Alan J. Wein, MD Professor and Chair. Division of Urology University of Pennsylvania School of Medicine Chief of Urology Hospital of the University of Pennsylvania Philadelphia, Pennsylvania

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		The definition of overactive bladder and stress incontinence.

Jump to bottom of the page My personal feeling is that the definition of overactive bladder has been unduly restricted in the past. The International Incontinence Society originally defined overactive bladder as involuntary bladder contractions demonstrated on urodynamics that were either due to a neurologic cause, in which case the condition was called detrusor hyperreflexia, or an non-neurogenic cause, in which case it was called detrusor instability. Now that, I think, unduly restricts the definition because it requires urodynamic confirmation. Which means that if a specialist were asked to pick out a patient with overactive bladder (urologist, urogynecologist), it would be fairly easy. But if a nonspecialist, a primary care physician, were asked to pick out a patient with overactive bladder because of the definition, unless they had special access to urodynamic studies they could not do it. To me, overactive bladder is a condition that includes urgency, frequency, urge incontinence, reflex incontinence, either singly or in any combination. The urodynamic definition of overactive bladder is different to me from the clinical description of the condition of overactive bladder. And I think that in reality, if you look hard enough in a patient that had urgency, frequency, etc., with ambulatory urodynamics let's say, you would probably find urodynamic evidence of involuntary bladder contraction. But I personally don't think that it should be a requirement to attach a diagnosis of overactive bladder or to say someone has the condition of overactive bladder. That is, I don't think urodynamics are necessary to make that diagnosis.

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