An imperative urge is a sudden categorical intense urge to urinate. It is observed in cystitis, other lesions of the bladder, injuries and diseases of the urethra, neurological pathologies. It accompanies some andrological and gynecological diseases. To determine the cause of the symptom, complaints are collected, an objective examination is carried out, laboratory and hardware techniques are used. Treatment includes antimicrobials, NSAIDs, hormones, other drugs, and physical therapy. Operations are performed according to indications.
Bladder diseases
The most common cause of imperative urges are acute cystitis and exacerbation of the chronic form of the disease. Along with this symptom, frequent painful urination with residual cuts and burning, nocturia, and pain above the pubis are noted. Sometimes subfebrile condition, turbidity of urine come to light. The clinical picture of cystitis varies somewhat depending on gender and hormonal status:
- Among women. In reproductive age, at least one episode of acute cystitis is observed in almost every woman. Many patients suffer from frequent exacerbations of chronic pathology. The high prevalence of the disease is due to the short and wide urethra, the penetration of infection from the adjacent vagina.
- In pregnant women. The most pronounced acute process occurs after SARS or hypothermia. Identified imperative urge, frequent urination. The severity of discomfort ranges from mild discomfort to severe pain in the suprapubic area. For the postpartum period, urinary retention, pain at the end of micturition, clouding of the first portion are typical.
- With a climax. Urination can become more frequent up to 3 times a day. Patients complain of sharp pain in the final phase of urination, constant pulling or aching pain in the lower abdomen. The course is often chronic, relapses are provoked by stress, sexual contact, alcohol, spicy food.
- In men. Relatively rare. Inflammation, as a rule, occurs against the background of stagnation of urine with KSD, tumors, urethral stricture, prostate adenoma, or is provoked by infections of neighboring organs: urethritis, vesiculitis, orchitis, epididymitis, prostatitis. Imperative urges are supplemented by stranguria, nocturia, terminal hematuria, pain in the initial and final stages of micturition.
Inflammation in the bladder can develop in the absence of an infection. Acute radiation cystitis manifests during treatment or a short period after completion of radiation therapy. The symptoms are reminiscent of the usual acute inflammation. The course of late radiation cystitis is chronic, constant imperative urges and persistent incontinence are due to the formation of a microcyst.
Interstitial cystitis also develops in the absence of the pathogen. Runs chronically. Characterized by slow progression. Imperative urges appear against the background of irreversible changes in the organ, preceded by prolonged dysuria and nocturia. Tuberculous cystitis is a complication of kidney tuberculosis. Urgent incontinence is combined with stranguria, pollakiuria, constant pain in the suprapubic region.
The occurrence of a symptom with a wrinkled bladder is due to malnutrition and a decrease in the volume of the organ. Most often provoked by tuberculosis. It can become the outcome of severe chronic infectious and non-infectious inflammatory processes. Urine is excreted in small portions after an irresistible urge. The number of mictions reaches 2 or more times a day.
Pathologies of the urethra
The symptom sometimes occurs with urethritis, especially specific, for example, gonorrhea. The presence of ineffective imperative urges, cessation of urination and pain in the lower abdomen with injuries indicates a complete rupture of the urethra. Prolapse of the urethral mucosa in women develops as a result of traumatic injuries, multiple births, and heavy physical exertion. Imperative urges are supplemented by a sensation of a foreign object, in some cases - incontinence.
Imperative urge to urinate
Tumors and tumor-like processes
Malacoplakia is a tumor-like disease, accompanied by the formation of granulomatous growths on the wall of the organ. It is most often diagnosed in women older than 5 years. The symptom is combined with painful micturition, increased urination up to 15-2 times a day. Possibly hematuria. Imperative urges are observed with the following neoplasms:
- Benign neoplasia of the urethra. In the early stages, they are often asymptomatic. Then dysuric disorders appear and grow: itching, burning, discomfort, deviation, splitting or spraying of the jet, partial incontinence. Bleeding, infravesical obstruction are possible.
