Frequent urge to urinate without pain, pain and burning, night and day
If the number of emptying of the bladder during the day exceeds the average physiological norm and there is no pain, urologists state a form of dysuria, such as frequent urination without pain.
Causes of the frequent urination without pain
Short-term painless increase in urination (more than eight a day) can be the result of the use of significant amounts of fluid and products that have a diuretic effect, hypothermia and even nervous overexertion. But all this is physiology, not related to dysuria - violation of urination.
However, there are reasons for frequent urination without pain (pollakiuria without cystalgia), in which these are the first signs of a disruption in the accumulation of urine. 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 reduction in the reabsorption of water in the kidneys.
Among the causes of frequent urination without pain and burning, urologists include dysuria of a psychogenic nature and neurogenic disorders of urination. In the first case, an increase in the number of deurinations occurs with depression, hysterical syndrome, and somatotrophic disorders associated with neurotic states.
Dysfunction of the bladder due to neurogenic disorders, the so-called neurogenic bladder, is revealed in pathologies caused by insufficient cerebral circulation 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, senile dementia.
There is also a similar syndrome of a hyperactive bladder (the so-called spinal cord), which causes frequent urination 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 (spontaneously occurring contractions) detrusor associated with both impaired conduction of nerve impulses in spine traumas, osteochondrosis and intervertebral hernias (infringing nerve endings) or damage to the myelin sheaths of the spinal nerves, and with pathological changes in the muscular fibers of the urinary wall the bubble. Urination at night (nocturia), as well as frequent urination during the day without pain in an overactive bladder , are combined in many patients with the inability to suppress a sharply arising imperative urge to urinate (urinary incontinence).
It should be remembered that pain when urinating indicates that there is a problem not related to hyperactivity of the bladder.
Risk factors
In addition to the above-mentioned problems of metabolism, neurological diseases, degenerative processes in the brain and CNS pathologies, experts call such risk factors for dysuria as a painless increase in urination, such as obesity and metabolic syndrome, chronic constipation (increasing pressure in the abdominal cavity), an increase in the prostatic glands - in men and prolapse of pelvic organs - in women.
Symptoms of frequent urination without pain due to bladder hyperactivity are most often troubling and complicating the lives of older people, because in the course of physiological aging the muscle tone and blood supply of lower urinary tract tissues decrease. As studies have shown, with age, even the capacity of the bladder decreases. And in urology there is the concept of "aging of the bladder" or geriatric dysfunction of urination - worsening of detrusor muscle function, fibrosis of the wall of the bladder and increased sensitivity to neurotransmitters (especially norepinephrine).
Normal work of the urinary tract with increased deurinations reversibly disrupts the use of certain pharmacological drugs, in particular: calcium gluconate; the antibiotic Metronidazole and all preparations containing it (Metrogil, Trichopolum, Metroxane, etc.), antihistamines and hypotensive drugs; strong analgesics; drugs of the group of calcium ion antagonists (used in cardiovascular diseases); anticonvulsants with carbamazepine, etc.
Pathogenesis
In diabetes mellitus, the total volume of urine increases, that is, polyuria and frequent urination are combined : insulin hormone deficiency leads to an excess of sugar in the blood, and the body tries to get rid of unused glucose, removing it with urine. In this case, 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 sensations is due to 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 tube, this hormone provides control of the reverse absorption of water in the kidneys and release from its excess in the form of urine. So, with a deficiency of vasopressin, many biochemical processes of water-salt metabolism are violated.
In cases of vascular diseases and neurodegenerative changes in the brain, the mechanism of increasing the number of deurinations is associated with damage and partial dysfunction of the core of the Barrington - the center of urination of the CNS located in the brain stem, as well as the structures associated with it (in the cortex of the frontal lobe of the brain, hypothalamus, gray matter of the midbrain ). Hence, from the receptors of the filled bladder, an afferent impulse arrives, in response to which the neuron-generated signal that stimulates the relaxation of the urethral sphincter should return.
The sympathetic nervous system has a tonic inhibitory effect on the bladder and a stimulating effect on the urethra, and this effect is provided by the stimulation of alpha and beta adrenergic receptors.
The pathogenesis of the disturbance of innervation with increased reflexivity of detrusor is explained by specialists in delaying or partially blocking the efferent impulses of the sympathetic nervous system due to damage to the Onuf nucleus in the ventral horn of the sacral part of the spinal cord (in the sacrum) or the pudental nerve coming from this nucleus to the muscles of the sphincter of the bladder.
