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FREQUENT URINATION IN WOMEN: ITS SYMPTOMS, CAUSING FACTORS, AND TREATMENT

Dr. Niren Rao | 16 May,2019

Simply put, frequent urination is the problem of having to go to the washroom again and again. Most of us urinate about 5-7 times during the day. Frequent urination by definition is having to go more than 8 times a day. More importantly, frequency is a problem when it starts interfering with day to day life or the patient becomes tired and frustrated because of the frequent trips to the bathroom. At times, people also get up frequently in the night to pass urine. Going up to two times in the night is normal but more than that is a cause of concern. Frequent urination in the night ( more than two times) is called nocturia. Along with this problem patients may also suffer from urgency, which is defined as sudden and strong desire to pass urine which if not controlled may also lead to leakage of a few drops of urine ( called urge incontinence).


DIAGNOSIS
Your urologist will ask some simple questions regarding your urination pattern which will help him to ascertain the cause of your frequency.


HISTORY TAKING

  • What is the time interval between each act of urination?
  • What is the approximate amount of urine voided per void?
  • How good is the urinary stream?
  • Do you have to strain to pass urine?
  • Can you postpone the act of passing urine or do you have to rush to the toilet? That is do you have urgency?
  • Do a few drops or a little amount of urine come out before you reach the washroom?
  • Do you have pain in the lower abdomen if you have to hold your urine?
  • Do you have leakage of urine while coughing/sneezing or while changing a posture?
  • How many times do you get up in the night to pass urine?
  • Do you experience a burning sensation while passing urine?
  • Is the act of passing urine painful?
  • Do you pass foul smelling urine?
  • If the problem of frequent urination is a recent one then is it associated with fever?
  • What is your average daily fluid intake?
  • Have you recently started taking any medicines prescribed by your doctor, for example, to treat high blood pressure?


INVESTIGATIONS


   1. Urine routine and microscopic examination and urine culture
This test provides a lot of information. If there is an infection in urine then the test will show pus cells. It may also show red blood cells. The pH of urine will also tell whether it is susceptible to infections. An alkaline pH makes urine susceptible to infections. Also, some infections tend to make urine alkaline. The culture report will tell about the bacteria causing infection as well as the medicines that can be used to treat the infection.

    2.Ultrasound-KUB with post-void residue
Ultrasound is done to see the status of kidneys, bladder, and ureters. It gives information such as the presence of stones in kidneys, ureters or bladder. A stone in bladder irritates the bladder mucosa and give rise to symptoms of frequent urination. A small stone in the distal part of the ureter near its junction with the bladder can also lead to frequent urination as well as urgency. Ultrasound also tells us about the amount of urine present in the bladder before passing urine as well as the amount which remains behind after the act of passing urine. Sometimes, frequent urination is because of the fact that the bladder is not able to store much urine. At other times, there remains a significant amount of urine even after urinating which can also lead to frequent urination.


3.Blood sugar testing
Your urologist will ask for a fasting and post meals blood sugar testing along with a blood test called HbA1c which gives information about the last 3 months of sugar control. Sometimes at the onset of diabetes, the first symptom is frequent urination.


4.UROFLOWMETRY


This test gives information about the flow speed, the amount of urine passed, and time taken to pass the urine. Depending on the curve of uroflow your urologist will be able to find whether there is any suggestion of obstruction in the urine passage.


5.URODYNAMIC STUDY
This is a specialized test which gives information about the filling and the dynamics of the bladder as well as information about the pressure generated inside the bladder during storage of urine as well as during the act of urinating. There are very specific indications to conduct this test and is not routinely recommended.

CAUSES OF FREQUENT URINATION AND TREATMENT


1.Urinary Tract infection
A UTI is an infection of the kidneys, ureters or bladder. This is the most common cause of frequent urination in women (particularly in the sexually active phase of life). It can easily be diagnosed on the basis of the symptoms of the patient as well as by conducting a urine routine microscopy and culture test. Patients may complain of frequency and urgency of urination. The act of passing urine may painful. The urine may smell foul and may be cloudy in color. There may also be associated with fever and lower abdominal or backache.
TREATMENT
Based on the culture report antibiotics are started to treat the infection. Along with it, supportive therapy is given to take care of fever and the burning sensation in the urinary tract. Patients are also advised to drink an adequate amount of water.


