Frequent urination

Alternastive Name:Urgency (the need to pass water); Urinary frequency or urgency

Definition:
Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, compelling urge to urinate, along with discomfort in your bladder.This  is  due to bladder spasms or contractions.

A frequent need to urinate at night is called nocturia. Most people can sleep for 6 to 8 hours without having to urinate. Middle aged and older men often wake to urinate once in the early morning hours.

Symptoms:
•Frequent urination, in the daytime and at night
•Involuntary loss of urine
•Sudden and urgent need to urinate (urinary urgency)

Causes:
A person’s ability to hold urine depends on normal function of the lower urinary tract, kidneys, and nervous system. The person must also have the physical and mental ability to recognize and respond to the urge to urinate.

 

click & see
The bladder’s ability to fill and store urine requires a working sphincter muscle (which controls the flow of urine out of the body) and a stable bladder wall muscle (detrusor).

The process of urination involves two phases:

•Filling and storage
•Emptying
During the filling and storage phase, the bladder stretches so it can hold the increasing amount of urine. The bladder of an average person can hold 350 ml to 550 ml of urine. Generally, a person feels like they need to urinate when there is approximately 200 ml of urine in the bladder.

The nervous system tells you that you need to urinate. It also allows the bladder to continue to fill.

The emptying phase requires the detrusor muscle to contract, forcing urine out of the bladder. The sphincter muscle must relax at the same time, so that urine can flow out of the body.

You may clicl & Watch this video about: Bladder function – neurological control :

The bladder of an infant automatically contracts when a certain volume of urine is collected in the bladder. As the child grows older and learns to control urination, part of the brain (cerebral cortex) helps prevent bladder muscle contraction. This allows urination to be delayed until the person is ready to use the bathroom.

Undesired bladder muscle contractions may occur from nervous system (neurological) problems and bladder irritation.

URGE INCONTINENCE

Urge incontinence is leakage of urine due to bladder muscles that contract inappropriately. Often these contractions occur regardless of the amount of urine that is in the bladder.

Together, frequent and urgent urination are classic signs of a urinary tract infection.

Diabetes, pregnancy, and prostate problems are other common causes of these symptoms.

Other causes include:

•Anxiety
•Enlarged prostate
•Interstitial cystitis
•Medicines such as diuretics
•Overactive bladder syndrome
•Prostatitis (infection of the prostate gland)
•Stroke and other brain or nervous system diseases
•Tumor or mass in the pelvis
•Urinary incontinence
•Vaginitis
•Infection
•Neurological diseases (such as multiple sclerosis)
•Neurological injuries (such as spinal cord injury or stroke)

Less common causes:
•Bladder cancer
•Bladder dysfunction
•Radiation therapy to the pelvis, used to treat certain cancers

Drinking too much before bedtime, especially caffeine or alcohol, can cause frequent urination at nighttime. Frequent urination may also simply just be a habit.
Risk Factors:
You should also think about being tested for diabetes, particularly if you’re feeling very thirsty, tired or have diabetes in the family.

Complications:
Physical complications are rare. However, psychological and social problems may arise, particularly if you are unable to get to the bathroom when you feel the urge.
Diagnosis:
Your health care provider will take a medical history and perform a physical examination. Medical history questions may include:

•When did the increased urinary frequency start?
•How many times each day are you urinating?
•Is there more frequent urination during the day or at night?
•Do you have an increased amount of urine?
•Has there been a change in the color of your urine? Does it appear lighter, darker, or more cloudy than usual? Have you noticed any blood?
•Do you have pain when urinating, or a burning sensation?
•Do you have other symptoms? Increased thirst? Pain in your abdomen? Pain in your back? Fever?
•Do you have difficulty starting the flow of urine?
•Are you drinking more fluids than usual?
•Have you had a recent bladder infection?
•Are you pregnant?
•What medications are you taking?
•Have you had any previous urinary problems?
•Have you recently changed your diet?
•Do you drink beverages containing alcohol or caffeine?

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Tests that may be done include:

•Urinalysis
•Urine culture and sensitivity tests
•Cystometry (a measurement of the pressure within the bladder)
•Cystoscopy
•Neurological tests (for some urgency problems)
•Ultrasonography (such as an abdominal ultrasound or a pelvic ultrasound)
Treatment is determined by the cause of the urgency and frequency. Antibiotics and medicine may be prescribed to lessen the discomfort, if needed.

Treatment:
The choice of treatment will depend on how severe the symptoms are, and how much they interfere with your lifestyle. There are three main treatment approaches for urge incontinence: medication, retraining, and surgery.

MEDICATION

If evidence of infection is found in a urine culture, your doctor will prescribe antibiotics.

Medications used to treat urge incontinence relax the involuntary bladder contractions and help improve bladder function. There are several types of medications that may be used alone or in combination:

•Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), solifenacin (Vesicare)
•These are the most commonly used medications for urge incontinence and are available in a once-a-day formula that makes dosing easy and effective.
•The most common side effects of these medicines are dry mouth and constipation. The medications cannot be used by patients with narrow angle glaucoma.
Flavoxate (Urispas) is an antispasmodic drug. However, studies have shown that it is not always effective at controlling symptoms of urge incontinence.

