What Causes Urinary Urgency?

Urgency is a sudden, compelling desire to pass urine that is difficult to postpone. It happens when the bladder muscle (the detrusor) contracts at the wrong time, or when the bladder lining is irritated and sends 'full' signals too early.

The first step is excluding reversible causes. A urinary infection is the commonest, and a simple urine test answers this. Stones, bladder tumours (uncommon) and, in men, prostate obstruction can also produce urgency. Once these are excluded, the usual diagnosis is overactive bladder (OAB) — a very common condition affecting both men and women, more so with age.

Treatment of OAB starts with behavioural measures: reducing caffeine and alcohol, adjusting fluid timing, and bladder training — gradually lengthening the interval between voids. Pelvic floor exercises help many people. If these are insufficient, medications that calm the bladder muscle are effective for a majority of patients, and further options exist for those who do not respond.

Urgency is not 'just ageing', and it is not something to be embarrassed about — it is one of the commonest reasons people see a urologist, and it usually improves substantially with treatment.