- Cancer of the urethra. The clinical picture is highly variable. The symptom is more often found in women, supplemented by cramps, pain, burning, urethrorrhagia, incontinence, pain during sexual intercourse. Difficulties in urination predominate in men.
- Bladder cancer. Increased urination, urgency, soreness, and other manifestations occur some time after the onset of episodic or persistent hematuria. Painful sensations spread to the bosom, groin, area of the sacrum. Difficulties in urination are possible, with massive bleeding - tamponade of the organ with blood clots.
With benign tumors of the detrusor, the symptom is observed infrequently, as a rule, it develops when inflammation is attached. Pain, hematuria, stranguria are noted. Sometimes ischuria is revealed.
Gynecological diseases
Urinary incontinence during menopause, strictly speaking, does not apply to gynecological pathologies, but is provoked by hypoestrogenism and an unfavorable obstetric and gynecological history. Develops gradually. Initially, pollakiuria, nocturia, burning sensation and dryness are observed. As the disease progresses, stress incontinence is replaced by urge incontinence.
The appearance of a symptom can also be provoked by a large cystocele. Severe bladder protrusion is accompanied by a sensation of a foreign body in the vagina, a feeling of overflow of the bladder, weakening of the jet. Urgent urges are combined with stress incontinence, soreness during sexual intercourse, pain in the lower abdomen.
Andrological diseases
Persistent urges, increased micturition, incontinence and nocturia are part of the irritative syndrome in prostate adenoma. Irritative manifestations are found: delay in the onset and prolongation of the period of urination, a sluggish intermittent stream, the need to strain, a feeling of incomplete emptying. With hypertrophy of the seminal tubercle, the symptom is supplemented by weakness of the jet, painful erections and premature ejaculation.
Neurological pathologies
Imperative urges are characteristic of overactive (OAB) and neurogenic (NMP) bladder. With OAB, nocturia and pollakiuria are determined, often in combination with incontinence. The manifestations of NMP are highly variable. The symptom is typical for the hyperactive type of the syndrome, accompanied by incontinence and pollakiuria. Urgent urges and other dysuric disorders are due to increased detrusor tone and weakness of the sphincters. Bladder dysfunction is observed in the following conditions:
- spinal cord injuries;
- multiple sclerosis;
- hemorrhagic and ischemic strokes;
- disorders of the spinal circulation;
- congenital anomalies of the nervous system;
- Binswanger's disease;
- hereditary cerebellar ataxia of Pierre-Marie;
- fixed spinal cord syndrome;
- dementia with Lewy bodies.
In addition, these conditions can complicate the course of diabetic and alcoholic polyneuropathy. Encephalitis, polyradiculoneuritis, tumors of the central nervous system also act as a provoking factor.
Urologist's consultation
Diagnostics
Determining the nature of the pathology is the responsibility of the urologist. According to the indications, patients are referred to a gynecologist, oncologist, neurologist, and other specialists. The doctor finds out the time and circumstances of the onset of the symptom, other details of the clinical picture, the dynamics of the development of the disease. Patients are asked to complete a urinary diary. Men with suspected adenoma undergo a digital examination of the prostate. As part of the diagnostics, the following procedures are performed:
- Gynecological examination. It is shown to all women, including those suffering from urological diseases. It allows to exclude diseases of the female genital organs with similar symptoms, to determine the provoking factors of incontinence during menopause, to detect cystocele.
- Ultrasonography. Ultrasound of the bladder confirms inflammation in cystitis, the presence of residual urine in adenoma and neurological disorders, visualizes tumors (mainly located in the region of the side walls of the organ). During the ultrasound of the prostate, the volume of the gland is determined, stagnant areas and calculi are detected. Ultrasound of the urethra is a method of express diagnostics for injuries.
- Urodynamic studies. They are considered an obligatory part of the examination for adenomas and disorders of the detrusor function of neurological origin. According to indications, they are carried out with cystitis, cystocele, and other pathologies. It is possible to perform uroflowmetry, cystometry, profilometry, sphincterometry, complex urodynamic study.
