Urgency: Bowel and Urinary Urgency Explained

What urgency means

Urgency is different from frequency. Frequency means going often. Urgency means the need to go comes on suddenly and strongly, sometimes with little warning, and can lead to leaking if a toilet is not close by. It affects quality of life far more than many people admit, causing people to plan routes around toilets or avoid going out.

Bowel urgency: causes

Short-term causes

• Gastroenteritis and food poisoning: sudden urgency with watery diarrhea, cramps and sometimes vomiting, lasting 1 to 3 days
• Coffee, alcohol, spicy or fatty food, and sugar alcohols (sorbitol, xylitol) in sugar-free products
• Medicines: antibiotics, magnesium, metformin, laxatives
• Anxiety: the "gut-brain axis" speeds up the bowel before stressful events

Ongoing causes

• Irritable bowel syndrome: urgency, cramping relieved by a bowel movement, bloating and loose or alternating stools, often worse after meals and in the morning. There is no bleeding or weight loss
• Ulcerative colitis and Crohn's disease: urgency is a hallmark of an inflamed rectum. Bloody diarrhea, mucus, night-time bowel movements, tenesmus (feeling you still need to go after emptying), fatigue and weight loss are common
• Microscopic colitis: watery diarrhea with urgency, often in women over 50, linked to some medicines such as NSAIDs and PPIs
• Bile acid diarrhea: after gallbladder removal or ileal disease
• Lactose intolerance and celiac disease
• Weak anal sphincter or pelvic floor: after childbirth injuries, anal surgery or aging, leading to urgency and fecal incontinence
• Radiation to the pelvis, for prostate, cervical or rectal cancer
• Bowel cancer: a change in bowel habit, especially with bleeding, weight loss or anemia in people over 45

Urinary urgency: causes

• Urinary tract infection: sudden urgency with burning, frequent small amounts, cloudy or smelly urine
• Overactive bladder: urgency with frequency and getting up at night, sometimes with leaking (urge incontinence), without infection
• Enlarged prostate in men: urgency with a weak stream and incomplete emptying
• Caffeine, alcohol and fizzy drinks, and drinking large volumes
• Diabetes: high blood sugar increases urine production
• Menopause: thinning of the bladder and urethra lining
• Interstitial cystitis: bladder pain with urgency
• Nerve conditions: multiple sclerosis, Parkinson's disease, stroke and spinal cord problems

See urinary urgency for more on bladder causes.

Clues that help find the cause

How doctors find the cause

The doctor will ask how long urgency has lasted, how often it happens, stool or urine appearance, blood, pain, night symptoms, diet, medicines, travel, childbirth history and family history. They may examine the belly and do a rectal exam.

Tests depend on whether the bowel or bladder is involved:

• Bowel: blood count, inflammation markers, celiac test, stool tests for infection and fecal calprotectin (a marker of bowel inflammation that helps tell IBD from IBS), and colonoscopy if red flags or abnormal tests
• Bladder: urine test and culture, a bladder diary, a bladder scan to check emptying, prostate exam in men, and sometimes urodynamic tests
• Anorectal tests: anal manometry and ultrasound for sphincter problems

Treatment for urgency

Bowel urgency

• Treat the cause: anti-inflammatory medicines for IBD, stopping trigger medicines, a gluten-free diet for celiac disease
• Diet changes: a low-FODMAP diet under a dietitian's guidance helps many people with IBS; limit caffeine, alcohol, sugar alcohols and very fatty meals
• Soluble fiber (psyllium) firms loose stools
• Loperamide at the label dose for diarrhea-predominant urgency, not for bloody diarrhea or fever
• Pelvic floor exercises and biofeedback to strengthen the sphincter and improve control
• Bowel retraining: gradually delaying going to the toilet to increase rectal tolerance
• Prescription options for IBS, such as antispasmodics and gut-directed medicines

Urinary urgency

• Treat infections with antibiotics
• Cut down caffeine and alcohol, and spread fluids evenly through the day
• Bladder training: gradually extending the time between toilet visits
• Pelvic floor muscle training
• Medicines for overactive bladder (antimuscarinics or beta-3 agonists), vaginal estrogen after menopause, or prostate medicines for men
• Botox injections into the bladder or nerve stimulation for severe cases

Practical tips

• Know where toilets are when you go out, and use apps that list public restrooms
• Carry a change of underwear and wipes for confidence
• Ask your doctor about a "can't wait" card, which many restaurants and stores honor
• Do not cut fluids too much, which concentrates urine and irritates the bladder

Frequently asked questions

Why do I suddenly need to poop urgently?

Short-term urgency usually comes from a stomach bug, food poisoning, coffee, alcohol or certain foods. If it keeps happening, likely causes are IBS, inflammatory bowel disease, microscopic colitis, food intolerances or a weak pelvic floor. Blood, weight loss or night-time diarrhea need medical assessment.

Is bowel urgency a sign of colitis?

It can be. Urgency is one of the main symptoms of ulcerative colitis because the inflamed rectum cannot hold stool. It usually comes with bloody diarrhea, mucus and frequent bowel movements. A stool calprotectin test and colonoscopy can confirm or rule out colitis.

What is the difference between urgency and frequency?

Frequency means going to the toilet more often than usual. Urgency means the need comes on suddenly and strongly and is hard to delay. They often occur together, for example in a urinary tract infection or overactive bladder.

Can anxiety cause urgency?

Yes. Stress and anxiety affect the nerves and hormones that control the gut and bladder, causing sudden urges before exams, travel or presentations. This is common in IBS. Persistent urgency should still be checked for other causes.

When should I worry about urgency?

See a doctor if urgency lasts more than a few weeks, causes accidents, or comes with blood in the stool or urine, fever, weight loss, or night-time symptoms. Urgency or leaking with new numbness in the groin or leg weakness is an emergency.