Frequent urges to urinate without pain, pain, or burning, at night or during the day

If the number of bladder empties during the day exceeds the average physiological norm and no pain occurs, urologists diagnose a form of dysuria such as frequent urination without pain.

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Causes frequent urination without pain

A short-term painless increase in urination frequency (more than eight times a day) may be a consequence of consuming significant amounts of liquid and products that have a diuretic effect, hypothermia, and even nervous tension. But all this is physiology and has nothing to do with dysuria – a urination disorder.

However, there are reasons for frequent urination without pain (pollakiuria without cystalgia), in which these are the first signs of impaired urine accumulation. This condition of the urinary system is observed with increased diuresis (polyuria) in patients with diabetes mellitus or in the presence of diabetes insipidus, which develops due to a decrease in water reabsorption in the kidneys.

Urologists include psychogenic dysuria and neurogenic urination disorders among the causes of frequent urination without pain or burning. In the first case, an increase in the number of urinations occurs with depression, hysterical syndrome, and somatotrophic disorders accompanying neurotic conditions.

Bladder dysfunction due to neurogenic disorders, the so-called neurogenic bladder, is detected in pathologies caused by insufficient cerebral blood flow and cerebral ischemia, as well as degenerative changes in its structures involved in supraspinal regulation of urination. Such disorders include strokes, brain tumors, multiple sclerosis, Parkinson's and Alzheimer's diseases, and senile dementia.

A similar syndrome of overactive bladder (so-called spinal) is also distinguished, in which frequent urination occurs in the morning and at night without pain, and the amount of urine released during each emptying of the bladder is relatively small. The cause of this syndrome is seen in increased reflexion (spontaneous contractions) of the detrusor, associated with both a violation of the conduction of nerve impulses in spinal injuries, osteochondrosis and intervertebral hernias (pinching nerve endings) or damage to the myelin sheaths of the spinal nerves, and with pathological changes in the muscle fibers of the bladder wall. Urination at night (nocturia), as well as frequent urination during the day without pain in overactive bladder in many patients is combined with the inability to suppress a sharply arising imperative urge to urinate (urinary incontinence).

It is important to remember that pain when urinating indicates that there is a problem that is not related to overactive bladder.

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Risk factors

In addition to the above-mentioned metabolic problems, neurological diseases, degenerative processes in the brain and CNS pathologies, experts cite such risk factors for dysuria in the form of painless increased urination as obesity and metabolic syndrome, chronic constipation (increasing pressure in the abdominal cavity), enlarged prostate gland in men and pelvic organ prolapse in women.

Symptoms of frequent urination without pain due to overactive bladder most often bother and complicate the lives of older people, since during physiological aging, muscle tone and blood supply to the tissues of the lower urinary tract decrease. As studies have shown, with age, even the capacity of the bladder decreases. And in urology, there is a concept of "bladder aging" or geriatric dysfunction of urination - deterioration of the detrusor muscle function, fibrosis of the bladder wall and increased sensitivity to neurotransmitters (especially norepinephrine).

The normal functioning of the urinary tract with increased urination is reversibly disrupted by the use of certain pharmacological drugs, in particular: calcium gluconate; the antibiotic Metronidazole and all drugs containing it (Metrogil, Trichopolum, Metroxan, etc.), antihistamines and hypotensive drugs; strong analgesics; drugs of the calcium ion antagonist group (used in cardiovascular diseases); anticonvulsants with carbamazepine, etc.

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Pathogenesis

In diabetes mellitus, the total volume of urine increases, i.e. polyuria and frequent urination are combined: deficiency of the hormone insulin leads to excess sugar in the blood, and the body tries to get rid of unused glucose by excreting it in the urine. At the same time, the osmotic pressure of all biological fluids increases, which causes the so-called osmotic diuresis - an increase in the excretion of water and salts by the kidneys.

In diabetes insipidus, the pathogenesis of pollakiuria without pain is hidden in the insufficient secretion of the antidiuretic hormone vasopressin by the hypothalamus, which regulates the amount of fluid in the body, including the production of urine by the kidneys. By binding to specific receptors of the renal collecting duct, this hormone ensures control of the reabsorption of water in the kidneys and the release of its excess in the form of urine. So, with a deficiency of vasopressin, many biochemical processes of water-salt metabolism are disrupted.

In cases of vascular diseases and neurodegenerative changes in the brain, the mechanism of increasing the number of urinations is associated with damage and partial dysfunction of the Barrington nucleus located in the brainstem - the urination center of the central nervous system, as well as associated structures (in the cortex of the frontal lobe of the brain, hypothalamus, gray matter of the midbrain). From here, an afferent impulse comes from the receptors of the filled bladder, in response to which a signal generated by neurons should return, stimulating relaxation of the urethral sphincter.

