A compelling need to urinate (urgency), which may feel like almost constant painful straining (tenesmus), can be caused by bladder irritation. Incontinence may occur if a person does not urinate immediately. Urgency may be caused by a bladder infection. Caffeine and alcohol use may contribute to urgency but rarely cause severe urgency by themselves. Rarely, a poorly understood inflammation of the bladder (interstitial cystitis) is the cause.
Doctors can usually determine the cause of urgency by the person's symptoms, the results of the physical examination, and urinalysis. If infection is suspected, urine culture may be needed. Sometimes, particularly if interstitial cystitis is suspected, cystoscopy and bladder biopsy are necessary.
Treatment is directed at the underlying disorder.
Last full review/revision March 2007 by Ralph E. Cutler, MD