Urinary urgency is a sudden categorical intense urge to urinate. It is observed with cystitis, other lesions of the bladder, injuries and diseases of the urethra, neurological pathologies. Accompanies some andrological and gynecological diseases. To determine the cause of the symptom, complaints are collected, an objective examination is carried out, laboratory and hardware techniques are used. Treatment includes antimicrobials, NSAIDs, hormones, other medications, and physiotherapy. According to the indications, operations are performed.
Why do urinary urgency arise
Diseases of the bladder
The most common cause of urinary urgency are acute cystitis and exacerbation of the chronic form of the disease. Along with this symptom, there is frequent painful urination with residual cuts and burning, nocturia, pain over the pubis. Sometimes subfebrility, turbidity of urine are detected. The clinical picture of cystitis varies somewhat depending on gender and hormonal status:
- In women. At the reproductive age, at least one episode of acute cystitis is observed in almost every woman. Many patients suffer from frequent exacerbations of chronic pathology. The high prevalence of the disease is caused by a short and wide urethra, the penetration of infection from a nearby vagina.
- In pregnant women. The most pronounced acute process occurs after acute respiratory viral infection or hypothermia. Urinary urgency, frequent urination are revealed. The severity of unpleasant sensations ranges from mild discomfort to severe pain in the suprapubic zone. For the postpartum period, urinary retention, pain at the end of the portion, turbidity of the first portion are typical.
- With menopause. Urination can become more frequent up to 30 times a day. Patients complain of sharp soreness in the final phase of urination, constant pulling or aching pain in the lower abdomen. The course is more often chronic, relapses are provoked by stress, sexual contacts, alcohol, spicy food.
- In men. It is diagnosed relatively rarely. Inflammation, as a rule, occurs against the background of stagnation of urine in ICD, tumors, urethral stricture, prostate adenoma, or is provoked by infections of neighboring organs: urethritis, vesiculitis, orchitis, epididymitis, prostatitis. Urinary urgency are supplemented by stranguria, nocturia, terminal hematuria, soreness in the initial and final stages of infection.
Inflammation in the bladder can develop in the absence of infection. Acute radiation cystitis manifests during treatment or after a short period after completion of radiation therapy. The symptoms resemble the usual acute inflammation. The course of late radiation cystitis is chronic, constant urinary urgency and persistent incontinence are caused by the formation of a microcyst.
Interstitial cystitis also develops in the absence of a pathogen. It proceeds chronically. Slow progression is characteristic. Urinary urgency appear against the background of irreversible changes in the organ, preceded by prolonged dysuria and nocturia. Tuberculous cystitis is a complication of kidney tuberculosis. Urgent incontinence is combined with stranguria, pollakiuria, constant pain in the supral region.
The occurrence of the symptom with a wrinkled bladder is due to hypotrophy and a decrease in the volume of the organ. It is most often provoked by tuberculosis. It can become the outcome of severe chronic infectious and non-infectious inflammatory processes. Urine is excreted in small portions after irresistible urges. The number of injections reaches 20 or more times a day.
Pathology of the urethra
The symptom sometimes occurs with urethritis, especially specific, for example, gonorrhea. The presence of ineffective urinary urgency, cessation of urination and pain in the lower abdomen during injuries indicates a complete rupture of the urethra. Prolapse of the urethral mucosa in women develops due to traumatic injuries, multiple births, heavy physical exertion. urinary urgency are complemented by the sensation of a foreign object, in some cases – incontinence.
Tumors and tumor-like processes
Malacoplakia is a tumor-like disease accompanied by the formation of granulomatous growths on the wall of the organ. It is more often diagnosed in women over 50 years of age. The symptom is combined with painful infections, increased urination up to 15-20 times a day. Hematuria is possible. Urinary urgency are observed in the following neoplasms:
- Benign neoplasia of the urethra. In the early stages, they are often asymptomatic. Then dysuric disorders appear and increase: itching, burning, discomfort, deviation, bifurcation or splashing of the jet, partial incontinence. Bleeding, infravesical obstruction are possible.