   2. Excessive Fluid Intake
Sometimes patients are habituated to drink a lot of water. It may also be because they tend to believe that more water intake may take care of constipation. At times people have a feeling of dryness in their throat and hence keep on sipping water to take care of that problem. In such cases, your urologist may advise you to make a diary i.e. patients are advised to note down the quantity of liquids taken during a 24 hr or 48 hr period along with the time of intake. Along with this, they are also asked to note down the time of passing urine along with the amount.
         TREATMENT
If the diary is suggestive that the amount of urine passed per day is proportionate to the amount of liquid intake then the patients are counseled to restrict their fluid intake and no medicines are needed.

   3. DIABETES
At times, high blood sugar levels or diabetes is diagnosed on the basis of complaints of the patient of frequent or excessive urination. An astute physician will advise you to get blood sugar fasting and post meals done to detect diabetes. The reason for frequent urination in diabetes is because the body is trying to get rid of excess blood sugar through urination.
TREATMENT
If the blood sugar levels are not very high then initially patients are advised to modify their diet and lifestyles. One should start exercising daily and restrict food intake/ eat healthily. If, on the other hand, blood sugar levels are alarmingly high then the patients may need to be started on medicines. The problem of frequent urination resolves once blood sugar levels are brought under control.

4.Bladder Stones
Bladder stones can also lead to symptoms of frequent urination. Usually, stones form in the bladder if there is some obstruction to urinary flow. At times, small stones from the kidney drop down into the bladder, and if they are unable to come out of the urethra, they tend to increase in size over time. Bladder stones tend to irritate the bladder mucosa and produce symptoms of urinary frequency. They can also lead to painful micturition and intermittency i.e. the urine tends to start and stop.
TREATMENT
After an ultrasonic examination confirms the diagnosis of bladder stones, they can be removed cystoscopically after fragmenting them into small pieces using the laser.

5.Urethral Stenosis
At times the urine passage called urethra tends to become narrow. This leads to decreased flow of urine, taking a long time to pass urine and a sense of incomplete emptying. Patients are not able to really completely empty their bladder. This leads to frequent trips to the bathroom to urinate. This problem is more common in females near menopause or a few years post menopause. It can be easily diagnosed with the help of a urine flow test as well as an ultrasound to look for post void residual urine.
TREATMENT
Under local anesthesia and antibiotic cover, the urethral passage is dilated using dilators. It is an office-based procedure which does not take more than 10 minutes and is not very painful. Post-dilatation the urine flow improves and the bladder is able to be emptied completely thus, solving the irritating problem of urinary frequency.

6.Weak Pelvic Floor Muscles
Post-childbirth, particularly after multiple normal vaginal deliveries, the muscles of the pelvic floor tend to become weak and lax. These muscles are very important as they support all the pelvic organs such as the urinary bladder, uterus, rectum, etc. As a result of muscle laxity, these organs tend to descend or move down leading to conditions such as uterus prolapse, rectum prolapse or cystocele. This, in turn, gives rise to the frequency of micturition as well as a condition known as stress incontinence i.e. leakage of a few drops or small amounts of urine on straining, lifting weights, sneezing, coughing or in severe cases even with the change of posture.
TREATMENT
After evaluation patients are taught exercises to strengthen their pelvic floor muscles, Kegels exercises. In severe cases, surgical correction of prolapsed organs may also be needed.

7. CONSTIPATION
People who are habitually constipated may also suffer from urinary frequency. This is because the urinary bladder and the rectum are lying adjacent to each other. In the case of constipation, the rectum is full of stool and presses on the urinary bladder. This does not allow the urinary bladder to actually ever completely empty leading to frequent trips to washroom to pass urine.
TREATMENT
Patients have to modify their lifestyles and dietary habits to avoid constipation. Regular physical exercises have to be incorporated into everyday life. Care should be taken to avoid de-hydration as that can lead to constipation. Diet should include salads, fruits, and green leafy vegetables.

