Dr. Huntley's
Diagnosis
Checklist
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See what questions
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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 has 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 specimen 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 assessment.
Bladder irritation from a calculus 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 multiple sclerosis. Commonly, visual and other sensory impairments are the earliest findings. Other findings include urinary frequency, incontinence, constipation, muscle weakness, paralysis, spasticity, intention tremor, hyperreflexia, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability.
Reiter’s syndrome is 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 symptoms 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 spinal 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 commonly associated with a UTI. 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.
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.
Instruct sexually active patients in safer sex practices. Advise 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, allowing frequent daily voiding.
Read excerpts from these other book chapters related to Urinary urgency:
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1 
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