A sudden compelling urge to urinate, accompanied by bladder pain, is a classic symptom of urinary
tract infection. 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
Ask the patient about the onset of urinary urgency and whether he's ever experienced it before. Ask
about other urologic symptoms, such as dysuria and cloudy urine. Also ask about neurologic
symptoms, such as paresthesias. Examine his medical history for recurrent or chronic urinary tract
infections or for surgery or procedures involving the urinary tract.
Obtain a clean-catch sample for urinalysis. 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
tenderness. If the patient's history or symptoms suggest neurologic dysfunction, perform a neurologic
Amyotrophic lateral sclerosis (ALS):
ALS occasionally produces urinary urgency.
More common findings include muscle weakness, cramping, atrophy, and coarse
fasciculations in the forearms and hands. Brain stem involvement produces speech, chewing,
swallowing, and breathing difficulty.
Bladder irritation can lead to urinary urgency and frequency,
dysuria, hematuria, and suprapubic pain from bladder spasms.
Multiple sclerosis (MS):
Urinary urgency can occur with or without the frequent
urinary tract infections that often accompany MS. Like MS's other variable effects, urinary
urgency may wax and wane. Commonly, visual 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.
In this self-limiting syndrome that primarily affects males,
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.
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 urinary stream, and bladder distention and discomfort may also occur.
Neuromuscular effects distal to the lesion may include weakness, paralysis, hyperreflexia,
sensory disturbances, and impotence.