- Cancer of the urethra. The clinical picture is characterized by significant variability. The symptom is more often found in women, supplemented by cuts, pains, burning, urethrorrhagia, incontinence, soreness during sexual acts. Men have difficulty urinating.
- Bladder cancer. Increased urination, urinary urgency, soreness and other manifestations occur some time after the appearance of episodic or permanent hematuria. Painful sensations spread to the womb, groin, sacrum area. There may be difficulties urinating, with massive bleeding – tamponade of the organ with blood clots.
With benign detrusor tumors, the symptom is observed infrequently, as a rule, develops with the addition of inflammation. There are pains, hematuria, stranguria. Sometimes ischuria is detected.
Urinary incontinence during menopause, strictly speaking, does not belong to gynecological pathologies, but is provoked by hypoestrogenia and an unfavorable obstetric and gynecological history. It develops gradually. At first, pollakiuria, nocturia, burning sensation and dryness are observed. With the progression of the disease, stress incontinence is replaced by urgent incontinence.
The appearance of the symptom can also be provoked by a large cystocele. Pronounced urinary protrusion is accompanied by a sensation of a foreign body in the vagina, a feeling of overflow of the bladder, weakening of the jet. Urgent urges are combined with stress incontinence, soreness during sexual intercourse, pain in the lower abdomen.
Persistent urges, increased frequency of infections, incontinence and nocturia are part of the irritative syndrome in prostate adenoma. Irritative manifestations are detected: delayed onset and prolongation of the period of urination, sluggish intermittent jet, the need for straining, a feeling of incomplete emptying. With hypertrophy of the seminal tubercle, the symptom is supplemented by weakness of the jet, painful erections and premature ejaculation.
Urinary urgency are characteristic of hyperactive and neurogenic bladder. With hyperactive, nocturia and pollakiuria are determined, often in combination with incontinence. The manifestations of neurogenic are highly variable. The symptom is typical for the hyperactive type of syndrome, accompanied by incontinence and pollakiuria. Urgent urges and other dysuric disorders are caused by increased detrusor tone and weakness of the sphincters. Violations of the functions of the bladder are observed in the following conditions:
- spinal cord injuries;
- multiple sclerosis;
- hemorrhagic and ischemic strokes;
- disorders of cerebrospinal circulation;
- congenital anomalies of the nervous system;
- Binswanger ‘s disease;
- hereditary cerebellar ataxia of Pierre-Marie;
- fixed spinal cord syndrome;
- dementia with Levi’s corpuscles.
In addition, these conditions can complicate the course of diabetic and alcoholic polyneuropathy. Encephalitis, polyradiculoneuritis, and CNS tumors also act as a provoking factor.
Determining the nature of the pathology is the responsibility of a urologist. According to the indications of patients, they are referred to a gynecologist, oncologist, neurologist, and other specialists. The doctor finds out the time and circumstances of the appearance of the symptom, other details of the clinical picture, the dynamics of the development of the disease. Patients are offered to fill out a diary of urination. Men with suspected adenoma undergo a finger examination of the prostate. As part of the diagnosis , the following procedures are performed:
- Gynecological examination. It is shown to all women, including those suffering from urological diseases. It allows to exclude diseases of the female genital organs with similar symptoms, to determine the provoking factors of incontinence during menopause, to detect cystocele.
- Ultrasonography. Ultrasound of the bladder confirms inflammation in cystitis, the presence of residual urine in adenoma and neurological disorders, visualizes tumors (mainly located in the area of the side walls of the organ). During prostate ultrasound, the volume of the gland is determined, stagnant areas and concretions are detected. Ultrasound of the urethra is a method of rapid diagnosis for injuries.
