Diagnosing Overactive Bladder

Medically Reviewed by Nazia Q Bandukwala, DO on May 25, 2024
4 min read

Even though urinary leakage affects some 33 million adults in the U.S., it can be an embarrassing subject to discuss, even with your doctor. That’s why overactive bladder, also known as OAB or urge incontinence, is often called the "hidden condition."

You might believe, as many people do, that overactive bladder is just an unpleasant but inescapable part of getting older. Actually it isn’t -- and there is something you can do. Seeing your doctor and having tests for overactive bladder can help you get treatment, get back into your old routine, and feel more like yourself again.

To get a diagnosis of overactive bladder, your doctor starts with a complete health history to learn about other urinary conditions you’ve had in the past, and when the problem started. Your doctor will examine you, ask questions, and perform tests.

Questions your doctor may ask about your OAB include:

  • How often do you urinate?
  • How often do you leak urine, and how severely?
  • Do you feel any pain or discomfort while urinating?
  • For how long has the urge or urinary incontinence been occurring?
  • Do you use incontinence pads, and if so, how many per day?
  • What medications are you taking?
  • Have you had any recent surgery or illnesses?

Keeping an OAB diary at home can help you answer these questions and help with an overactive bladder diagnosis. Each day, write down how much you drink, when you urinate, how much you urinate each time, and whether you ever feel an urgent need to go.

Your doctor will then examine your abdomen, pelvis, genitals, and rectum. You might also have a neurological exam to look for problems in your nervous system that could affect your ability to urinate. Constipation can also lead to urinary incontinence and urinary retention.

There are a number of tests for overactive bladder, depending on your health history and symptoms. For these tests, you’ll likely see a urologist (a doctor who is trained to treat urinary disorders). If you’re a woman, you can also visit a urogynecologist.

Tests for overactive bladder include:

Urinalysis. Taking a urine sample allows your doctor to check for conditions that can cause overactive bladder. A urinalysis looks for the presence of these substances in the urine:

Postvoid residual volume. This test checks to see whether the bladder empties fully by passing a flexible tube called a catheter through your urethra and into your bladder after you’ve urinated. The catheter drains the urine that remains in your bladder and measures it. Another way to test postvoid residual urine is with a bladder scanner that uses ultrasound, a test that uses sound waves to look at how much urine is left in your bladder after you go.  The bladder scanner is a painless procedure.  Ultrasound gel is placed on your lower abdomen and the machine calculates the volume of urine left in your bladder.  

Bladder stress 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.

Ultrasound. This test uses sound waves to visualize the bladder and other parts of the urinary tract.

Cystoscopy. This test uses a thin, lighted instrument called a cystoscope to visualize the inside of the urethra and bladder.

Urodynamic testing. This series of tests measures how well your bladder holds and empties urine. Because these tests can be both invasive and expensive, urodynamic testing is usually reserved for people who have unusual symptoms or who haven’t responded to treatment.

Urodynamic tests include:

  • Uroflowmetry. As you urinate, this test measures the amount and speed of the urine flow to see if there is any obstruction affecting urination.
  • Cystometry or cystometrogram. his test evaluates bladder function by measuring the pressure in the bladder as it fills with sterile warm water. It also assesses urge sensation and bladder-filling capacity.
  • EMG or electromyogram. This measures the sphincter muscle contractions before, during, and after voiding. A condition called detrusor-sphincter dyssynergia can cause incontinence. This is where the sphincter muscle contracts instead of relaxes during urination. By contracting, the bladder muscle has to exert more pressure, which can lead to urinary retention and damage to the bladder. EMG is done in conjunction with the cystometrogram.

Voiding cystourethrogram. This bladder test looks for structural problems in the bladder and urethra. A liquid contrast dye is injected into your bladder with a catheter and then X-rays are taken while you urinate.

These OAB tests can help diagnose whether your condition has something to do with an infection or other illness, a blockage, or poorly functioning bladder muscles. Knowing the cause of your overactive bladder can help your doctor find the right treatment for you.