Frequent urges to urinate at night without and with pain: what to do and how to treat

Frequent urination at night without an increase in the volume of urine itself is called nocturia, if more fluid is released at night than during the day - nocturia. Two thirds of all daily visits to the toilet should occur during the day. It is believed that one night urination is enough for a healthy person. The exception is the fact of taking diuretics, drinking a large volume of liquid or eating fruits and vegetables containing a lot of liquid, pregnancy. An unprovoked increase in night visits to the toilet signals a disease and requires the intervention of specialists.

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Causes frequent urination at night

In addition to the already mentioned physiological reasons for frequent urination at night, similar symptoms are caused by various diseases. Thus, nocturia is provoked by:

• prostate adenoma;
• inflammation of the urinary tract;
• genital infections;
• nocturnal enuresis;
• overactive bladder;
• diabetes mellitus or diabetes insipidus;
• neoplasms in the urinary tract;
• kidney stones;
• reactive arthritis;
• a number of gynecological diseases;
• menopause in women;
• age-related incontinence.

Nocturia is caused by:

• chronic renal failure;
• cirrhosis of the liver;
• heart failure.

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Risk factors

Risk factors include hypothermia, which causes cystitis, stress, neuroses, the first and third trimesters of pregnancy, taking diuretics, and increased calcium concentration in the urine.

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Pathogenesis

The urinary bladder contains 0.5-0.7 liters of fluid, in a healthy state it is able to hold 0.3 liters for 2-5 hours. The pathogenesis of the disease is based on irritation of the receptors of the bladder neck and urethra, abundantly equipped with nerve endings. They act as a kind of sensors that are triggered in the event of stretching of the urinary bladder as it fills. The impact on the sensors as a result of any of the listed reasons gives a false signal to the brain, which is perceived as an "order" to contract the muscles. At this time, the urge to urinate occurs.

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Epidemiology

Statistics show that there are quite a lot of people in the world who suffer from frequent nighttime trips to the toilet. By the age of 60, half of the population experiences such a problem, and by the age of 80, all 90%. Enuresis, which also forces you to get out of bed at night, often occurs late, and is more common in children (more than 90% of all carriers). Among men over 50, every fourth has been diagnosed with prostate adenoma. By adding pregnant women and people with various pathologies of the urinary system to this group, the full scale of the epidemiology becomes obvious.

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Symptoms

Symptoms of frequent urination at night that should alert you and make you see a urologist are:

• inability to cope with a strong urge and delay emptying the bladder;
• small volume of urine excreted;
• pain, burning sensation when urinating;
• pain in the lower back and lower abdomen;
• change in color and sometimes an unpleasant odor of urine;
• blood or purulent fragments in the urine;
• increase in body temperature;
• deterioration of general condition;
• a constant feeling of thirst, despite drinking a large amount of liquid;
• dry mucous membranes, weight loss;
• swelling, paleness of the skin;
• pressure surges (increases in case of renal failure, decreases in case of heart failure);
• shortness of breath and inability to bear physical exertion.

Well, the first signs are unreasonable frequent urges to urinate at night, which occur more than once a night.

Frequent urination in women at night

It can be explained by a banal reason of overdoing it in eating watermelons, grapes, drinking soft drinks in the heat or tea in the cold. Also, the use of diuretics, for example, to reduce blood pressure, makes the body remove fluid in increased volumes. But if frequent nighttime urges cannot be explained by these factors, then you should understand the symptoms and find the cause of what is happening. With a normal water-mud balance, the volume of urine is 1.5-1.8 liters. To remove fluid from the body, a dozen urinations are enough, and at night there should be no more than 2-3 for older women, and for young women - 1 time is enough. Of course, each case is individual, their own adjustments can be made by the features of the anatomical structure (prolapse of the bladder, narrowing of the urethra, disorders in the musculoskeletal framework of the pelvis). If everything is normal with this, then the reasons should be sought among the above. Inflammation of the ovaries, myoma and prolapse of the uterus may be added to them. In the last two cases, frequent urges arise due to pressure on the bladder. The age of a woman, the onset of menopause is associated with a gradual fading of the ovarian function, and therefore a decrease in the production of sex hormones, which in turn entails a decrease in tissue elasticity. This leads to a weakening of the sphincters, the muscles that control the flow of urine leaving the bladder.

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Frequent urination at night during pregnancy

Another reason for frequent urination at night in women is pregnancy. This is especially evident in the first and third trimesters of pregnancy. Along with the intensive growth of the fetus, the hormonal background changes, the metabolism increases. With the onset of pregnancy, a special hormone, chorionic gonadotropin, begins to be produced in the woman's body, which increases urination. Also, through the placenta, the waste products of the fetus enter the body of the expectant mother, which are excreted through her urinary system. Another aspect of increased urges is the mechanical impact on the pelvic organs due to the growth of the fetus and the increase in the abdomen. In the second trimester of pregnancy, although the fetus has grown compared to the first, its location shifts to the abdominal cavity, so the pressure on the bladder weakens.

