Bladder Urgency: What Is This Symptom And What Diseases Is It Associated With?
Urine production is essential for the survival of human beings. With an intake of two liters of water per day, 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 the environment.
On the other hand, it is worth noting that The act 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 their offspring, delimit their territory unequivocally and send chemical messages to the rest of the populations and/or species. For all these reasons, although sometimes it is difficult for us, it is necessary to retain urine and wait for an appropriate social (and biological) moment.
Unfortunately, there are people who have problems retaining urine or perceiving the real state of their bladder, which makes the urination process extremely difficult and decreases the quality of life to a greater or lesser extent. Today we tell you everything about bladder urgency
The word tenesmus, according to the medical dictionary of the Clínica Universidad Navarra (CUN), refers to a feeling of continuous desire, generally unproductive, 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 more pain in the area analyzed.
For its part, bladder urgency can be defined as the sensation or complaint on the part of the patient indicating incomplete emptying of the bladder once urination has occurred, despite the fact that there is no more urine that must 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 only on the patient’s perception (clinical sign). Tenesmus and failure to empty are correlated in some cases, but a person can have tenesmus and have a completely empty bladder
Although bladder 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 that lead to tenesmus occur are 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 sometimes associated with a real problem with passing all the urine (PVR. post void residual), but on other occasions establishing this correlation is impossible. The etiology of cases of bladder urgency with a PVR value of 0 or close to 0 continues to be studied.
Bladder urgency in the clinic
Although we are dealing with a subjective event, it is necessary for doctors around the world to be able to quantify it in a certain 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 Index (IPSS), with the aim of being able to clearly and concisely evaluate the genitourinary symptoms of patients with problems in this environment. physiological.
The approach of this system is very simple; 8 questions that refer to the patient’s sensations and signs in the last 30 days, which can be categorized into 5 levels of intensity: 1 (none), 2 (less than once in five), 3 (less than half of the time), 4 (more than half of the time), 5 (almost always). These are the questions that the IPSS poses in each case:
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, bladder urgency is represented in the first of these questions, since it refers to the sensation of lack of bladder emptying directly.
Finally, it should be noted that the final question changes the focus of the process somewhat, since it refers to the impact on quality of life related to urinary urgency and other symptoms of the urogenital system. This last question can be scored from 1 to 6, from delighted (1) to fatal (6). Although it may seem anecdotal and rudimentary, these types of standardized questionnaires help a lot in clinical practice.
Bladder urgency and LUTS
Bladder urgency is part of the lower urinary tract symptoms or LUTS, for its English translation Lower Urinary Tract Symptoms These are not clinical entities or diseases in themselves, but rather 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, since there are many more signs that can show the aforementioned diseases. These include increased urination frequency during the day, a weaker than normal urinary stream, difficulty in beginning to excrete urine, and many others.
Lower urinary tract symptoms are divided into 3 categories. These are the following:
Therefore, at a clinical level, urinary urgency is a post-micturition symptom included in the Lower Tract Urinary Symptoms. Furthermore, it should be noted that this symptom is completely related to the rest of those described: If urinary urgency appears, it is very likely that other LUTS will occur The more severe the rest of the LUTS are, the worse the patient will perceive the bladder urgency.
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, of which 50 million 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, since these are the most affected by genitourinary symptoms during old age. With all this data, it is clear to us that problems in the excretory system are extremely common, especially associated with age.
Therefore, if you feel bladder urgency or any of the signs previously described, it is best to go to the doctor as soon as possible. Various online portals will be able to quantify your discomfort with the International Prostate Symptom Index (IPSS), but only a medical professional will be able to elucidate the cause of your discomfort. Don’t let time pass.
