The Urge

Often when we think Women’s health, the most common dysfunction people immediately think of is leakage. Whether that is leakage during a certain activity such as sneezing, laughing, coughing (stress urinary incontinence) or leaking on the way to the toilet (urge urinary incontinence).

Some people often don’t associate other symptoms such as urgency, frequency and increased nighttime voids as bladder related issues.

In actual fact, if I were to ask Women what is more bothersome to them, the leakage or the urgency coupled with or without frequency and nighttime voids, the later would be what is impacting their quality of life more. Leakage on most occasions Women can manage e.g they might be happy to wear a panty liner during exercise in the event that they might have a small leak. But urinary urgency has a significant impact on quality of life.

Urinary urgency is defined by the International Continence Society as the complaint of a sudden compelling desire to pass urine, which is difficult to defer.

 

Often the urge is very unexpected and unprovoked, and can literally happen at any time.

The issue with urgency is that it’s often followed by a fear/anxiety/stress response because the urge is so difficult to defer that you are compelled to find a place to toilet immediately.

 

It can be difficult if, for argument’s sake, you’re at a park where there is no toilet, teaching at a school in the classroom where you can’t leave your students for 5 minutes or on a bus, in which you can’t just stop and get off. In fact, urgency symptoms can be so severe that people won’t leave the house in fear of leaking should they not be able to find a toilet in time when the urge hits.

Urgency is a symptom of the overactive bladder (OAB). OAB can be coupled with or without leakage, usually with frequency and nocturia (more than 2 voids during a night). The frequency is often related to self-management tool patients adopt to try and avoid leakage. Another term used is Detrusor Overactivity.

This is diagnosed via an urodynamic test of your lower urinary system (a probe measuring pressure) in which a bladder spasm is detected when a sudden rise in pressure within the bladder detected during the filling phase. Interestingly though, there is evidence to suggest that bladder spasms are not always the cause of urgency, in fact, you can have a bladder spasm detected on urodynamics but the patient not reports any urge sensation. Thus, OAB is a subjective complaint of urgency as noted by the patient.

There are many treatment options that do not have to involve pharmaceutical or surgical interventions. Both conditions can be treated and managed through a Women’s Health Physiotherapist. Controlling urgency can take time and patience as the bladder is retrained to override the message of urgency.

If urgency/frequency and increased night time voiding is a concern of yours, please feel free to book in with Lauren, the Women’s health Physio here at Physionorth for further advice.