What is urinary urgency?

Urinary Urgency: Definition and Clinical Significance

Urinary urgency is defined as a sudden, compelling desire to pass urine which is difficult to defer. 1 This sensation is the hallmark symptom of overactive bladder (OAB) syndrome and can significantly impact a patient's quality of life.

Characteristics of Urinary Urgency

Urgency differs from the normal sensation of bladder filling in several important ways:

• It presents as a sudden and compelling need to urinate that is difficult to postpone
• It may occur with or without actual urinary incontinence
• When urgency leads to involuntary leakage, it is termed urgency urinary incontinence (UUI) 2
• It is often accompanied by increased urinary frequency and nocturia

Clinical Differentiation Between Types of Urgency

There are qualitative differences in urgency experienced by different patient populations:

• OAB patients: Experience a sudden, compelling urge that is difficult to postpone; they void primarily to avoid incontinence 1
• IC/BPS patients: May experience a more constant urge to void rather than the classic sudden compelling need; they typically void to avoid or relieve pain 1

Diagnostic Considerations

When evaluating urinary urgency, clinicians should:

• Document the presence and severity of urgency symptoms
• Distinguish urgency from other lower urinary tract symptoms
• Consider using voiding diaries to quantify frequency and timing of urgency episodes
• Rule out other conditions that can cause similar symptoms:
  • Urinary tract infection
  • Bladder outlet obstruction
  • Neurological disorders
  • Medication side effects

Impact on Quality of Life

Urinary urgency can have profound negative effects on quality of life:

• Disruption of daily activities and social interactions
• Sleep disturbances due to nocturia
• Anxiety about potential incontinence episodes
• Reduced participation in physical activities

Management Approaches

Treatment of urinary urgency depends on the underlying cause but generally follows a stepwise approach:

1. Behavioral modifications:

   • Timed voiding
   • Fluid management
   • Pelvic floor muscle training

2. Pharmacological options for OAB-related urgency:

   • Antimuscarinic medications (e.g., tolterodine) 3
   • Beta-3 adrenergic agonists (e.g., mirabegron) 4

3. Advanced therapies for refractory cases:

   • Botulinum toxin injections
   • Neuromodulation
   • Surgical interventions in select cases

Common Pitfalls in Diagnosis and Management

• Failure to distinguish between urgency subtypes: Urgency in OAB vs. IC/BPS requires different treatment approaches
• Misinterpreting nocturia: When associated with OAB, nocturia typically presents with small-volume voids, unlike nocturnal polyuria which presents with normal or large-volume voids 2
• Overlooking mixed symptoms: Many patients have both stress and urgency components to their incontinence
• Inadequate follow-up: Treatment efficacy should be regularly reassessed and adjusted as needed

Urinary urgency remains a challenging symptom to precisely define and measure in clinical practice, but proper identification and characterization are essential for effective management and improving patient outcomes.