Fast Five Quiz: Overactive Bladder

Bradley Schwartz, DO


September 25, 2020

A comprehensive physical examination can help to determine the nature, severity, and impact of the symptoms in patients with OAB.

Pulmonary and cardiovascular evaluation may be indicated to assess control of cough or the need for medications such as diuretics.

An abdominal examination is performed to rule out diastasis recti, masses, ascites, and organomegaly, which can influence intra-abdominal pressure and urinary tract function. A palpable bladder may imply overflow incontinence or an obstructive problem.

A pelvic examination is used to evaluate inflammation, infection, atrophy, and pelvic organ prolapse. Such conditions can increase afferent sensation, leading to urinary urgency, frequency, dysuria, and OAB. The urethra and trigone are estrogen-dependent tissues, so estrogen deficiency can contribute to urinary incontinence and urinary dysfunction. The most common signs of inadequate estrogen levels include:

  • Thinning and paleness of the vaginal epithelium

  • Loss of rugae

  • Disappearance of the labia minora

  • Presence of a urethral caruncle

In women, the levator ani muscle function can be evaluated by asking the patient to tighten her vaginal muscles and hold the contraction as long as possible. Normally, a woman can hold such a contraction for 5-10 seconds. Voluntary levator ani muscle contractions that are very weak or absent are an indication that biofeedback training sessions with a pelvic floor physical therapist may be necessary.

The bimanual examination should also include a digital rectal examination to check anal sphincter tone and, for fecal impaction, the presence of occult blood or rectal lesions. In men, the rectal examination should also be focused on the prostate to rule out benign prostatic hyperplasia or prostate cancer.

A neurologic examination is important. This involves assessment of the lumbosacral nerve roots and should include evaluation of the deep tendon reflexes, lower extremity strength, sharp/dull sensation, and the bulbocavernosus and clitoral sacral reflexes. Abnormal findings (eg, deep tendon hyperreflexia or an absent bulbocavernosus reflex) should alert the physician to possible underlying neurologic lesions contributing to urinary incontinence.

Read more about the physical examination findings in OAB.


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