Urinary urgency

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Synonyms and keywords: urgency

Overview

Urinary urgency is a sudden, compelling urge to urinate. It is often, though not necessarily, associated with interstitial cystitis, urge urinary incontinence, polyuria and nocturia. Urinary urgency often occurs as a result of irritation and/or inflammation of the urothelium (aka the bladder wall). In interstitial cystitis, urinary frequency and urgency are the hallmark symptoms, in addition to nocturia and dyspareunia. In many cases, however, these symptoms are often exacerbated by the consumption of foods and/or beverages that are high in acid and caffeine, particularly coffees, regular teas, green teas, sodas, diet sodas and, surprisingly, fruit juices. Cranberry juice, for example, often causes extreme urgency in patients with a damaged bladder lining due to its high acid content.

Causes

Life Threatening Causes

• Appendicitis
• Congestive heart failure
• Kidney cancer
• Liver failure
• Occupational cancer
• Pelvic tumors
• Pheochromocytoma
• Squamous cell carcinoma of lung 
• Stroke
• Urethral cancer
• Urinary tract neoplasm 

Common Causes

• Acromegaly
• Addison's disease
• behavioral or psychogenic water drinking
• Congestive heart failure
• Cushing's syndrome
• Diabetes insipidus
• Diabetes mellitus
• Drugs- BCG vaccine
• Emphysematous cystitis
• Enlarged prostate from disease or benign prostatic hyperplasia
• Fanconi syndrome/renal glycosuria
• Glomerulonephritis
• high doses of riboflavin
• Hyperaldosteronism/Conn's syndrome
• Hypercalcaemia
• Hypercalcemia (most commonly from cancer)
• Hyperthyroidism
• Hypokalemia
• hypopituitarism
• Interstitial cystitis
• Interstitial nephritis
• Intestinal obstruction (occurs after toxins begin to be absorbed from the damaged intestine)
• Liver failure/ cirrhosis
• Lupus or other connective tissue disease related cystitis
• Neurologic damage
• Partial obstruction of the urinary tract
• Pheochromocytoma
• Polycythemia
• Pregnancy
• Pyometra in certain animals or appendicitis in humans
• Reactive arthritis/Reiter's syndrome
• Renal Tubular Acidosis
• SIADH
• Side effect of lithium to treat manic disorders see lithium thirst
• Sjogren's Syndrome
• Squamous cell carcinoma of lung (a paraneoplastic consequence)
• Urinary tract infection - although it more commonly causes frequent passage of small volumes of urine rather than a large volume