8.Excess Intake Of Coffee, Tea Or Alcohol
Coffee, tea, and alcohol have a diuretic effect. This means they lead to more production of urine. People who are habituated to drink a lot of coffee throughout the day or take a lot of alcohol in the night may end up going to the washroom a lot because of the diuretic effect.
In order to prevent frequent urination the amount of these beverages consumed throughout the day should be limited.

9.Overactive Bladder
Overactive bladder is a very common cause of urinary frequency and urgency. In this condition, patients feel a sudden and very strong desire to pass urine which they are unable to postpone. There  may also be a leakage of a few drops or urine befor reaching the toilet
TREATMENT
After the diagnosis has been made by your urologist he may prescribe you a few medicines to curb your involuntary contractions of the bladder. Patients are also advised to restrict their fluid intake and practice timed voiding and avoid postponing the act of passing urine so that the bladder is never very full.

10. Interstitial Cystitis
Interstitial cystitis, also known as painful bladder syndrome, is a debilitating condition caused by chronic inflammation of the bladder. Patients have pain in their lower abdomen and perineum on bladder filling. They are unable to store a large amount of urine and pain subsides only after the passage of urine. They suffer from frequency, urgency and at times incontinence( leakage) of urine. The exact cause of the condition is unknown. It is often diagnosed after ruling out other common conditions which can lead to these symptoms such as urinary tract infections, bladder stones, endometriosis, tuberculosis, bladder cancer, etc.
TREATMENT
Unfortunately, there is no definite cure for this condition. It may subside,disappear with time or it may exaggerate. A combination of medicines, painkillers, cystoscopic overdistension of the bladder, biofeedback, relaxation techniques, yoga, etc are used to treat this condition.

11.TUBERCULOSIS
Rarely tuberculosis can affect the genitourinary system. It usually affects people who are immune-compromised due to diabetes, old age or HIV infection. Rarely it affects healthy people who have previously been afflicted with some other form of tuberculosis such as pulmonary tuberculosis. In late stages of the disease or in untreated cases the bladder capacity decreases and the bladder is not able to store more urine. In some cases, the bladder capacity may be as low as 50 ml only. This leads to day time frequency of urination as well as nocturia ( frequent urination at night). Patients may end up needing to pass urine every 10-15 minutes.

TREATMENT
After diagnosing the disease based on urine and blood tests as well as cystoscopy and bladder biopsy patients are started on antitubercular medicines. These medicines are taken for a prolonged duration ( 6 to 9 months). Medicines are started also to decrease the urge to pass urine. In rare cases, surgery is needed to increase bladder capacity.

12.MEDICINES
Certain medicines when taken are known to increase urine production. For example, your physician may prescribe you diuretic medicines to control high blood pressure. If on taking such medicines one is troubled by increased urinary frequency then they should consult their physicians for change of medicines

13. Bladder cancer
Very rarely a masquerading bladder cancer may present with symptoms of urinary frequency and urgency. Patients may not necessarily have hematuria i.e. blood in their urine. When all common possible causes have been ruled out your urologist may ask for urine cytology test to look for malignant cells and chose to do a cystoscopic examination of the bladder to rule out cancer.
TREATMENT
Any lesion if present in bladder needs to be removed endoscopically and sent for biopsy. Depending on the result of biopsy your urologist will guide on the need for further treatment such as repeat endoscopic surgery, intravesical chemotherapy and repeat cystoscopic examinations.

To summarise frequent urination in women can be because of numerous causes. An astute urologist should be able to solve your problem based on your history, symptoms and relevant investigations. The cause is often as simple as habitual increased fluid intake. At other times it is simply because of a urine infection or high blood sugar. The cause can be different at different age groups but most of the times are easily treatable with simple medicines, exercises, and lifestyle modifications. It is always better to seek a professional opinion than self-medicating or to start worrying about perceived misdiagnosis.

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