The International Continence Society (ICS) defines urinary urgency as “a sudden compelling desire to pass urine, which is difficult to deter”. Recent studies have suggested that different subtypes of urinary urgency may exist among patients who present with lower urinary tract symptoms (LUTS). The aim of this study is to examine the demographic, clinical, and psychosocial differences among participants who experience one or more of these symptoms of urinary urgency: “the sudden need to rush to urinate” (the sudden urgency group) versus “the constant need to urinate” (the constant urgency group) using data from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN).

Adult women and men seeking treatment for their LUTS were recruited into the LURN one-year observational cohort study from six US tertiary care centers. Demographic and clinical data were collected at the baseline visit. At their 12-month follow-up visit, participants completed the following self-reported measures: the LURN Comprehensive Assessment of Self-reported Urinary Symptoms (CASUS), the Genitourinary Pain Index (GUPI), the Pelvic Floor Distress Inventory (PFDI-20), the Perceived Stress Scale (PSS), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal (GI) bowel incontinence, GI constipation, GI diarrhea, depression, anxiety, sleep disturbance, and physical function (mobility subdomain) measures. The CASUS item, “In the past 7 days, how often did you feel a sudden need to rush to urinate?” has response options of “never,” “a few times,” “about half the time,” “most of the time,” and “every time.” Participants answering “about half the time” or more were considered to have sudden urgency. The CASUS item, “In the past 7 days, did you have a constant need to urinate that did not go away?” had responses of “yes” and “no,” and participants answering “yes” were considered to have constant urgency. These responses were used to group participants who experienced sudden urgency only, constant urgency only, or both sudden and constant urgency. Demographics, clinical characteristics, and patient-reported measures were compared between groups using analysis of variance (ANOVA), chi-square tests, and non-parametric equivalents where appropriate. P-values were adjusted for multiple testing using the false discovery rate (FDR).

Based on the 12-month follow-up CASUS responses, there were 251 participants who had sudden urgency only (n=156, 62%), constant urgency only (n=36, 14%), or both (n=59, 24%). Those with sudden urgency only were, on average, the oldest (60.6 years vs. 54.2 for the constant urgency group, and 58.4 years for both, p-value=0.014, Table 1). There was a significantly higher proportion of men who experienced constant urgency only (69%) and a higher proportion of women who experienced both sudden and constant urgency (64%, p-value=0.005). There was also a significantly higher proportion of African-Americans who experienced constant urgency only (20%) and both sudden and constant urgency (36%, p-value=0.004) compared to other racial groups. 
Participants with both sudden and constant urgency reported more pain, urinary symptoms and associated distress, bowel symptoms, and psychological symptoms compared to those with only sudden urgency or constant urgency only. GUPI total scores were 19.2 (SD=8.4) on average, compared to 13.5 (SD=7.0) and 13.8 (SD=7.9) for other two groups (p<0.001). In particular, the GUPI pain subscale was 2.3-3.2 points higher (p<0.001). In females the PFDI-20 scores were 111.8 (SD 65.8) in the combined symptom group compared to 46.8 (SD=30.9) in the constant only group and 72.1 (SD=42.4) in the sudden only group (p<0.001). PROMIS measures were at or slightly below reference population means of 50 for the constant urgency only group and sudden urgency only group, while scores for the combined group were 2.9-3.9 points above the mean on average, with the exception of sleep disturbance, which was similar across groups. These measures were not significantly different between participants in the sudden urgency only group and constant urgency only group, with the exception of the PROMIS physical function T-score which was significantly lower for participants with sudden urgency only (46.3 vs. 50.8, p-value=0.005).
Patterns of urinary symptoms related to urgency and pain sensations differed across the three groups (Figure 1). In the twelve symptoms assessed, there were significant differences in the responses between urgency groups for nine of them: nocturia (p-value=0.011), fear of leaking with urgency (p-value<.001), UUI (p-value<.001), pain with bladder filling (p-value=0.015), pain while the bladder is full (p-value=0.016), satisfaction with bladder condition (p-value=0.032), overall bother of urinary symptoms (p-value=0.014), overall severity of bladder problems (p-value=0.003), and measure of bladder function (p-value=0.001). Compared to participants with both sudden and constant urgency, those with only constant urgency had significantly lower ratings for all nine of these symptoms, except for satisfaction with bladder condition and bladder function which were significantly higher, while those with only sudden urgency had significantly lower ratings of pain while filling, pain while the bladder is full, overall severity of bladder problems and significantly higher ratings of bladder function. Those with only constant urgency had significantly lower ratings of nocturia, fear of leaking with urgency, UUI and significantly higher ratings of bladder function compared to participants reporting only sudden urgency.

Of the treatment-seeking participants in this study who reported urgency, the majority (62%) reported sudden urgency only. Fewer (14%) reported constant urgency only. A quarter (24%) reported both sudden and constant urgency, raising the possibilities that participants may not understand the difference between the two sensations (constant vs. sudden ), and/or they have experienced both symptoms as reported. Men and African-Americans were more likely to report constant urgency. The reasons behind these demographic differences are unknown. The differences in sex may be explained by the higher rates of urgency without UUI in men compared to women. It may also be because African-Americans reported less UUI compared to White participants. Having both sudden and constant urgency adds to the overall severity and burden (both urological and non-urological – e.g., worse urinary symptoms and associated distress, more pain, worse pelvic floor dysfunction, worse GI function, and more psychosocial issues). When restricting the comparisons to the sudden urgency only and the constant urgency only groups, there were no differences in terms of their pain, GI function, anxiety, depression, or perceived stress levels. Whether there may be fundamental differences in underlying pathophysiology between the two subgroups (sudden vs. constant) is unknown, and this warrants further investigation.

Women and men seeking treatment for their LUTS endorsed either or both of the following symptoms: “the sudden need to rush to urinate” (sudden urgency) and/or “the constant need to urinate” (constant urgency). Participants with both sudden and constant urgency reported more pain, urinary symptoms, bowel and psychological symptoms compared to those with only sudden urgency or only constant urgency.