How is frequent urination treated?

Medical treatment for frequent urination

The underlying cause of frequent urination will determine the course of treatment. The causes and treatment options are explained below:

• Alcohol, caffeine, certain foods and sweeteners – If these components are found to be the cause of your frequent urination, then it will be advised that you avoid them.
• UTI (urinary tract infection) – Your doctor is likely to prescribe an antibiotic such as phenazopyridine, which is used to treat the symptoms of a UTI such as pain and a burning sensation when urinating. It is also recommended that you drink plenty of water.
• Diabetes – If your blood sugar levels are very high (i.e. you suffer from hyperglycaemia), then frequent urination is typically one of the initial symptoms of this condition. If you are a diagnosed diabetic and suffer from frequent urination, then your doctor will treat your blood sugar levels by adjusting your insulin intake or your glucose-lowering medication in an attempt to manage your blood glucose levels.
• Use of diuretics – Diuretics are commonly prescribed as a part of the treatment for high blood pressure, however, these medications lead to frequent urination and fluids are flushed from the body. Thiazides are commonly prescribed if you have hypertension (i.e. high blood pressure). Speak to your doctor about taking your medications less frequently or in the morning to prevent having to wake up to urinate at night.
• Prostate issues – If you have issues with your prostate then this condition will be treated by a specialist known as a urologist. The two commonly prescribed drugs for an enlarged prostate are:
  • 5-alpha-reductase inhibitors (5ARIs) – These aid in reducing the hormone levels (predominantly testosterone and dihydrotestosterone (DHT)⁶ ) that cause the growth of the prostate.
  • Alpha blockers – These drugs aid in smoothing and relaxing muscle cells in the body, including those of the bladder.

          In some cases, surgery may be needed to treat issues with the prostate.

• Pregnancy – Frequent urination is unfortunately part of pregnancy and there is not much that can be done to alleviate this symptom, particularly in the later stages of pregnancy. It can help to reduce your consumption of carbonated beverages and caffeine. However, it is not advised that you reduce your overall intake of fluid as it is vital to stay hydrated. It can be helpful to consume the majority of liquids during the day and try to reduce your intake of fluids in the evenings. When you use the bathroom, trying to lean forward slightly to help empty out your bladder more effectively.
• Interstitial cystitis – Also known as painful bladder syndrome, this condition is typically treated by a specialist known as a urologist. Some medications prescribed in the treatment of this condition include antihistamines, pentosan polysulfate sodium (Elmiron), pain-killers and tricyclic antidepressants. In some cases, surgery may be needed to treat the condition, however, this is rarely the option suggested by doctors.
• Stroke and other neurological conditions – If a stroke or neurological condition (nervous system disorder) affects the bladder this is referred to as a neurogenic bladder. Depending on the specific neurological cause of frequent urination, your doctor may suggest drugs such as anticholinergic medications (tolterodine and oxybutynin), Botox injections to restrict the tension in the muscles of your bladder or bladder retraining (see more below).
• Bladder cancer – A urologist will lead the treatment of bladder cancer, this may involve surgery, followed by radiation and/or chemotherapy.
• Overactive bladder syndrome – Bladder retraining is often the first recommendation when it comes to treating an overactive bladder and gain control over frequent urination. There are also a number of drugs which may be prescribed for this condition, some of these include:
  • Oxybutynin (Ditropan XL)
  • Oxybutynin as a skin patch (Oxytrol)
  • Oxybutynin gel (Gelnique, Gelnique 3%)
  • Mirabegron (Myrbetriq)
  • Trospium (Sanctura)
  • Tolterodine (Detrol, Detrol LA)
  • Darifenacin (Enablex)
  • Fesoterodine (Toviaz)
  • Solifenacin (Vesicare)

Other treatment options to stimulate the nerves and regulate nerve impulses to the bladder and aid in improving the symptoms of an overactive bladder include sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). Surgery to increase the capacity of your bladder or to remove the bladder are regarded as the last resort in treatment.

Treating frequent urination through self-care at home

Retraining your bladder

If you have problems controlling your bladder (i.e. suffer from urinary incontinence), never know when you are going to suddenly feel the uncontrollable urge to urinate and fear leaking urine when out with friends or at work, or if you suffer overactive bladder syndrome or from a neurological condition that leads to bladder issues, then retraining your bladder may be beneficial for you.

Bladder retraining is a type of behavioural therapy that aids in helping you to regain urinary control. This technique is a gradual one that teaches you to hold in your urine for a little longer each time which helps to prevent uncontrollable urination and leakage over the long term.
 
There are several different ways that you can retrain your bladder if you suffer from issues of urinary incontinence such as:

• Urge incontinence – This refers to a strong and sudden urge to urinate as a result of your bladder contracting even when it is not full.
• Stress incontinence – You may suddenly lose urine with laughing, coughing sneezing or even jogging. The pressure on your abdomen from these actions may cause your bladder walls to contract.
• Mixed incontinence – This is a combination of urge incontinence and stress incontinence.
• Overflow incontinence – This refers to issues that prevent you from fully emptying your bladder which may lead to urine leakage.
• Bed-wetting - Bladder retraining is also beneficial for children who are bed-wetter’s.