Frequent urination in men at night

Frequent urination in men at night can be considered a fact when it happens more often than once every 2 hours. Sometimes night urges make you get up 10-15 times a night, which interferes with normal existence. In addition to the reasons inherent in both articles, there are also purely male ones. These include prostatitis and adenoma. Prostatitis is an inflammation of the prostate gland, which is located around the urethra and irritates the bladder receptors. With adenoma, the canal is squeezed, creating an obstacle to the outflow of urine.

Frequent urination at night in the elderly

As a rule, it is associated with age-related changes: the elasticity of the bladder decreases, its lining thickens, the sphincter muscles weaken, the kidneys work worse and urine is excreted in small doses. In addition, with age, many other health problems accumulate. Thus, cardiovascular diseases, including hypertension, require daily intake of drugs - diuretics, which reduce blood pressure by removing fluid from the body. Chronic infectious diseases of the urinary organs can make themselves known, and since immunity is weakened in old age, this results in various urological problems.

Frequent urination at night in children

Frequent urination in children at night does not always indicate a disease. The structure of a child and his organs differs from that of an adult. For example, the kidneys of a newborn are not yet fully formed, this process continues for several years. In the first months of life, a child urinates at least 25 times a day, by the age of one this figure is approximately 16 times, gradually decreasing with each passing year. After 6 years, the average figure is 5-6 times. At this age, a healthy child can sleep all night without getting up to go to the toilet, or after drinking a lot of water or eating fruit, get up several times a night. Frequent urge to urinate at night for no apparent reason should cause concern for parents if accompanied by pain and burning during urination, aching pain in the lower back and abdomen, the appearance of a specific smell and color of urine, and sometimes sediment or flakes in it, severe thirst with sufficient volumes of liquid drunk. Spontaneous urine leakage in a child after 5 years (enuresis) is also a reason to consult a specialist. Frequent urination without pain at night, even without the above symptoms, may indicate malformations of the genitourinary system, heart problems, neuroses and even mental illnesses.

Diagnostics frequent urination at night

Diagnosis of frequent urination at night is based on patient complaints, urine and blood test results, and various instrumental examination options. The specialist determines the accompanying symptoms, amount of fluid consumed, and medications taken.

Urine analysis is examined for the number of leukocytes and erythrocytes, the presence of protein. An increase in leukocytes, protein in the urine indicates an inflammatory process of the urinary system - cystitis, pyelonephritis, urethritis. An increase in the level of erythrocytes indicates the presence of sand or stones in the kidneys. Protein can also signal glomerulonephritis - damage to the glomeruli of the kidneys. To identify bacteria, urine is cultured. If they are found, a sensitivity test to antibiotics is carried out, which will be needed to treat the infection.

A daily urine collection is also performed. Each portion is poured into one container, after which its volume is measured and examined for glucose, salts and protein. An increased glucose content indicates diabetes mellitus. In diabetes insipidus, a low specific gravity of urine in the kidneys is noted. Patients also record the rhythm of urination and its single volume over several days, a decrease in which will allow the doctor to suspect neoplasms in the bladder or kidney stones. Changes in the biochemical blood test may indicate renal failure or cirrhosis of the liver, and in the general analysis - the presence of inflammation.

Instrumental diagnostics includes ultrasound of the bladder and kidneys. The examination is carried out with a full and empty bladder. This can reveal defects in the urinary system and kidney development, as well as inflammation. X-ray examination is also relevant. Its implementation requires preliminary preparation - bowel cleansing and intravenous injection of a contrast agent 5 minutes before the procedure. Thanks to it, the images will capture the path of passage in the kidneys and ureter.

Voiding cystourethrography also uses a contrast agent, but introduced through a catheter. This method determines abnormalities of the bladder and urethra, the degree of weakening of the sphincter.

Renoangiography and dynamic and static scintigraphy - a radiodiagnostic drug is used intravenously, its negative impact on the body is significantly less than X-ray radiation, and the information content of the method is higher.

Cystoscopy - an optical instrument is inserted through the urethra into the bladder and examined.

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Differential diagnosis

There are many reasons for frequent nighttime urination, so the task of differential diagnostics with similar symptoms is to determine the true cause for correct treatment. Thus, in the case of prostate gland, the PSA (prostate-specific antigen) test is used - a tumor marker for differentiation from a malignant tumor. They also resort to tissue biopsy.

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Treatment frequent urination at night

Treatment of frequent urination at night depends entirely on the diagnosis. Detection of diabetes mellitus will require normalization of blood sugar levels and their constant monitoring. In case of genitourinary infections, therapy consists of antibiotics. Treatment of overactive bladder requires the use of drugs that reduce the tone of the wall or relax the neck of its sphincter apparatus. Men suffering from prostate adenoma are prescribed drugs that help relax the muscles of the prostate gland, which reduces the pressure of urine on it and expands its passage through the prostatic section.