- Urodynamic studies. They are considered a mandatory part of the examination for adenomas and disorders of detrusor function of neurological genesis. According to the indications, they are carried out with cystitis, cystocele, and other pathologies. It is possible to conduct uroflowmetry, cystometry, profilometry, sphincterometry, complex urodynamic examination.
- Radiography. Urethrography is informative for tumors and injuries of the urethra, an increase in the seminal mound. It is more often performed by retrograde contrast. In detrusor cancer, cystography is indicated. In case of neurological disorders, a comprehensive examination is performed to assess the state of the urinary system. Overview and excretory urography, miction and conventional urethrocystography, radioisotope renography can be prescribed.
- Endoscopic methods. Examination of the urethra by urethroscopy or urethrocystoscopy is required for mucosal prolapse, benign tumors and cancer of the urethra, pathology of the seminal tubercle. Patients with detrusor neoplasia, NMP undergo cystoscopy. With cystitis, the study is carried out during remission. If necessary, the visual inspection is supplemented with a biopsy sample.
- Laboratory tests. The presence of an inflammatory process is confirmed by general blood and urine tests. To establish the level of lesion, a three-glass sample is carried out. To determine the pathogen and its sensitivity to antibacterial agents, a microbiological study is performed. For tumors, malacoplakia, histological analysis is performed. In men with adenoma, the PSA level is examined.
The list of other methods depends on the nature of the pathology. For neoplasia, CT and MRI of the bladder, pelvic organs, and abdominal cavity may be recommended. Patients with neurological diseases are prescribed echoencephalography, neurophysiological methods, tomographic studies of the brain and spinal cord.
The tactics of treating urinary urgency are determined by the nature of the disease:
- Bacterial cystitis. Antibacterial therapy is carried out, uroseptics, NSAIDs, combined herbal preparations are prescribed. Intravesical instillation, UHF, iontophoresis, inductothermy are used.
- Interstitial cystitis. Antihistamines, synthetic mucopolysaccharides, tricyclic antidepressants, electrical stimulation, acupuncture, massage are used.
- Malacoplakia. Antibiotics from the group of fluoroquinolones, phagocytosis stimulants, combined agents containing derivatives of diaminopyrimidines and sulfonamides are effective. When immunosuppression is possible, drugs with immunosuppressive effect are canceled.
- Prolapse of the urethra. Warm sedentary herbal baths are useful. To restore urodynamics and facilitate the discharge of urine, catheterization of the bladder is performed. The technique can also be used as a method of mucosal reduction, sometimes replacing surgery.
- Incontinence during menopause. Hormone replacement therapy is indicated for patients. In some cases, antidepressants, M-cholinolytics and alpha-adrenomimetics are additionally prescribed. Non-drug treatment includes urogynecological pessaries, electrostimulation, paraurethral administration of volume-forming drugs.
- Prostate adenoma. Conservative therapy is recommended at the initial stages, including herbal remedies, alpha-blockers, 5-alpha reductase inhibitors. To combat infectious complications, antibiotics are used, vasodilators are added to the treatment regimen to improve the flow of medications to the prostate in the presence of atherosclerosis.
- Neurological pathologies. Tactics are determined individually, taking into account the type of disorder. It is possible to use alpha-blockers, tricyclic antidepressants, anticholinergics, antihypoxants, antioxidants. Behavioral therapy, physical therapy, laser therapy, diadynamotherapy, electrostimulation are effective.
Depending on the cause of urinary urgency , the following operational techniques are used:
- Urethral rupture: suprapubic epicystostomy, primary urethrourethroanastomosis, delayed plastic surgery on a catheter.
- Mucosal prolapse: sling urethropexy, mucosal plication or resection.
- Neoplasms: excision of benign tumors, transurethral or circular resection of the urethra, bladder TUR, detrusor resection, cystectomy.
- Prostate adenoma: transurethral resection, laser enucleation or vaporization, adenomectomy.
- Neurological pathologies: epicystostomy, pyelostomy, botulinum toxin injection, augmentation cystoplasty, sacral neuromodulation.