Urinary urgency

A sudden compelling urge to urinate (urinary urgency), accompanied by bladder pain, is a classic symptom of a 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.

History and physical examination

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 complete drug history.

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 examination.

Medical causes

Bladder calculus.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.

Multiple sclerosis (MS).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, vision 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.

Reiter's syndrome.In Reiter's syndrome, urinary 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.

Spinal cord lesion.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.

Urethral stricture.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.

UTI.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.

Other causes

Treatments.Radiation therapy may irritate and inflame the bladder, causing urinary urgency.

Nursing considerations

▪ 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 and monitor intake and output.

▪ Administer an antibiotic and a urinary anesthetic, such as phenazopyridine.

Patient teaching

▪ Explain the underlying disorder and treatment plan.

▪ Instruct the patient in safer sex practices.

▪ Discuss proper genital hygiene.

▪ Explain the need for adequate fluid intake and frequent voidings.

▪ Explain how to perform Kegel exercises.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Reduced urine

Read excerpts from these other book chapters related to Reduced urine:

Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Reduced urine

• Back to symptom: Reduced urine: Introduction (review 138 causes)
• Next Book Extract About Reduced urine: URINE COLOR CHANGES (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Reduced urine

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

 » Next page: URINE COLOR CHANGES (Differential Diagnosis in Primary Care)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• URINE COLOR CHANGES (Differential Diagnosis in Primary Care)
• ANURIA AND OLIGURIA (Differential Diagnosis in Primary Care)
• Medications causing Reduced urine
• Videos relating to Reduced urine
• Diagnosis Checklist for Reduced urine

Tools & Services:

• Bookmark this page
• Take a survey relating to Reduced urine
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City