Frequent Urination: Causes and Treatments

Gotta go all the time? The technical name for your problem is frequent urination. In most people the bladder is able to store urine until it is convenient to go to the toilet, typically four to eight times a day. Needing to go more than eight times a day or waking up in the night to go to the bathroom could mean you're drinking too much and/or too close to bedtime. Or it could signal a health problem.

Causes of Frequent Urination

Frequent urination can be a symptom of many different problems from kidney disease to simply drinking too much fluid. When frequent urination is accompanied by fever, an urgent need to urinate, and pain or discomfort in the abdomen, you may have a urinary tract infection. Other possible causes of frequent urination include:

Diabetes. Frequent urination with an abnormally large amount of urine is often an early symptom of both type 1 and type 2 diabetes as the body tries to rid itself of unused glucose through the urine.

Pregnancy. From the early weeks of pregnancy the growing uterus places pressure on the bladder, causing frequent urination.

Prostate problems. An enlarged prostate can press against the urethra (the tube that carries urine out the body) and block the flow of urine. This causes the bladder wall to become irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.

Interstitial cystitis. This condition of unknown cause is characterized by pain in the bladder and pelvic region. Often, symptoms include an urgent and/or frequent need to urinate.

Diuretic use. These medications that are used to treat high blood pressure or fluid buildup work in the kidney and flush excess fluid from the body, causing frequent urination.

Stroke or other neurological diseases. Damage to nerves that supply the bladder can lead to problems with bladder function, including frequent and sudden urges to urinate.

Hypercalcemia.It means the calcium levels in your blood are above normal. Causes include overactive parathyroid glands (hyperthyroidism or hyperparathyroidism), other illness (tuberculosis, sarcoidosis), inactivity, and even cancer (lung, breast, kidney, multiple myeloma). Besides frequent urination, symptoms of hypercalcemia may include:

• Excessive thirst
• Stomach upset
• Nausea and vomiting
• Constipation
• Bone and muscle pain and weakness
• Brain issues: Confusion, fatigue, and depression
• Heart issues (rare): Racing or skipping pulse (arrhythmia) and other heart problems

Diabetes insipidus. This is a rare condition that causes your body to make a lot of urine that is "insipid," or colorless and odorless. Most people pee out 1 to 2 quarts a day.

Other causes.Less common causes include pelvic organ prolapse (in females), bladder cancer, ovarian cancer, bladder dysfunction, and radiation therapy.

Often, frequent urination is not a symptom of a problem, but is the problem. In people with overactive bladder syndrome, involuntary bladder contractions lead to frequent and often urgent urination, meaning you have to get to a bathroom right now -- even if your bladder is not full. It may also lead you to wake up once or more during the night to use the bathroom.

Diagnosing the Cause of Frequent Urination

If urinary frequency interferes with your lifestyle or is accompanied by other symptoms such as fever, back or side pain, vomiting, chills, increased appetite or thirst, fatigue, bloody or cloudy urine, or a discharge from the penis or vagina, it's important to see your doctor.

To diagnose the cause of frequent urination, your doctor will perform a physical exam and take a medical history, asking questions such as the following:

• Are you taking any medications?
• Are you experiencing other symptoms?
• Do you have the problem only during the day or also at night?
• Are you drinking more than usual?
• Is your urine darker or lighter than usual?
• Do you drink alcohol or caffeinated beverages?

Depending on the findings of the physical exam and medical history, your doctor may order tests, including:

Blood Tests. Routine blood test can check for kidney function, electrolytes, and blood sugars

Urinalysis. The microscopic examination of urine that also involves a number of tests to detect and measure various compounds that pass through the urine.

Cystometry. A test that measures the pressure inside of the bladder to see how well the bladder is working; cystometry is done to determine if a muscle or nerve problem may be causing problems with how well the bladder holds or releases urine. There’s a broader term called urodynamics that includes tests such as cystometry, uroflowmetry, urethral pressure and others.

Cystoscopy. A test that allows your doctor to look at the inside of the bladder and urethra using a thin, lighted instrument called a cystoscope. There’s a broader term called urodynamics that includes tests such as cystometry, uroflowmetry, urethral pressure and others.

Neurological Tests. Diagnostic tests and procedures that help the doctor confirm or rule out the presence of a nerve disorder.

Ultrasonography. A diagnostic imaging test using sound waves to visualize an internal body structure.

Treatment for Frequent Urination

Treatment for frequent urination will address the underlying problem that is causing it. For example, if diabetes is the cause, treatment will involve keeping blood sugar levels under control.

The treatment for overactive bladder should begin with behavioral therapies, such as:

• Bladder retraining. This involves increasing the intervals between using the bathroom over the course of about 12 weeks. This helps retrain your bladder to hold urine longer and to urinate less frequently.
• Diet modification. You should avoid any food that appears to irritate your bladder or acts as a diuretic. These may include caffeine, alcohol, carbonated drinks, tomato-based products, chocolate, artificial sweeteners, and spicy foods. It's also important to eat high-fiber foods, because constipation may worsen the symptoms of overactive bladder syndrome.
• Monitoring fluid food intake. You should drink enough to prevent constipation and over-concentration of urine. Avoid drinking just before bedtime, which can lead to nighttime urination.
• Kegel exercises. These exercises help strengthen the muscles around the bladder and urethra to improve bladder control and reduce urinary urgency and frequency. Exercising pelvic muscles for five minutes three times a day can make a difference in bladder control.
• Biofeedback. This technique can help you learn how your pelvic muscles work to help you better control them.

Treatment may also include drugs such as darifenacin (Enablex), desmopressin acetate (Noctiva), imipramine (Tofranil), mirabegron (Myrbetriq), oxybutynin (Ditropan), oxybutynin skin patch (Oxytrol), solifenacin (Vesicare), tolterodine extended-release (Detrol LA), and trospium extended-release (Sanctura XR). Oxytrol for women is the only drug available over the counter. Darifenacin is specifically for people who wake up more than twice a night to urinate.

There are other options for those who do not respond to lifestyle changes and medication. The drug Botox can be injected into the bladder muscle causing the bladder to relax, increasing its storage capacity, and reducing episodes of leakage.

Several types of surgery are also available. The least invasive involve implanting small nerve stimulators just beneath the skin. The nerves they stimulate control the pelvic floor and the devices can manipulate contractions in the organs and muscles within the pelvic floor.

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