Urinary urgency: what is this symptom and what diseases is it associated with?

Tenesmus vesicalis is a disorder associated with urination problems. Let's see its characteristics.

Urine production is essential for human survival. With a daily intake of two liters of water, it is estimated that the average person excretes 0.8 to two liters of urine every 24 hours.

This fluid contains toxic substances produced during cellular metabolism (urea), allows the elimination of harmful elements ingested (alcohol and drugs) and maintains the electrolyte and homeostatic balance between the blood, tissues and environment.

On the other hand, it should be noted that the fact of urinating in specific spaces is a human social construct, but also a behavioral adaptation.. Many animals create latrines in the natural environment and, with them, centralize the sources of diseases and keep them away from the offspring, delimit their territory in an unequivocal way and send chemical messages to the rest of the populations and/or species. For all these reasons, even if it is sometimes difficult, it is necessary to withhold urine and wait for an appropriate social (and biological) moment.

Unfortunately, there are people who have problems in holding urine or perceiving the real state of their bladder, which greatly hinders the process of urination and decreases to a greater or lesser degree the quality of life. Today we tell you all about bladder urgency.

What is urinary urgency?

The word tenesmus, according to the medical dictionary of the Clínica Universidad Navarra (CUN) refers to a sensation of continuous, generally unproductive, desire to urinate or defecate. In the case of rectal tenesmus, the sensation may be accompanied by pain, cramping and straining to defecate. On the other hand, bladder urgency is not usually accompanied by further pain in the area tested.

On the other hand, tenesmus vesicalis can be defined as the sensation or complaint on the part of the patient that indicates incomplete emptying of the bladder once urination has occurred, even though there is no more urine to be excreted.. In English, this term is generally known as feeling of incomplete bladder emptying.

At this point, it is essential to differentiate between sensation and reality. Bladder urgency is a subjective condition (symptom), while the presence of residual urine in the bladder, visualized by ultrasound, is an objective fact that is not based solely on the patient's perception (clinical sign). Urgency and lack of voiding are correlated in some cases, but a person can have urgency and have a completely empty bladder..

Although urgency may not have a specific physiological meaning, it is caused by an anatomical mechanism. In this case, the sensation of "lack of emptying" is caused by Muscle spasms of the urogenital diaphragm. The area where the contractions and spasms leading to tenesmus occur is defined as an essential part of the birth canal, formed by the deep transverse muscle of the perineum, as well as the urethra and its sphincter.

Tenesmus is sometimes associated with a real problem in passing all of the urine. (PVR. post void residual), but at other times this correlation is impossible to establish. The etiology of cases of urinary urgency with a PVR value of 0 or close to 0 continues to be studied.

Bladder urgency in the clinic

Although this is a subjective event, it is necessary for physicians around the world to be able to quantify it in some way and standardize the severity of the underlying disease based on it. For this reason, in 1992, the World Health Organization (WHO) approved the International Prostate Symptom Score (IPSS), with the aim of being able to clearly and concisely evaluate the genitourinary symptoms of patients with problems in this physiological environment.

The approach of this system is very simple; 8 questions referring to the patient's sensations and signs in the last 30 days, which can be categorized into 5 levels of intensity1 (none), 2 (less than once in five), 3 (less than half the time), 4 (more than half the time), 5 (almost always). These are the questions asked by the IPSS in each case:

• During the past 30 days,how many times have you had the sensation of not completely emptying your bladder when you finished urinating?
• During the last 30 days, how many times have you had to urinate again within two hours after urinating?
• How many times have you noticed, when urinating, that the flow stopped and continued intermittently?
• How many times have you had difficulty holding your urine?
• How many times have you noticed during urination that the urine stream is not very strong?
• How many times have you had to squeeze or strain to urinate?
• How many times do you usually get up from the time you go to bed until you wake up to urinate?
• How would you feel if you had to spend the rest of your life with your prostate symptoms as you feel them now?

All these questions are focused on the last 30 days before the consultation and can be rated from 1 to 5.. As you can see, urinary urgency is represented in the first of these questions, since it refers to the sensation of lack of bladder emptying directly.

Finally, it is worth noting that the final question shifts the focus of the process a bit, as it refers to the impact of quality of life related to urinary urgency and other urogenital symptoms. This last question can be scored from 1 to 6, from delighted (1) to fatal (6). Although it may seem anecdotal and rudimentary, this type of standardized questionnaire is very helpful in clinical practice.

Urinary urinary urgency and LUTS

Urinary urgency is part of the Lower Urinary Tract Symptoms (LUTS), or lower urinary tract symptoms.. These are not clinical entities or diseases per se, but represent signs or symptoms of other pathologies, such as prostatitis, bladder cancer, diabetes, kidney stones and many others.

Bladder urgency is not alone in this category, as there are many more signs that may be evidence of the diseases mentioned above. These include increased frequency of urination during the day, a weaker than normal urinary stream, difficulty in starting to pass urine, and many others.

Lower urinary tract symptoms are divided into 3 categories. These are as follows:

• Filling symptoms: increased frequency of urination, incontinence, voiding urgency, etc. These are perceived by patients as the most bothersome.
• Voiding symptoms: they refer to the type of urine stream and the effort the patient must make to empty the bladder.
• Post-voiding symptoms: urinary urgency or post-urinary dribbling.

Therefore, at the clinical level, urinary urgency is a postvoiding symptom included in the Lower Tract Urinary Symptoms. Furthermore, it should be noted that this symptom is completely related to the other symptoms described: if bladder urgency is present, it is very likely that other LUTS are present. The more severe the other LUTS are, the worse the patient's perception of urinary urgency will be.

Summary

Unfortunately, urinary urgency and other LUTS are quite common symptoms in the general population. Currently, urinary incontinence is estimated to affect 200 million people, 50 million of whom are located in high-income Western regions. In Spain, this lower urinary tract symptom affects 20 to 45% of women over 20 years of age.

On the other hand, all unified LUTS have a prevalence of 40% of elderly men, as they are the most affected by genitourinary symptoms.The prevalence of LUTS in the elderly is 40%, as they are the most affected by genitourinary symptoms during old age. With all these data, it is clear that problems in the excretory system are extremely common, especially associated with age.

Therefore, if you experience bladder urgency or any of the previously described signs, it is best to see a doctor promptly. Several online portals will be able to quantify your discomfort with the International Prostate Symptom Score (IPSS), but only a medical professional will be able to elucidate the cause of your discomfort. Don't let time pass.