Epidemiology
According to some researchers, 9-43% of women and 7-27% of men develop the syndrome of a hyperactive bladder, that is, this problem with urination more often affects women. The average daily urination in patients with increased detrusor reflexivity is 12.
And according to the World Journal of Urology, the general prevalence of hyperactive bladder is 14% (in the USA to 17%), and it is diagnosed in the same way in patients of both sexes. And if in people under 40-45 years of age, who turned to a urologist for frequent urination, the syndrome of the hyperactive bladder is detected in less than 10% of cases, then after 60-65 years this figure increases three to four times .
Symptoms
Perhaps the symptoms of frequent urination without pain (and without increasing the total volume of excreted urine) are caused by small concretions in the bladder, which irritate the nerve endings of the detrusor - the muscles of the bladder membrane, with the reduction of which empties its cavity. Also, frequent urination during the day without pain can be with an elevated urate content of oxalic acid salts (hyperoxaluria), with electrolyte imbalance and a lack of sodium in the body - hyponatremia. But the 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 reasons of pollakiuria and risk factors for its development concern women. In addition, frequent urination in women without pain is characteristic of pregnancy: due to changes in the hormonal background and the pressure of 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 the omission of the uterus and all the formations in it, primarily the myoma, also put pressure on the bladder. And in the period of postmenopause, hypoestrogenism (an irreversible reduction in the synthesis of estradiol) decreases muscle tone, and the ligament and muscle of the pelvic diaphragm (pelvic floor), lono-urethral and loburnococcyoma ligaments, supporting the bladder and urinary canal, are weakened. Therefore, with age, many women have a need for more frequent emptying.
Frequent nocturnal urination in men without pain
Traditionally, frequent nighttime urination in men without pain (nocturia) is associated with obstruction of the bladder outlet due to benign prostatic hyperplasia: as it increases, the bladder and urethra are subjected to mechanical pressure, which results in blockage of the urine flow and irritation of the bladder wall, why it begins to decline, even if the amount of urine in it is small.
But in one third of cases, the symptoms of the lower urinary tract in older men are the result of local changes: atrophy of urothelium and muscle tissues, degeneration of nerves, atherosclerosis of blood vessels (leading to detrusor ischemia). Such pathophysiological changes can be associated with a stroke, heart and kidney failure, surgical intervention for prostatitis or problems with the urethra. Less common causes include bladder cancer or pelvic organs and radiation therapy.
Frequent urination in children without pain
While diabetes or psychogenic factors can cause frequent urination in children without pain, it should be borne in mind that the volume of the children's bladder is less than in adults: for example, in a seven-year-old child, it averages 240 ml (almost half the capacity in adults).
Children of this age usually empty the bladder approximately 6-9 times a day. When this happens more often, but without the presence of pain, and there may be nocturnal enuresis, then after the examination of the child, a diagnosis of dysfunctional urination can be made.
Some children, mostly girls, have an ideopathic hyperactive bladder, which can be either a congenital pathology - with a decreased capacity of the bladder or weakness of its walls due to the diverticulum formed during intrauterine development, and the consequence of permanent constipation.
Diseases and conditions of the central nervous system that affect the frequency of urination in children include epilepsy, cerebral palsy, brain tumors (gliomas). Read more - Neurogenic bladder in children
Diagnostics of the frequent urination without pain
The diagnosis of frequent urination without pain based on modern urology is based on anamnesis and complex examination of patients, which includes the elucidation of the drinking regimen, the number of urination and their single volume, the presence of other symptoms, the possible intake of medications (including diuretics), alcohol or beverages with caffeine.
Urine tests are required (total clinical, bacteriological, diurnal, sugar, density and osmolarity) and blood (glucose, insulin, serum electrolytes, chlorine, renin, creatinine, thyroid hormones, antibodies, etc.).
Instrumental diagnostics using ultrasound (ultrasound), contrast cysto- and urethrography, ultrasonography (ultrasound), ultrasound imaging, Cystoscopy, endoscopic urethroscopy, cystometry and uroflowmetry.
Differential diagnosis
Differential diagnostics are very important, which makes it possible to distinguish between polyuria in diabetes (both types) or problems with the adrenal and thyroid gland, as well as polyuria and polydipsia in schizophrenia, Bartter's syndromes and Gitelman syndromes due to increased urination due to neurogenic or spinal syndromes.