- Radiography. Urethrography is informative for tumors and injuries of the urethra, an increase in the seminiferous hillock. Often performed by retrograde contrast. In detrusor cancer, cystography is indicated. In case of neurological disorders, a comprehensive examination is performed to assess the state of the urinary system. Plain and excretory urography, voiding and conventional urethrocystography, radioisotope renography may be prescribed.
- Endoscopic methods. Inspection of the urethra by ureteroscopy or urethrocystoscopy is required for prolapse of the mucosa, benign tumors and cancer of the urethra, pathology of the seminal tubercle. Patients with detrusor neoplasia, NMP undergo cystoscopy. With cystitis, the study is carried out during the period of remission. If necessary, a visual examination is supplemented with a biopsy.
- Laboratory tests. The presence of an inflammatory process is confirmed by the data of general blood and urine tests. To determine the level of damage, a three-cup test is carried out. To determine the pathogen and its sensitivity to antibacterial agents, a microbiological study is performed. For tumors, malacoplakia, a histological analysis is performed. In men with adenoma, PSA levels are examined.
The list of other methods depends on the nature of the pathology. In case of neoplasia, CT and MRI of the bladder, pelvic organs, and abdominal cavity can be recommended. Patients with neurological diseases are prescribed echoencephalography, neurophysiological methods, tomographic studies of the brain and spinal cord.
Treatment
Conservative therapy
The tactics of treating imperative urges is determined by the nature of the disease:
- Bacterial cystitis. Antibacterial therapy is carried out, uroseptics, NSAIDs, combined herbal preparations are prescribed. Apply intravesical instillations, UHF, iontophoresis, inductothermy.
- Interstitial cystitis. Antihistamines, synthetic mucopolysaccharides, tricyclic antidepressants, electrical stimulation, acupuncture, and massage are used.
- Malakoplakia. Antibiotics from the group of fluoroquinolones, phagocytosis stimulants, combined agents containing diaminopyrimidine derivatives and sulfonamides are effective. With immunosuppression, if possible, drugs with an immunosuppressive effect are canceled.
- Prolapse of the urethra. Warm sitz herbal baths are helpful. To restore urodynamics and facilitate the discharge of urine, bladder catheterization is performed. The technique can also be used as a way to reduce the mucosa, sometimes replacing the operation.
- Menopausal incontinence. Patients are shown hormone replacement therapy. In some cases, antidepressants, M-anticholinergics and alpha-agonists are additionally prescribed. Non-drug treatment includes urogynecological pessaries, electrical stimulation, paraurethral administration of volume-forming drugs.
- BPH. Conservative therapy is recommended in the initial stages, including herbal remedies, alpha-blockers, 5-alpha reductase inhibitors. To combat infectious complications, antibiotics are used, and vasodilators are added to the treatment regimen to improve the flow of medicines into the prostate in the presence of atherosclerosis.
- neurological pathologies. Tactics are determined individually, taking into account the type of disorder. It is possible to use alpha-blockers, tricyclic antidepressants, anticholinergics, antihypoxants, antioxidants. Effective behavioral therapy, exercise therapy, laser therapy, diadynamic therapy, electrical stimulation.
Surgery
Depending on the cause of imperative urges, the following operational methods are used:
- Urethral rupture: suprapubic epicystostomy, primary urethrourethroanastomosis, delayed catheter plasty.
- Mucosal prolapse: sling urethropexy, plication or mucosal resection.
- Neoplasms: excision of benign tumors, transurethral or circular resection of the urethra, TUR of the bladder, detrusor resection, cystectomy.
- Prostate adenoma: transurethral resection, laser enucleation or vaporization, adenomectomy.
- Neurological pathologies: epicystostomy, pyelostomy, botulinum toxin injection, augmentation cystoplasty, sacral neuromodulation.