Syndromic conditions are becoming more recognised and diagnosed more frequently. Treating symptoms and promoting quality of life by approaching them as a syndrome instead of an end organ process is becoming common medical practice. Historically physicians were trained to start a diagnostic workup by fitting the symptoms and signs into a syndromic diagnosis, then looking for which dysfunctional organ or tissue is causing those symptoms. This is known as the topographic diagnosis. This technique then identifies the etiological diagnosis. Traditional teaching is that only after the etiological diagnosis is made can the prescription of a specific treatment ensue with the aim to cure disease and end the symptoms. With this approach, treatment of symptoms is thought to be insufficient. Physicians have been pressed to determine etiologies and arrive at a definitive diagnosis. However, a closer look at the look at the literature makes it obvious that syndromic diagnoses, based on unspecific diagnostic criteria, are progressively being given the rank of disease. Research in these areas is more focused on symptom treatment rather than searching for the possible topographies and etiologies associated with symptoms. This is the case now for diagnoses such as overactive bladder (OAB), painful bladder syndrome/interstitial cystitis (PBS/IC), irritable bowel syndrome (IBS), fibromyalgia and others.
In a recent publication,Somatic syndromes and chronic pain in women with overactive bladder, Reynolds et al have investigated the overlapping of syndromic diagnoses among carefully selected women with OAB symptoms. About 80% of study subjects reported various somatic symptoms in addition to OAB symptoms, suggesting overlap with other chronic pain syndromes such as fibromyalgia, vulvodynia and IBS. The presence of symptoms from cormorbid chronic pain syndromes is thought to influence the impact of OAB on quality of life. This strongly suggests that many topographies may initiate those symptoms and that there is a myriad of different phenotypes of urgency/frequency syndromes. The nomenclature OAB infers an end organ etiology, namely the bladder. While this diagnosis may alleviate frustration in absence of an etiology, at the end of the day do our patients really benefit from this diagnosis?
Article by the Publications and Communications Committee
Reynolds WS, Mock S, Zhang X, Kaufman M, Wein A, Bruehl S, Dmochowski R.
Somatic syndromes and chronic pain in women with overactive bladder. Neurourol
Urodyn. 2016 Jul 1. doi: 10.1002/nau.23060.