Urgency

Editor: Jane Meijlink Last updated: 16 August 2018

Current definition

2017: (1) Urgency: A compelling need to urinate which is difficult to defer (pain, pressure, discomfort).FN9 The Working Group identified the following adjustments as applying more descriptively, for example, to Interstitial Cystitis/Bladder Pain Syndrome patients: a compelling need to urinate, due to pain or an unpleasant sensation, that is difficult to defer.FN10

Footnotes: FN9 This was a change from a previous definition in 1988 which stated that urgency may be associated with two types of dysfunction: (i) Overactive detrusor function (motor urgency), and (ii) Hypersensitivity (sensory urgency). FN10 The change in definition in 2002 with introduction of the word ‘‘sudden’’ effectively restricted this term to overactive bladder syndrome and there was no mention of another sensation of urgency (urgent need to void) due to pain or hypersensitivity.

History

1988 (2) . Urgency (this is defined as a strong desire to void accompanied by fear of leakage or fear of pain) Urgency may be associated with two types of dysfunction: (a) Overactive detrusor function (motor urgency) (b) Hypersensitivity (sensory urgency)

2002 (3)

  1. LOWER URINARY TRACT SYMPTOMS 1.1 Urgency is the complaint of a sudden compelling desire to pass urine, which is difficult to defer. (CHANGED) 1.7.2. Symptom syndromes suggestive of lower urinary tract dysfunction Urgency, with or without urge incontinence, usually with frequency and nocturia, can be described as the overactive bladder syndrome, urge syndrome or urgency-frequency syndrome. (NEW)

2010 (4) . Bladder Storage Symptoms (iii) Urgency: Complaint of a sudden, compelling desire to pass urine which is difficult to defer.vi Footnote vi The use of the word ‘‘sudden,’’ defined as ‘‘without warning or abrupt,’’ used in earlier definitions has been subject to much debate. Its inclusion has been continued. Grading of ‘‘urgency’’ is being developed.

Controversy

The 2002 complete change in the definition of urgency by Abrams et al (3) compared with that of 1988 (2), and with the addition of the word “sudden”, effectively restricted use of the term urgency to overactive bladder conditions, thereby excluding all painful/hypersensitive bladder conditions. This document immediately generated considerable controversy and many publications. These included the following:

2004 In 2004, “Urgency” was debated at the Annual Scientific Meeting of the ICS in Paris (5): “Attempts to measure urgency are confounded by difficulties in understanding its definition, the context of normal urge to void, and the power of suggestion in most clinical environments”.(5) In a response to this article, Meijlink noted that it does “seem premature to draw up a restrictive definition of the term “urgency” - automatically excluding all patients with a painful bladder syndrome - before adequate research has been carried out into the nature and all causes of the sensation of urgency in all patients with an urgency/frequency bladder problem.” (6). Response from the author: “We must keep in mind that this is a symptom, and the definition of urgency must be applicable in whatever clinical situation the symptom is present, including such entities as urinary tract infection”.

2009 (7) This editorial stated: “At ICS 2004, held in Paris, an ICS sponsored workshop debated the new terminology contained in the 2002 report [Abrams et al., 2002] and made the following suggestions: The ICS definition of urgency is the complaint of a sudden compelling desire to pass urine which is difficult to defer. Urgency remains a symptom that is much discussed and suggestions have been made which are intended to ‘‘improve’’ the definition.”

“Urgency incontinence: there was general agreement that urge incontinence should be renamed as urgency incontinence to be consistent with the term urgency and to avoid the use of ‘‘urge" which in the English language has the same meaning as ‘‘desire’’ which should be the preferred term. Similarly the term urge syndrome should be changed to urgency syndrome.”

Blaivas et al joined in the debate: (8)
“We believe, however, that there are two types of urgency— an intensification of the normal urge to void (Type 1 urgency) and the all or none sensation just described (Type 2 urgency). Type 1 urgency is similar to the sensation that occurs when one defers urination for a long time after the urge to void is perceived, that is, a gradual urge that builds up in intensity until it becomes ‘‘a compelling desire to void that is difficult to defer.’’ “

2014 (9) The 2002 ICS standardization document “caused some controversy in the IC world by changing its earlier 1988 definition of urgency (“Urgency may be associated with two types of dysfunction: a. Overactive detrusor function [motor urgency], b. Hypersensitivity [sensory urgency]”). In 2002, this was redefined as “a sudden compelling desire to void”, thereby essentially restricting this term to urge/urgency incontinence in overactive bladder. Two practical consequences of this redefinition were: (i) that many researchers and physicians were now claiming that IC patients do not suffer from urgency; and (ii) no progress was made in research into urgency in IC patients. This led to the controversial and questionable term “persistent urge” being coined at a meeting of the Association of Reproductive Health Professionals in 2007 in the USA.” (9)

2015 (10) Meijlink continued on this theme: “…at a meeting of the Association of Reproductive Health Professionals (ARHP) in 2007 in the USA, the term “persistent urge” was coined to replace the term urgency in definitions for this group of patients, with a definition of IC/PBS (published May 2008) now reading as: “Pelvic pain, pressure or discomfort related to the bladder, typically associated with persistent urge to void or urinary frequency, in the absence of urinary infection or other pathology” . However, persistent urge does not mean an urgent need to void; at most it is another description of frequency or hypersensitivity, whereas an urgent need to void in IC/BPS/HSB patients is due to the presence of overwhelming pain or other unpleasant sensation.” (10)

It seems clear that there is indeed an “urgent” need a) to distinguish between different types of urinary urgency and b) not to exclude any groups of patients who suffer from an urgent need to urinate. Both patients and professionals therefore look forward to seeing a revision of this terminology by the ICS Standardisation Steering Committee, hopefully within the not too distant future.

References

  1. Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, Hanno P, Fraser MO, Homma Y, Garrido G, Gomes MJ, Elneil S, van de Merwe JP, Lin AT, Tomoe H. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn. 2017 Apr;36(4):984-1008.

  2. Abrams P, Blaivas JG, Stanton SL, Andersen JT. The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Neurourol Urodyn. 1988;7:403-427. (Also published: Scand J Urol Nephrol Suppl. 1988;114:5-19 and World J Urol. 1989;6:233-245)

  3. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn 2002;21:167–78. (Also published in: Urology. 2003 Jan;61(1):37-49)

  4. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29:4–20.

  5. Brubaker L. Urgency: the cornerstone symptom of overactive bladder. Urology. 2004 Dec;64(6 Suppl 1):12-6.

  6. Meijlink JM. Urgency: the cornerstone symptom of overactive bladder. Urology. 2005 Jul;66(1):230-1.

  7. Abrams P1, Artibani W, Cardozo L, Dmochowski R, van Kerrebroeck P, Sand P; International Continence Society. Reviewing the ICS 2002 terminology report: the ongoing debate. Neurourol Urodyn. 2009;28(4):287.

  8. Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C. Two types of urgency. Neurourol Urodyn. 2009;28(3):188-90. doi: 10.1002/nau.20525.

  9. Meijlink JM. Interstitial cystitis and the painful bladder: a brief history of nomenclature, definitions and criteria. Int J Urol. 2014 Apr;21 Suppl 1:4-12.

  10. Meijlink JM. Patient-centred standardization in interstitial cystitis/bladder pain syndrome—a PLEA. Transl Androl Urol. 2015 Oct;4(5):499-505.

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