Causes by Organ System

Cardiovascular	Congestive heart failure, Hypertension-like disorders, Stroke
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Aminohippurate, Bendrofluazide, Bumetanide, Caffeine, Canagliflozin, Cardioquin, Conivaptan, Dapagliflozin, Diuretics, Empagliflozin, Frusemide, Hydrochlorothiazide, Isosorbide, Lithium, Mannitol, Parasympatholytic drugs, Quinaglute dura-tabs, Quinalan, Quinidex, Quinidine, Quinora, Quin-release, Riboflavin, Siadh, Sorbitol
Ear Nose Throat	Sjogren's syndrome
Endocrine	Acromegaly, Addison's disease, Cushing's syndrome, Fanconi syndrome, Hyperaldosteronism, Hyperparathyroidism, Hyperthyroidism, Hypopituitarism, Pheochromocytoma, Polydipsia
Environmental	No underlying causes
Gastroenterologic	Appendicitis, Constipation, Diverticulitis, Hyperglycaemia, Intestinal obstruction , Liver failure
Genetic	Nephronophthisis type 1
Hematologic	Diabetes insipidus, Diabetes mellitus, Diverticulitis, Hypercalcemia , Hyperglycaemia, Hypokalemia, Polycythemia
Iatrogenic	Radiation therapy
Infectious Disease	Poliomyelitis, Tabes dorsalis, Tolvaptan, Urethra infection, Urinary tract infection
Musculoskeletal/Orthopedic	Pelvic tumors, Spinal cord injury, Spinal cord lesions
Neurologic	Ataxia, Calcification of basal ganglia , Diabetic neuropathy, Multiple sclerosis, Nephronophthisis type 1, Neurogenic bladder, Neurologic damage, Pudendal nerve entrapment , Spastic paraplegia , Stroke
Nutritional/Metabolic	Diabetes insipidus, Diabetes mellitus, Excessive water consumption, Hypercalcemia , Nutrasweet
Obstetric/Gynecologic	Pregnancy, Pyometra , Salpingitis, Spastic pelvic floor syndrome , Vaginitis
Oncologic	Bladder cancer, Occupational cancer , Pelvic tumors, Pheochromocytoma, Squamous cell carcinoma of lung , Urethral cancer, Urinary tract neoplasm
Ophthalmologic	No underlying causes
Overdose/Toxicity	Alcohol, Caffeine
Psychiatric	Anxiety
Pulmonary	Emphysematous cystitis, Squamous cell carcinoma of lung
Renal/Electrolyte	Cystitis, Excessive water consumption, Glomerulonephritis, Hyperaldosteronism, Hypokalemia, Kidney cancer, Kidney stones , Medullary cystic kidney disease type 1, Medullary cystic kidney disease type 2, Polydipsia, Pyelonephritis , Renal calculus, Renal tubular acidosis
Rheumatology/Immunology/Allergy	Reiter's syndrome, Sicca syndrome, Sjogren's syndrome, Systemic lupus erythematosus
Sexual	No underlying causes
Trauma	Hemorrhoids, Spinal cord injury, Spinal cord lesions
Urologic	Acute bacterial prostatitis, Benign prostate hyperplasia , Bladder calculi, Bladder cancer, Bladder distention , Bladder irritation, Bladder neck obstruction, Bladder outflow obstruction, Blocked urine flow, Chronic interstitial cystitis , Detrusor instability, Enlarged prostate , Incontinence , Interstitial cystitis , Interstitial nephritis, Median bar hypertrophy, Overactive bladder syndrome, Partial obstruction of the urinary tract, Prostatic hypertrophy, Prostatitis, Urethra infection, Urethral cancer, Urethral stricture, Urge incontinence , Urinary tract infection, Urinary tract neoplasm
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Acromegaly
• Acute bacterial prostatitis
• Addison's disease
• Alcohol
• Aminohippurate
• Anxiety
• Appendicitis
• Ataxia
• Bendrofluazide
• Benign prostate hyperplasia 
• Bladder calculi
• Bladder cancer
• Bladder distention 
• Bladder irritation
• Bladder neck obstruction
• Bladder outflow obstruction
• Blocked urine flow
• Bumetanide
• Caffeine
• Calcification of basal ganglia
• Canagliflozin
• Cardioquin
• Chronic interstitial cystitis 
• Congestive heart failure
• Conivaptan
• Constipation
• Cushing's syndrome
• Cystitis
• Dapagliflozin
• Detrusor instability
• Diabetes insipidus
• Diabetes mellitus
• Diabetic neuropathy
• Diuretics
• Diverticulitis
• Empagliflozin
• Emphysematous cystitis
• Enlarged prostate 
• Excessive water consumption
• Fanconi syndrome
• Frusemide
• Glomerulonephritis
• Hemorrhoids
• Hydrochlorothiazide
• Hyperaldosteronism
• Hypercalcemia 
• Hyperglycaemia
• Hyperparathyroidism
• Hypertension-like disorders
• Hyperthyroidism
• Hypokalemia
• Hypopituitarism
• Incontinence 
• Interstitial cystitis 
• Interstitial nephritis
• Intestinal obstruction 
• Isosorbide
• Kidney cancer
• Kidney stones 
• Lithium
• Liver failure
• Mannitol
• Median bar hypertrophy
• Medullary cystic kidney disease type 1
• Medullary cystic kidney disease type 2
• Multiple sclerosis
• Nephronophthisis type 1
• Neurogenic bladder
• Neurologic damage
• Nutrasweet
• Occupational cancer
• Overactive bladder syndrome
• Parasympatholytic drugs
• Partial obstruction of the urinary tract
• Pelvic tumors
• Pheochromocytoma
• Poliomyelitis
• Polycythemia
• Polydipsia
• Pregnancy
• Prostatic hypertrophy
• Prostatitis
• Pudendal nerve entrapment 
• Pyelonephritis 
• Pyometra 
• Quinaglute dura-tabs
• Quinalan
• Quinidex
• Quinidine
• Quinora
• Quin-release
• Radiation therapy
• Reiter's syndrome
• Renal calculus
• Renal tubular acidosis
• Riboflavin
• Salpingitis
• Siadh
• Sicca syndrome
• Sjogren's syndrome
• Sorbitol
• Spastic paraplegia
• Spastic pelvic floor syndrome 
• Spinal cord injury
• Spinal cord lesions
• Squamous cell carcinoma of lung 
• Stroke
• Systemic lupus erythematosus
• Tabes dorsalis
• Tolvaptan
• Urethra infection
• Urethral cancer
• Urethral stricture
• Urge incontinence 
• Urinary tract infection
• Urinary tract neoplasm 
• Urine leakage
• Vaginitis

Support Resource

• Interstitial Cystitis Network (ICN)

Intervention

• Bladder Friendly Diet (aka IC Diet)
• Behavioural Techniques
• Anti-Cholinergic

See also

• Urination
• Polyuria
• Urinary incontinence#Urge incontinence
• http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm

References

• Katharine K. O’Dell & Sarah McGee. "Acupuncture for Urinary Urgency In Women Over 50: What Is the Evidence?". UROLOGIC NURSING - February 2006 - Volume 26 Number 1.

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