An Empirical Phenomenological-Psychological Investigation of Urinary Urgency in Incontinent Women

Many barriers to help seeking for urinary incontinence (UI) have been reported in the literature. In the past decade, studies of Overactive Bladder Syndrome (OABS), a condition characterized by symptoms of urinary urgency with or without urgency incontinence, have suggested that urinary urgency may be a useful target to promote recognition of continence problems at earlier stages of illness. This qualitative study was conducted to advance health promotion through the clarification of the phenomenon of urinary urgency in ambulatory incontinent women diagnosed with OABS. Ten female patients with a diagnosis of OABS or mixed UI with clinically significant urinary urgency were recruited at a community urological clinic. Interviews were conducted to obtain descriptions of situations in which urinary urgency occurred. Three transcripts were analyzed using the empirical phenomenological-psychological approach and a single psychological structure was generated. Phenomenological reflections revealed that urinary urgency was an episodic phenomenon that was lived through in association with a concomitant urine flow (flow urgency) or a sense of imminent flow (pre-flow urgency). During episodes of urinary urgency, participants were aware that they lacked the capacity to contain urine in a situation (sense of inefficacy), and they felt “pressed” to get to a toilet quickly, as well as uncertain about being able to get to a toilet before urine leakage emerged. Irrespective of whether urine leakage occurred, all participants described emotional sequelae related to the disclosure of urinary flow to others (i.e., distress, embarrassment, sense of inadequacy), which the women attempted to alleviate using material, psychological, relational, and medical strategies. The emotional impact was intensified when access to toilets was hindered by idiographic health and environmental circumstances. These structural features may be useful for enhancing communication between healthcare practitioners and patients regarding urgency during consultations. The results supported a conception of urine containment as an embodied, generative capability that is influenced by one sense of efficacy, or self belief in that capability. The results also supported the need to explore ways in which self-efficacy could be enhanced in patients diagnosed with OABS as a means to promote therapeutic change.