The technique for bladder retraining

Before beginning with bladder retraining, it is likely that your doctor will suggest that you keep a urination diary (also known as a bathroom diary) in which you record when you have the urge to urinate and when you notice urine leakage. This will then act as a guide to help you through the below techniques as you practice gaining increased urinary control:

• Scheduling bathroom visits – Based on the entries in your diary, you can determine how often you are urinating. Once you have figured this out, then add roughly ten to fifteen minutes to this time to wait until you urinate. To put this into context, if you are urinating every hour, then schedule your visits to the bathroom every hour and fifteen minutes. You will have to try and urinate at every visit you have scheduled, regardless of whether you actually have to urinate or not. You will then begin to gradually increase the amount of time between your bathroom visits.
• Delaying urination – When feeling the urge to go to the toilet, hold this in for about five minutes. Then, increase this time gradually by roughly ten minutes, try and get to a point where you can hold it for at least a few hours without having to urinate. During this process, if your need to urinate becomes intense, then try to distract yourself through work or using techniques such as counting down from 100. You can also try certain relaxation and breathing techniques such as meditation and mindfulness. If you really can’t hold it, and to prevent any accidents from occurring, then you should go to the bathroom. However, you should only go again during your next scheduled toilet break.
• Kegels – Kegel exercises aid in strengthening your pelvic floor to enhance urine control, these are the muscles that you use when you start and stop urinary flow. Kegels may be extremely effective for women who suffer from incontinence. Bear in mind, men can also perform these exercises. The below explains how to perform Kegels (the technique is the same for women as it is for men):
  • Find your pelvic floor muscles – To find these muscles, you can stop urinating midstream, once you have found these then squeeze these and hold.
  • Perfect the technique – By now you have found your pelvic floor muscles during urination and know what it feels like to tighten them. The best positions to perform Kegels, when not urinating, is either sitting or lying down.
    Once you tighten the pelvic floor muscles, hold the contract for a few seconds, then relax for a few seconds. Try this technique a few times. As your muscles begin to grow stronger, begin to increase the contractions to ten seconds each.

• Maintain focus – To achieve the best results, try not to tighten or contract the muscle in your buttocks, thighs and abdomen and isolate just the pelvic floor muscles. It is best not to hold your breath when performing these exercises but to rather breathe normally during them.
• Repeat – Once you have the technique down and can hold your pelvic floor muscles for a few seconds at a time, then try to repeat Kegels three time a day in sets of ten repetitions (holding for five to ten seconds, then relaxing for five to ten seconds).
  
  It is best not to always perform Kegels when urinating as some experts believe that this may lead to a bladder infection. Rather perform these when sitting at your desk, walking or when standing.
  
  To further improve bladder retraining, you can try these additional tips:
  • Limit your intake of beverages that cause an increase in urination, this includes alcohol, tea, coffee and carbonated drinks.
  • Try to drink fewer liquids before going to bed.
  • Urinate before going to sleep at night and when you wake up in the morning, even if you feel as though you don’t need to.
  • Keep a bathroom diary and discuss this with your doctor to ensure that you are on track.

The outcome of bladder retraining

You will know you have completed bladder retraining when:

• You are able to go for longer periods of time between urinating
• You have more control over the urge to urinate
• You can hold more urine in your bladder

You are unlikely to see any significant results in the first few days, bear in mind, bladder retraining often takes roughly 12 weeks to work.

If you have practiced bladder retraining for longer than 12 weeks and have not seen any results, then speak to your doctor about other treatment options such as medication or surgery.

Follow-up for frequent urination

If you were given any medications for frequent urination during a doctor’s appointment, then the dosage for these should be followed accordingly in order to ensure the best results. If your doctor suggested bladder retraining, then it may take a few weeks to see results. Should you continue to have issues with frequent urination when this symptom, according to your doctor, should have eased up, then it is advised that you schedule a follow-up consultation. 

Prevention of frequent urination

Frequent urination may be caused by a variety of health conditions, and in these instances, generally cannot be prevented until the underlying condition is successfully treated and resolves.

By avoiding excessive intakes of food and fluids with a diuretic effect, you may be able to reduce urinary frequency. Performing Kegel exercises will aid in strengthening the muscles of your pelvic floor, helping you to gain more bladder control.

It is advised that you discuss any symptoms that seem unusual to you with your doctor in order to prevent these from progressing.

Outlook for frequent urination

The outlook for frequent urination will depend on the condition causing the disorder and the success of the treatment for it. In most cases, frequent urination is not a cause for concern and can be resolved by drinking fewer liquids (the recommended intake of fluid daily is 3,000 ml for men and 2,200 ml for women)⁷.

 

^References:

^{6. NCBI. 2009. The role of 5-alpha-reductase inhibitors in prostate pathophysiology: Is there an additional advantage to inhibition of type 1 isoenzyme? Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698784/ [Accessed 24.10.2017]}

^{7. NCBI.  2010. How much water do I really need to drink? Available: https://www.ncbi.nlm.nih.gov/pubmed/20356431 [Accessed 19.01.2018]}