Treatment of the frequent urination without pain
Often enough to make adjustments to their eating habits (fluid restriction, avoiding caffeine), and the amount of urination normalizes. However, in some cases, treatment of frequent urination without pain is required.
Do not self-medicate, because with this symptom special medicines are used, and, for example, Kanefron with frequent urination without pain is not used, but is recommended only with inflammation of the bladder (cystitis).
Treatment of polyuria and increased urination with diabetes is a treatment for diabetes: type I needs insulin, and how type II diabetes is treated, read in the publication - Kidney diabetes insipidus
With the majority of pathologies leading to more frequent painless mikings, doctors advise taking vitamins A, E, B1, B2, B6, PP. Pharmacological agents, usually antimuscarinic (anticholinergics), are recommended only if behavioral therapy is ineffective. In addition, the drugs in this group have many side effects, especially in the elderly.
We list some drugs used to treat frequent urination with a neurogenic and hyperreflective urinary bladder.
Oxybutynin hydrochloride (Oxybutynin, Sibutin, Ditropan, Driptan and other trade names) is administered internally - one tablet (5 mg) once a day. Contraindications include problems with the intestines (ulcerative colitis and Crohn's disease), glaucoma and age of up to five years; and the most common side effects are expressed in constipation or diarrhea, nausea, dry mouth, discomfort in the stomach, increased heart rate, sleep disturbance.
Detruzitol (Detroly, Urotol) is dosed individually (depending on the age), taken once a day (one hour before meals or on an empty stomach); in pediatric practice is not used. There may be side effects in the form of dry eyes and mucous membranes of the mouth, dyspepsia, abdominal pain, headache, redness of the face, tachycardia, confusion and memory impairment.
The same contraindications and side effects have other agonists of alpha and beta adrenoreceptors: Mirabegron (Betmiga), Flavoxat (Uripas), Solifenacin (Vesicar).
A preparation Desmopressin (Minirin, Nurema) is used for a deficiency of endogenous vasopressin: 0.1-0.2 mg twice a day (maximum daily dose - 1.2 mg). At the same time, it is recommended to reduce fluid intake. Among the contraindications of this medication, cardiac and / or renal failure, fibroids of the bladder, deficiency of electrolytes in the blood, prerequisites or presence of cerebral pressure, age up to 12 months are noted. Possible side effects include headache, dizziness, nausea and vomiting, seizures and heart rhythm disturbances.
More useful information in the article - How is the neurogenic bladder treated?
In patients with overactive bladder, botulinum toxin A (Botox) can be used, which is introduced into the muscles of the bladder and blocks the action of acetylcholine, partially paralyzing the detrusor. As noted by urologists, the positive effect of this method lasts up to nine months.
Surgical treatment of a hyperactive bladder is extremely rare, and it consists of:
- in the implantation under the skin of the nerve stimulants, providing contraction in the pelvic organs and the muscles of the pelvic diaphragm;
- in a myectomy with an increase in the volume of the bladder or in the replacement of the bladder with a portion of the small or large intestine.
Physiotherapeutic treatment can be carried out using sessions of low-frequency electrostimulation of the muscular fibers of the pelvic floor. In addition, since impulses of the perineal muscles of the pelvic diaphragm reduce the contractions of the muscular walls of the bladder, urologists recommend patients with pollakiuria and overactive bladder exercises Kegel to strengthen the muscles of the pelvic floor. These exercises should be performed 30 to 80 times a day for two to three months.
The currently known herbal treatment is a herbal remedy of traditional Chinese medicine Gosha-jinki-gan (Gosha-jinki-gan).
Complications and consequences
Any kind of dysuria, including frequent urination without pain, not only worsen the quality of life, but can also give complications - depending on their causes. These are inflammatory processes in the urinary tract, and incomplete emptying of the bladder, leading to stagnation of urine and the formation of stones.
The increase in urination with hyperactive bladder syndrome eventually causes urinary incontinence, which can range from accidental leakage of urine to total inability to keep it in the bladder.
Forecast
How this symptom can develop, and how to cure it (after all, the drugs work only during the period of their intake), it is difficult to forecast, because the causes that cause this kind of dysuria are very different. And geriatric dysfunction of the bladder and pollakiuria with multiple sclerosis only progress and can lead to complete loss of control of urination.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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