Medicines

Treatment of urinary tract infections (UTI) depends on the location of the inflammation and its complexity. Uncomplicated inflammations are treated for 3-5 days with fluoroquinolone drugs: levofloxacin, ofloxacin, ciprofloxacin. For complicated infections, the course of treatment is 7-14 days.

Levofloxacin is a broad-spectrum antibiotic that affects the membrane, the cell wall of the bacteria, destroying it. It is available in the form of tablets and injection solution. Tablets of 0.25 g are taken once before meals or between meals. For prostatitis, the course of treatment is longer - 28 days, once a day for 0.5 g. Tablets are not chewed and washed down with plenty of water. The drug is contraindicated for children under 18, pregnant women, during lactation, patients with epilepsy, with hypersensitivity to it. Side effects are possible in the form of nausea, vomiting, diarrhea, a sharp decrease in blood pressure, urticaria, bronchospasms, dizziness, drowsiness, general weakness.

Alternative drugs are cephalosporins of the II-IV generation: axetil, cefixime, cefuroxime, cefoperazone, cefepime.

Cefuroxime is a second-generation antibiotic, its mechanism of action is to destroy the bacterial cell wall, the release form is tablets. Take 125 mg twice a day after meals. Duration of treatment is 7 days. Possible side effects: nausea, abdominal pain, vomiting, diarrhea, confusion, jaundice. Contraindicated in renal failure, hypersensitivity to the drug.

Alpha-adrenergic blockers are used to treat prostate adenoma. Here are some of them: terazosin, doxazosin, silodosin, alfuzosin.

Terazosin is an antihypertensive drug that dilates venous and arterial vessels. Tablets are white, green, orange, light brown, depending on the dosage. The recommended dose for adenoma is 5-10 mg per day, starting with a smaller dose and gradually increasing. The clinical effect occurs on average in two weeks. During treatment, it is necessary to monitor diuresis. Weakness, nasal congestion, nausea, and swelling are possible during the drug intake. It has contraindications for people with allergies to the components of the drug.

For nocturnal enuresis, the following medications are prescribed: Priloigan, Elivel, Anafranil, Sarotene, Amizole.

Priloigan is a drug in the form of tablets, dragees and a solution for intramuscular injection with an antidepressant, antidiuretic effect. The therapeutic daily dose is calculated taking into account age and weight. Children aged 6-8 years are prescribed 25 mg, 9-12 years - 25-50 mg, older than this age - 50-75 mg. The drug should be taken once a day an hour before bedtime. The regimen can be changed if incontinence occurs at the beginning of the night. In this case, the dose is divided into two doses: in the middle of the day and before bedtime. If there is no improvement after a week, the dose is increased, but not more than to 75 mg. The drug is contraindicated in hypersensitivity, pregnancy, alcoholism, cardiovascular diseases, epilepsy, in old age. Side effects are expressed in skin rashes, nausea, abdominal pain, decreased concentration, insomnia.

Vitamins

Vitamins make us healthier, more resilient, and boost our immunity, protecting us from infections. You can buy vitamin complexes at the pharmacy and take them, or you can saturate your body with a tasty mixture of different fruits: mince dried apricots, nuts, lemon, raisins, prunes, and add honey. If frequent nighttime urination is caused by diabetes, you should not use this recipe.

Physiotherapy treatment

Physiotherapy is used in combination with medication. Thus, prostate massage is prescribed for prostate adenoma. Kegel exercises, which consist of alternately contracting and relaxing the pelvic floor muscles, are used to strengthen the muscles of the pelvis, bladder, and urethra. Electrophoresis with drugs and UHF therapy are used for various urinary tract infections. Pyelonephritis, prostatitis, and cystitis are treated with warm ozokerite compresses, which have a resorptive, anti-inflammatory effect. It should not be used during periods of exacerbation. Physiotherapeutic methods such as laser therapy, ultrasound, and electric currents are used for urolithiasis. These procedures relax the muscles of the urinary system and have an anti-inflammatory effect. Mineral baths are indicated in cases of surgical or crushed stone extraction. Physiotherapeutic methods are also used for uterine fibroids. Contraindications to them include the large size of the tumor. Gynecologists may recommend radon and iodine-bromine baths, electrophoresis, and magnetic therapy.

Folk remedies

The arsenal of folk remedies for frequent nighttime urination includes baths, compresses, teas, infusions and tinctures. If the ailment is associated with inflammation of the urinary system, you can take warm baths, adding plant infusion to the water (oat straw, hay dust, pine branches are crushed, poured with boiling water and infused).