The sympathetic nervous system has a tonic inhibitory effect on the bladder and a stimulating effect on the urethra, and this effect is mediated by stimulation of alpha- and beta-adrenergic receptors.

Experts explain the pathogenesis of innervation disorders with increased detrusor reflexivity by a delay or partial blocking of efferent impulses of the sympathetic nervous system due to damage to the Onuf nucleus in the ventral horn of the sacral spinal cord (in the sacral region) or the pudendal nerve running from this nucleus to the sphincter muscles of the bladder.

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Epidemiology

According to some researchers, overactive bladder syndrome occurs in 9-43% of women and 7-27% of men, meaning that this urination problem affects women more often. The average daily number of urinations in patients with increased detrusor reflex is 12.

And according to the World Journal of Urology, the overall prevalence of overactive bladder is 14% (in the US up to 17%), and it is diagnosed with equal frequency in patients of both sexes. And if in people under 40-45 years of age who consult a urologist about frequent urination, overactive bladder syndrome is detected in less than 10% of cases, then after 60-65 years this figure increases three to four times.

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Symptoms

It is possible that the symptoms of frequent urination without pain (and without an increase in the total volume of urine excreted) are caused by small stones in the bladder, which irritate the nerve endings of the detrusor - the muscle of the bladder lining, the contraction of which empties its cavity. Also, frequent urination during the day without pain can be caused by an increased content of oxalic acid salts in the urine (hyperoxaluria), with an electrolyte imbalance and a lack of sodium in the body - hyponatremia. But frequent emptying of the bladder at night is characteristic of primary hyperaldosteronism (Conn's syndrome).

Frequent urination in women without pain

All the above-mentioned causes of pollakiuria and risk factors for its development also concern women. In addition, frequent urination in women without pain is typical for pregnancy: due to changes in hormonal levels and as a result of pressure from the growing uterus on the bladder. This is a physiologically conditioned temporary condition that does not require any medical intervention.

It should be borne in mind that prolapse of the uterus and all formations in it, primarily myoma, also exert pressure on the bladder. And in the postmenopausal period, against the background of hypoestrogenism (irreversible reduction in estradiol synthesis), muscle tone decreases, and the ligaments and muscles of the pelvic diaphragm (pelvic floor), the pubourethral and pubococcygeal ligaments that support the bladder and urethra weaken. Therefore, with age, many women have a need for more frequent emptying.

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Frequent night urination in men without pain

Traditionally, frequent nocturnal urination in men without pain (nocturia) is associated with obstruction of the bladder outlet due to benign prostatic hyperplasia: when it enlarges, the bladder and urethra are subject to mechanical pressure, which leads to blockage of urine flow and irritation of the bladder wall, causing it to contract, even if the amount of urine in it is small.

But in one-third of cases, lower urinary tract symptoms in older men are the result of local changes: atrophy of urothelial and muscle tissue, nerve degeneration, atherosclerosis of blood vessels (leading to detrusor ischemia). Such pathophysiological changes may be associated with a history of stroke, heart or kidney failure, surgery for prostatitis or urethral problems. Less common causes include bladder or pelvic cancer and radiation therapy.

Frequent urination in children without pain

Although diabetes or psychogenic factors can cause frequent urination in children without pain, it must be taken into account that the capacity of a child's bladder is smaller than that of adults: for example, in a seven-year-old child it is on average 240 ml (almost half the capacity of an adult).

Children of this age usually empty their bladders about 6-9 times a day. When this happens more often, but without pain, and nocturnal enuresis may be present, then after examining the child, a diagnosis of dysfunctional urination can be made.

Some children, mostly girls, have idiopathic overactive bladder, which can be either a congenital pathology - with reduced bladder capacity or weakness of its walls due to a diverticulum formed during intrauterine development, or a consequence of constant constipation.

Diseases and conditions of the central nervous system that affect urinary frequency in children include epilepsy, cerebral palsy, brain tumors (gliomas). Read more - Neurogenic bladder in children

Diagnostics frequent urination without pain

The diagnosis of frequent urination without pain carried out in modern urology is based on the anamnesis and comprehensive examination of patients, which includes determining the drinking regimen, the number of urinations and their one-time volume, the presence of other symptoms, possible use of medications (including diuretics), consumption of alcohol or drinks with caffeine.

Urine tests (general clinical, bacteriological, daily, for sugar, for density and osmolarity) and blood tests (for glucose levels, insulin, serum electrolytes, chlorine, renin, creatinine, thyroid hormones, the presence of antibodies, etc.) are required.

To determine the condition of the bladder, kidneys and all pelvic organs, including the prostate gland in men and reproductive organs in women, as well as to establish the urodynamic features of dysuria, instrumental diagnostics are used using: ultrasound echography (US), contrast cysto- and urethrography, cystoscopy, endoscopic urethroscopy, cystometry and uroflowmetry.

