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How to diagnose overactive bladder (OAB)

In most cases, OAB can be diagnosed by clinical history, physical examination and urinalysis to rule out infection or blood in the urine.5

Signs and symptoms of OAB6

  • Urinary urgency (hallmark symptom)
  • Urge urinary incontinence (may or may not be present)
  • Urinary frequency and nocturia (usually present)

Taking a careful clinical history is fundamental for diagnosis and should include details of the type, timing and severity of urinary incontinence (UI), associated voiding and other urinary symptoms. Patients should also be asked about any other health conditions and for details of current medications, as these may impact on their symptoms.5

  • This will then allow UI to be categorised into stress urinary incontinence (SUI), urgency urinary incontinence (UUI) or mixed urinary incontinence (MUI), and help identify those patients needing rapid referral to a specialist.5
  • In women, an obstetric and gynaecological history may help to understand the underlying cause of their UI and identify factors that may impact on treatment decisions.5
  • The physical assessment should include an abdominal examination to detect an enlarged bladder or other abdominal mass, and perineal and digital examination of the rectum (prostate) and/or vagina.5
  • Bladder diaries kept by the patient over a period of at least 3 days can play a valuable role in assessing the OAB symptoms, such as frequency of UI episodes. They can also be used to quantify urodynamic variables, such as voided volume and 24-hour or nocturnal total urine volume.5
  • Ultrasound is recommended for the assessment of post void residual urine volume. The use of imaging (i.e. magnetic resonance imaging, computed tomography and X-ray) is not recommended for the routine assessment of UI.5,7

Risk factors for OAB8

Risk factors for OAB may be modifiable or non-modifiable

Non-modifiable risk factors

  • Age
  • Sex
  • Metabolic syndrome
  • Post-menopausal
  • Benign prostatic hyperplasia
  • Pelvic organ prolapse in women

Modifiable risk factors

  • Alcohol
  • Smoking
  • Obesity
  • Caffeine
  • Carbonated drinks
  • Spicy foods
  • Bladder stones

OAB: overactive bladder.

BOTOX® is indicated for the management of bladder dysfunctions in adult patients who are not adequately managed with anticholinergics: overactive bladder with symptoms of urinary incontinence, urgency and frequency.9


  1. Allergan. Data on file. INT/0423/2016
  2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
  3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
  4. Allergan. Data on file. 014
  5. EAU Guidelines on Urinary Incontinence in Adults. Available from:  Accessed April 2022
  6. Abrams P, Cardozo L et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002;21(2):167-178
  7. National Institute for Health and Care Excellence (NICE). NG123: Urinary incontinence and pelvic organ prolapse in women: management. Available at: Accessed April 2022
  8. Hutchinson A, Nesbitt A et al. Overactive bladder syndrome: Management and treatment options. Australian journal of general practice 2020;49(9): 593-598
  9. BOTOX® Summary of Product Characteristics. Available at: Accessed April 2022

Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.


Adverse events should be reported. Reporting forms and information can be found at

Adverse events should also be reported to AbbVie on [email protected] 


Date of preparation: April 2022. UK-BUO-220009.