Urinary urgency (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Frequent urination means needing to urinate more often than usual.

What are the symptoms of Urinary urgency?
Urgent urination is a sudden, compelling urge to urinate, along with discomfort in your bladder. A frequent need to urinate at night is called nocturia. Most people can sleep for 6 to 8 hours without having to urinate. Middle aged and older men often wake to urinate once in the early morning hours.

What causes Urinary urgency?
Together, frequent and urgent urination are classic signs of a urinary tract infection.

Diabetes, pregnancy, and prostate problems are other common causes of these symptoms.

Other causes include:

Less common causes:
 * Anxiety
 * Enlarged prostate
 * Interstitial cystitis
 * Medicines such as diuretics
 * Overactive bladder syndrome
 * Prostatitis (infection of the prostate gland)
 * Stroke and other brain or nervous system diseases
 * Tumor or mass in the pelvis
 * Urinary incontinence
 * Vaginitis
 * Bladder cancer
 * Bladder dysfunction
 * Radiation therapy to the pelvis, used to treat certain cancers
 * Drinking too much before bedtime, especially caffeine or alcohol, can cause frequent urination at nighttime. Frequent urination may also simply just be a habit.

Home Care Follow the therapy recommended by your doctor to treat the underlying cause of your urinary frequency or urgency. It may help to keep a diary of times and amounts of urine voided to bring with you to the doctor.

In some cases, you may experience some urinary incontinence for a period of time. You may need to take steps to protect your clothing and bedding.

Who is at highest risk?
Presence of any of the above disease mentioned above increasing your frequency

When to seek urgent medical care?
Call your health care provider for an appointment if:
 * Your symptoms are causing you problems
 * You have pelvic discomfort or burning with urination
 * Your symptoms occur daily

Diagnosis
TDuring a physical examination, the health care provider will look at the abdomen and rectum. Women will also have a pelvic exam. Men will also have a genital exam. In most cases the physical exam reveals nothing abnormal.

If there are nervous system (neurologic) causes, other abnormalities may be found.

Tests include the following:

Further tests will be performed to rule out other types of incontinence. The "Q-tip test" measures the change in the angle of the urethra at rest and when straining. An angle change of greater than 30 degrees often is a sign that the muscles supporting the bladder are weak. This is common in stress incontinence.
 * EMG (myogram) - rarely needed
 * Inspection of the inside of the bladder (cystoscopy)
 * Pad test (after placement of a previously weighed sanitary pad, the patient exercises, then the pad is weighed to determine urine loss)
 * Pelvic or abdominal ultrasound
 * Post-void residual volume (PVR) to measure amount of urine left after urination
 * Urinalysis or urine culture to rule out urinary tract infection
 * Urinary stress test (the patient stands with a full bladder and coughs)
 * Urodynamic studies (measurement of pressure and urine flow)
 * X-rays with contrast dye

Treatment options
Treatment is determined by the cause of the urgency and frequency. Antibiotics and medicine may be prescribed to lessen the discomfort, if needed.

What to expect (Outlook/Prognosis)?
How well you do depends on your symptoms, an accurate diagnosis, and proper treatment. Many patients must try different therapies (some at the same time) to reduce symptoms.

Instant improvement is unusual. Perseverance and patience are usually required to see improvement. A small number of patients need surgery to control their symptoms.

Possible complications
Physical complications are rare. However, psychological and social problems may arise, particularly if you are unable to get to the bathroom when you feel the urge.

Prevention
For nighttime urination, avoid excessive fluid before going to bed, particularly coffee, other caffeinated beverages, and alcohol.