A Short History of Urgency: Implications for Biopsychosocial Assessment and Conservative Treatment of Overactive Bladder

This paper is a clinical commentary exploring urinary urgency as a sensory experience, its underpinning pathobiological mechanisms, and assessment and treatment implications for physical therapists. Urinary urgency, the defining symptom of overactive bladder, is a sensation with debated definition. Research on the nature of this sensation suggests phenotypes with variability in sensory quality, including physical and affective descriptors. Similarly, a plethora of research suggests variation in underlying mechanisms. As yet, there is no clear evidence that differing mechanisms present as discreet sensory phenotypes. As such, urinary urgency may reflect multiple underlying pathologies and/or dysfunction in sensory processing. The implication for physical therapists is that a thorough biopsychosocial assessment must guide decisions about onward referral for red flag investigation and the formation of a comprehensive conservative treatment plan.