Urinary Urgency

What is urinary urgency?

Urinary urgency is a sudden, uncontrollable need to urinate (pee). Once you feel the need to pee, you have a very short amount of time to get to a bathroom before you leak pee (urinary incontinence).

There are many possible causes of urinary urgency. But the good news is that most causes aren’t serious, and healthcare providers can often treat the cause.

What is urinary urgency a symptom of?

Some of the most common causes of urinary urgency include:

• Urinary tract infections (UTIs), also known as a bladder infection.
• Overactive bladder (OAB).
• Enlarged prostate (benign prostatic hyperplasia).
• Prostate infection (prostatitis).

Why do I have the urge to pee but don’t have a UTI?

Other causes of urinary urgency may include:

• Inflammation in your vagina (vaginitis).
• Bladder inflammation (cystitis).
• Menopause, which causes low estrogen in your body and vaginal and urinary tissues to thin.
• Conditions that affect your nerves, including diabetes or multiple sclerosis (MS).

Other factors may contribute to urinary urgency but may not be the main cause. This may include:

• Certain triggers. These may include hearing or seeing running water, washing your hands or cold temperatures.
• Taking diuretic medications. Diuretics are a type of medication that makes you pee more often.
• Drinking alcohol and caffeinated drinks. Alcohol and caffeine act like diuretics by affecting the hormone vasopressin. Vasopressin helps decrease the amount of pee your body makes. If you don’t have as much vasopressin in your bloodstream, your bladder fills up faster.
• Smoking. Smoking may affect your bladder’s capacity. That means it holds less pee.
• Other food-related triggers. Other foods/drinks that can irritate your bladder include acidic foods (like citrus or tomatoes), carbonation and artificial sugars or sweeteners.
• A body mass index (BMI) greater than 25 (have overweight/obesity). This can put pressure on your bladder and weaken your pelvic floor muscles. Your pelvic floor muscles help with your ability to control when you pee.
• Vaginal prolapse. This is when your uterus or vaginal walls fall within your vagina, causing a bulge in your vagina.

How do I stop urinary urgency?

Treating urinary urgency depends on its cause. But you may be able to help manage it with:

• Lifestyle changes.
• Bladder training or timed voiding.
• Kegel exercises.
• Medications.
• Medical procedures.

Lifestyle changes

You may need to drink fewer fluids and avoid alcohol and caffeinated drinks, such as coffee, tea or soda pop. Quitting smoking and maintaining a healthy weight for you can also help.

It can help to keep a bladder, fluid and food diary to try to identify patterns or triggers. Record everything you eat and drink and also when you pee or feel a strong urgency. See if the bladder problems correlate with certain foods or drinks.

Bladder training or timed voiding

You use the bathroom at set times throughout the day to prevent your bladder from getting too full, such as every two hours. It’s important that you pee to empty your bladder, even if you don’t feel like you have to go.

Kegel exercises (pelvic floor exercises)

Kegel exercises (pelvic floor exercises) help strengthen your pelvic floor muscles. A pelvic floor physical therapist will teach you the proper techniques and may use biofeedback to ensure you’re working out the proper muscles.

Medications

Medications can help treat many different causes of urinary urgency. A healthcare provider may prescribe antibiotics to get rid of a UTI, alpha-blockers to relax your prostate muscle or anticholinergic or beta-3 adrenergic medications to relax your bladder muscles.

Medical procedures

A provider may recommend specific treatments according to your urinary urgency cause. You may need a urinary catheter to drain your bladder.

Botulinum toxin (Botox^®) shots in your bladder or functional electrical stimulation (nerve stimulation) can help treat an overactive bladder.

There are also many procedures to reduce the size of your prostate.

What are the possible complications or risks of not treating urinary urgency?

It depends on what’s causing urinary urgency. But your symptoms may get worse, and you may develop urinary incontinence.

Untreated UTIs may spread to other parts of your body, including your kidneys or prostate. In rare cases, they may even cause sepsis.

When should urinary urgency be treated by a doctor or healthcare provider?

Urinary urgency can have a big impact on your quality of life. It’s a good idea to talk to a healthcare provider if you have urinary urgency symptoms.

You should also reach out to a provider if you have urinary urgency and you:

• Have signs of an infection, including fever, chills, flank pain, bloody urine (hematuria), cloudy urine, penile or vaginal discharge, or nausea and vomiting.
• Often feel very tired (fatigue).
• Experience unexplained weight loss.
• Are hungrier or thirstier.

How will a healthcare provider diagnose the cause of urinary urgency?

A healthcare provider will usually:

• Review your health history.
• Ask you questions about your urinary urgency and any other symptoms.
• Perform a physical exam, including a pelvic exam or digital rectal exam.

They may also recommend tests, including:

• Urinalysis (pee test).
• Urine culture.
• Imaging tests, including a pelvic ultrasound or abdominal ultrasound, to see how much pee is left in your bladder after you use the bathroom.
• Urodynamic testing.
• Inserting a thin camera (cystoscope) into your bladder to look at your bladder lining (cystoscopy).

What can mimic a urinary tract infection?

Many different conditions may feel like a UTI but aren’t. These include:

• Some sexually transmitted infections (STIs), like chlamydia or gonorrhea.
• Overactive bladder.
• Kidney stones.
• Vaginitis, like a vaginal yeast infection.
• Interstitial cystitis/bladder pain syndrome (IC/BPS).
• Hormone changes from menopause or some cancer treatments.