Urinary urgency

A sudden compelling urge to urinate accompanied by bladder pain is a classic symptom of urinary tract infection (UTI). As inflammation decreases bladder capacity, discomfort results from the accumulation of even small amounts of urine. Frequent voiding in an effort to alleviate this discomfort produces urine output of only a few milliliters at each voiding.

Urgency without bladder pain may point to an upper-motor-neuron lesion that has disrupted bladder control.

History and physical examination

Ask the patient about the onset of urinary urgency and whether he’s ever experienced it before. Ask about other urologic symptoms, such as dysuria and cloudy urine. Also ask about neurologic symptoms such as paresthesia. Explore his medical history for recurrent or chronic UTIs and for surgery or procedures involving the urinary tract.

Obtain a clean-catch urine specimen for urinalysis and culture and sensitivity tests. Note urine character, color, and odor, and use a reagent strip to test for pH, glucose, and blood. Then palpate the suprapubic area and both flanks for distention and tenderness. If the patient’s history or symptoms suggest neurologic dysfunction, perform a neurologic examination.

Medical causes

Amyotrophic lateral sclerosis (ALS)

ALS occasionally produces urinary urgency. More common findings include muscle weakness, cramping, atrophy, and coarse fasciculations in the forearms and hands. Brain stem involvement causes difficulty speaking, chewing, swallowing, and breathing. Cognitive function is usually unaffected.

Bladder calculus

Bladder irritation can lead to urinary urgency and frequency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. Pain may be referred to the penis, vulva, lower back, or heel.

Multiple sclerosis (MS)

Urinary urgency, frequency, and incontinence are common urologic findings in MS. Like other symptoms of MS, these effects may wax and wane. Visual and sensory impairments are usually the earliest findings. Others include constipation, muscle weakness, paralysis, spasticity, intention tremor, hyperreflexia, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability.

Reiter’s syndrome

In this self-limiting syndrome that primarily affects males, urinary urgency and other symptoms of acute urethritis occur 1 to 2 weeks after sexual contact. Other symptoms include asymmetrical arthritis of the knees, ankles, or metatarsal phalangeal joints; conjunctivitis in one or both eyes; and ulcers on the penis, mouth, tongue, palms, or soles.

Spinal cord lesion

Urinary urgency can result from incomplete cord transection when voluntary control of sphincter function weakens. Urinary frequency, difficulty initiating and inhibiting a urine stream, and bladder distention and discomfort may also occur. Neuromuscular effects distal to the lesion include weakness, paralysis, hyperreflexia, sensory disturbances, and impotence.

Urethral stricture

Bladder decompensation produces urinary urgency, frequency, and nocturia. Early signs and symptoms include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence may occur.

UTI

Urinary urgency is commonly associated with UTIs. Other characteristic urinary changes include frequency, hematuria, dysuria, nocturia, cloudy urine, and sometimes urinary hesitancy. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.

Other causes

Treatments

Radiation therapy may irritate and inflame the bladder, causing urinary urgency.

Special considerations

Prepare the patient for the diagnostic workup, including a complete urinalysis, culture and sensitivity studies and, possibly, neurologic tests.

Increase the patient’s intake of fluids, especially water, if not contraindicated, to dilute the urine and diminish the feeling of urgency. Administer an antibiotic and a urinary anesthetic such as phenazopyridine.

Pediatric pointers

In young children, urinary urgency may appear as a change in toilet habits, such as a sudden onset of bed-wetting or daytime accidents in a toilet-trained child. Urgency may also result from urethral irritation by bubble bath salts.

Patient counseling

Instruct sexually active patients in safer sex practices. Teach women and girls about proper genital hygiene such as cleaning from front to back to reduce contamination from fecal bacteria. Instruct women to maintain adequate fluid intake to promote frequent urination.

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

Other Book Chapters Related to Urinary incontinence

Read excerpts from these other book chapters related to Urinary incontinence:

Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Urinary incontinence

• Back to symptom: Urinary incontinence: Introduction (review 240 causes)
• Next Book Extract About Urinary incontinence: Urinary incontinence (Professional Guide to Signs & Symptoms (Fifth Edition))
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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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