2005).