Tricyclic antidepressants (imipramine, doxepin) have also been used to treat urge incontinence because of their ability to “paralyze” the bladder smooth muscle. Possible side effects include:

•Blurred vision
•Dizziness
•Dry mouth
•Fatigue
•Insomnia
•Nausea
DIET

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Drink plenty of water:

•Drinking enough water will help keep odors away.
•Drinking more water may even help reduce leakage.
Some experts recommend controlling fluid intake in addition to other therapies for managing urge incontinence. The goal of this program is to distribute fluids throughout the course of the day, so the bladder does not need to handle a large volume of urine at one time.

Do not drink large quantities of fluids with meals. Limit your intake to less than 8 ounces at one time. Sip small amounts of fluids between meals. Stop drinking fluids approximately 2 hours before bedtime.

It also may be helpful to eliminate foods that may irritate the bladder, such as:

•Caffeine
•Carbonated drinks
•Highly acidic foods such as citrus fruits and juices
•Spicy foods

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BLADDER RETRAINING

Managing urge incontinence usually begins with a program of bladder retraining. Occasionally, electrical stimulation and biofeedback therapy may be used with bladder retraining.

A program of bladder retraining involves becoming aware of patterns of incontinence episodes. Then you relearn skills necessary for bladder storage and proper emptying.

Bladder retraining consists of developing a schedule of times when you should try to urinate. You try to consciously delay urination between these times.

One method is to force yourself to wait 1 to 1 1/2 hours between trips to the bathroom, despite any leakage or urge to urinate in between these times. As you become skilled at waiting, gradually increase the time intervals by 1/2 hour until you are urinating every 3 – 4 hours.

KEGEL EXERCISES……..click & see

Pelvic muscle training exercises called Kegel exercises are primarily used to treat people with stress incontinence. However, these exercises may also be beneficial in relieving the symptoms of urge incontinence.

The principle behind Kegel exercises is to strengthen the muscles of the pelvic floor to improve the function of the urethral sphincter. The success of Kegel exercises depends on proper technique and sticking to a regular exercise program.

Another approach is to use vaginal cones to strengthen the muscles of the pelvic floor. A vaginal cone is a weighted device that is inserted into the vagina. The woman contracts the pelvic floor muscles in an effort to hold the device the place. The contraction should be held for up to 15 minutes and should be performed twice daily. Within 4 – 6 weeks, about 70% of women trying this method had some improvement in symptoms.
You may click to see :1.Kegel Exercises For Men.….2.Kegel Exercises For Women

BIOFEEDBACK AND ELECTRICAL STIMULATION

Biofeedback and electrical stimulation can help identify the correct muscle group to work, to make sure you are performing Kegel exercises correctly.

Some therapists place a sensor in the vagina (for women) or the anus (for men) to assess contraction of the pelvic floor muscles. A monitor will display a graph showing which muscles are contracting and which are at rest. The therapist can help you identify the correct muscles for performing Kegel exercises.

Electrical stimulation involves using low-voltage electric current to stimulate the correct group of muscles. The current may be delivered using an anal or vaginal probe. The electrical stimulation therapy may be performed in the clinic or at home. Treatment sessions usually last 20 minutes and may be performed every 1 – 4 days.

SURGERY

Surgery can increase the storage ability of the bladder and decrease the pressure within the bladder. It is reserved for patients who are severely affected by their incontinence and have an unstable bladder (severe inappropriate contraction) and a poor ability to store urine.

Augmentation cystoplasty is the most often performed surgical procedure for severe urge incontinence. In this surgery, a segment of the bowel is added to the bladder to increase bladder size and allow the bladder to store more urine.

Possible complications are those of any major abdominal surgery, including:

•Blood clots
•Bowel obstruction
•Infection
•Pneumonia
There is a risk of developing abnormal tubelike passages (urinary fistulae) that result in abnormal urine drainage, urinary tract infection, and difficulty urinating. Augmentation cystoplasty is also linked to a slightly increased risk of developing tumors.

Sacral nerve stimulation is a newer surgical option that consists of an implanted unit that sends small electrical pulses to the sacral nerve. The electrical pulses can be adjusted to each patient’s symptoms.

ACTIVITY

People with urge incontinence may find it helpful to avoid activities that irritate the urethra and bladder, such as taking bubble baths or using harsh soaps in the genital area.

MONITORING

Urinary incontinence is a long-term (chronic) problem. Although you may be considered cured by treatment, you should continue to see your health care provider to evaluate the progress of your symptoms and monitor for possible treatment complications.
Home Care:
Follow the therapy recommended by your doctor to treat the underlying cause of your urinary frequency or urgency. It may help to keep a diary of times and amounts of urine voided to bring with you to the doctor.

In some cases, you may experience some urinary incontinence for a period of time. You may need to take steps to protect your clothing and bedding.

 

Prevention:
For nighttime urination, avoid excessive fluid before going to bed, particularly coffee, other caffeinated beverages, and alcohol.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/001270.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm
http://hubpages.com/hub/Benefits-of-Kegal-Exercises
http://www.urogynics.org/pages/pops/seif/uui.html
http://www.healthcentral.com/incontinence/treatment-000050_12-145.html

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