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. Repeated, 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.
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. Examine his medical history for recurrent or chronic UTIs or for surgery or procedures involving the urinary tract.
Obtain a clean-catch sample for urinalysis and culture. 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.
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.
Urinary urgency can occur with or without the frequent UTIs that can accompany MS. Like MS’s other variable effects, urinary urgency may wax and wane. Commonly, visual and sensory impairments are the earliest findings. Others include urinary frequency, incontinence, constipation, muscle weakness, paralysis, spasticity, intention tremor, hyperreflexia, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability.
In Reiter’s syndrome — a self-limiting syndrome that primarily affects males — urgency occurs with other symptoms of acute urethritis 1 to 2 weeks after sexual contact. Arthritic and ocular symptoms and skin lesions usually develop within several weeks after sexual contact. These include asymmetrical arthritis of knees, ankles, or metatarsal phalangeal joints; conjunctivitis; and ulcers on the penis, or skin, or in the mouth.
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.
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.
Urinary urgency is often associated with this infection. Other characteristic urinary changes include frequency, hematuria, dysuria, nocturia, and cloudy urine. Urinary hesitancy may also occur. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Radiation therapy may irritate and inflame the bladder, causing urinary urgency.
Prepare the patient for the diagnostic workup, including a complete urinalysis, culture and sensitivity studies, and possibly neurologic tests.
You should increase the patient’s fluid intake, 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.
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. Girls may experience vaginal discharge and vulvar soreness or pruritus.
Read excerpts from these other book chapters related to Urinary tract infection:
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
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Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1 
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