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Differential diagnosis

Differential diagnostics are very important, allowing one to distinguish polyuria in diabetes (both types) or problems with the adrenal glands and thyroid gland, as well as polyuria and polydipsia in schizophrenia, Bartter and Gitelman syndromes from increased urination due to neurogenic or spinal syndromes.

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Treatment frequent urination without pain

Often, it is enough to make adjustments to your eating habits (limiting fluids, avoiding caffeine), and the amount of urination will normalize. However, in some cases, treatment of frequent urination without pain is required.

Do not self-medicate, since special medications are used for this symptom, and, for example, Canephron is not used for frequent urination without pain, but is recommended only for inflammation of the bladder (cystitis).

Treatment of polyuria and frequent urination in diabetes is the treatment of diabetes: insulin is needed for type I, and how to treat type II diabetes, read in the publication - Renal diabetes insipidus

For most pathologies that lead to increased frequency of painless urination, doctors recommend taking vitamins A, E, B1, B2, B6, PP. Pharmacological agents, usually antimuscarinic (anticholinergics), are recommended only if behavioral therapy is ineffective. In addition, drugs in this group have many side effects, especially in the elderly.

Here are some medications used to treat frequent urination in neurogenic and hyperreflexive bladder.

Oxybutynin hydrochloride (Oxybutynin, Sibutin, Ditropan, Driptan and other trade names) is prescribed orally - one tablet (5 mg) once a day. Contraindications include intestinal problems (ulcerative colitis and Crohn's disease), glaucoma and age under five years; and the most common side effects are constipation or diarrhea, nausea, dry mouth, stomach discomfort, increased heart rate, sleep disturbances.

Detrusitol (Detrol, Urotol) is dosed individually (depending on age), taken once a day (an hour before meals or on an empty stomach); it is not used in pediatric practice. There may be side effects in the form of dry eyes and mucous membranes of the mouth, dyspepsia, abdominal pain, headache, facial flushing, tachycardia, confusion and memory impairment.

Other alpha- and beta-adrenergic receptor agonists have the same contraindications and side effects: Mirabegron (Betmiga), Flavoxate (Uripas), Solifenacin (Vesicar).

And the drug Desmopressin (Minirin, Nourema) is used for a deficiency of endogenous vasopressin: 0.1-0.2 mg twice a day (maximum daily dose is 1.2 mg). At the same time, it is recommended to reduce fluid intake. Contraindications to this drug include cardiac and/or renal failure, fibrous changes in the bladder, electrolyte deficiency in the blood, prerequisites or presence of cerebral pressure, age up to 12 months. Possible side effects include headache, dizziness, nausea and vomiting, seizures and heart rhythm disturbances.

More useful information in the article - How to treat neurogenic bladder

Patients with overactive bladder may be treated with botulinum toxin A (Botox), which is injected into the bladder muscles and blocks the action of acetylcholine, partially paralyzing the detrusor. As urologists note, the positive effect of this method lasts up to nine months.

Surgical treatment of overactive bladder is used extremely rarely and consists of:

• in the implantation of nerve stimulators under the skin, which ensures contractions in the pelvic organs and muscles of the pelvic diaphragm;
• in myectomy with an increase in the volume of the bladder or in replacing the bladder with a section of the small or large intestine.

Physiotherapy treatment can be carried out using low-frequency electrical stimulation sessions of the pelvic floor muscle fibers. In addition, since the impulses of the perineal muscles of the pelvic diaphragm reduce contractions of the bladder muscle walls, urologists recommend Kegel exercises to strengthen the pelvic floor muscles for patients with pollakiuria and overactive bladder. These exercises should be performed 30-80 times a day for two to three months.

The currently known herbal treatment is the traditional Chinese medicine herbal remedy Gosha-jinki-gan.

Complications and consequences

Any type of dysuria, including frequent urination without pain, not only worsens the quality of life, but can also cause complications, depending on their causes. These include inflammatory processes in the urinary tract and incomplete emptying of the bladder, leading to urine stagnation and stone formation.

The increased frequency of urination in overactive bladder syndrome eventually causes urinary incontinence, which can range from occasional leaks of urine to a complete inability to hold urine in the bladder.

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Prevention

There is no set of measures to prevent frequent urination without pain. The only available method is to monitor your health and, in case of problems with urination, consult a doctor.

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Forecast

It is difficult to predict how this symptom may develop and how its treatment will end (after all, the drugs only work during the period of their intake), since the causes of this type of dysuria are very different. And geriatric bladder dysfunction and pollakiuria in multiple sclerosis only progress and can lead to a complete loss of control over urination.

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