Apply a compress with grated onion to the lower abdomen and keep it there for at least an hour.

For prostate adenoma, ointment applications are used. To prepare it, take 50 g of beeswax and vegetable oil, as well as 100 g of pine rosin. All this is placed in a container and kept on the fire, stirring constantly, but not bringing to a boil. The ointment, cooled to 40 degrees, is applied in a thin layer to the surface of the fabric. Bee products are also used to treat this ailment. After defecation, suppositories made from propolis, royal jelly and cocoa butter in doses of 0.2 g, 0.01 g and 2 g, respectively, are inserted into the rectum.

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Herbal treatment

For the treatment of each disease that causes frequent night urges, herbalists have recipes that allow, if not to cure the disease, then to alleviate the condition. First of all, these are anti-inflammatory, antibacterial plants. Everyone is familiar with oak bark. To prepare a medicinal infusion, you need to take a tablespoon of bark per glass of water, pour boiling water over it and leave it to brew for an hour. All the liquid must be drunk during the day in small portions of 1-2 teaspoons at a time.

The same medicinal properties are found in such herbs as horsetail, corn silk, bear's ears, birch leaves and buds. They are used to treat inflammation of the urinary tract. The course of taking the infusion lasts 2-4 weeks, then is interrupted for a week and repeated again. The infusion is prepared at the rate of a spoonful of grass per glass of boiling water, left on the fire or in a water bath for 15-20 minutes, then infused for 1-2 hours. Drink a third of a glass during the day. This is a diuretic, so trips to the toilet will become even more frequent, but the infection will be eliminated from the body faster. At the same time, it is necessary to replenish calcium, since it is excreted along with the liquid.

To treat fibroids and other benign tumors in women, prepare decoctions from the following herbs: chamomile, yarrow, motherwort, calendula, buckthorn. Two tablespoons of the mixture are poured with half a liter of water, brought to a boil. Infuse for 30 minutes. Take 150 g warm twice a day. The course lasts 15-30 days, after a week's break it can be repeated.

Homeopathy

Homeopathy gives a good therapeutic effect in urological diseases that provoke frequent urge to urinate. Here are some of them: black elder flowers, cannabis, equisetum, pareriera, etc.

Adenoma-gran is used to treat prostate adenoma. It is available in 10g granules. Take 5 granules under the tongue daily 20 minutes before meals or an hour after for 2 months, and repeat after a 7-10 day break. There are no side effects or contraindications.

Antidiabetic agent - arsenic comp ioв-diabetes. This agent is made in the form of drops and helps to avoid complications and stop the disease. Adults are prescribed 8-10 drops in a quarter glass of water twice a day. Side effects and contraindications are in case of individual intolerance to the drug. Regarding pregnant women, no studies have been conducted.

For frequent urge to urinate, accompanied by pain and burning, acute prostatitis of the prostate gland, men are prescribed the homeopathic drug Afala. In the morning and at night, without mixing with food, 2 tablets are placed under the tongue and kept until completely dissolved. The course of treatment is long, up to 4 months. If necessary, the dose is increased to 4 tablets. After a break of 1-4 months, the treatment can be repeated. The drug is not prescribed to children and women. Side effects - in the form of allergic reactions.

Viburcol is used to treat women with infectious diseases of the genitals. Release form - suppositories. Contraindications and side effects have not been found. Dose - 1 pc. 3-4 times a day. The course of treatment is up to two weeks at the discretion of the doctor.

Surgical treatment

A number of diagnoses that cause frequent urination at night require surgical treatment. Thus, if medication in combination with other methods does not bring relief in the case of prostate adenoma, it is necessary to resort to surgical intervention. Large uterine fibroids with various complications, kidney stones larger than 5 mm, causing frequent attacks - all this is a reason to perform surgical treatment. In any case, the doctor, after a comprehensive examination, will decide on the advisability of surgery.

Complications and consequences

The consequences and complications of frequent urination depend on the cause that prompted them. Thus, age-related incontinence, enuresis or overactive bladder can reduce the quality of life, lead to anxiety, sleep disturbances, depression. With prostate adenoma, other neoplasms or kidney stones, everything can end with blockage of the ureter, and this is a direct threat to life. Untreated urinary tract infections can affect the kidneys, which leads to renal failure, or even complete death of the organ.

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Prevention

Preventive measures to prevent the unpleasant symptom of frequent night urination include measures to avoid hypothermia, a healthy diet that excludes spicy and fatty foods, and limits sweets. Quitting smoking and excessive alcohol consumption, playing sports, and hardening will improve the health of the body and prevent many diseases that result in such an unpleasant symptom.

Forecast

The prognosis for frequent urination at night is favorable in most cases with timely treatment of the underlying diagnosis causing the nighttime urges. With age-related incontinence, the prognosis for life is favorable, and numerous modern care products will help maintain its quality.

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