Pollakiuria

Any urinary disorders, including pollakiuria, significantly impair the quality of life and socialization of patients, both adults and children. As a result, unfavorable psychological conditions can develop, including those with a severe course. Early diagnostic measures and identification of the underlying pathology that provoked the development of pollakiuria, helps to timely start treatment and sooner relieve the patient's life.

Epidemiology

Little is known about the frequency of pollakiuria, since it is not an independent nosologic unit, but a symptom. According to some data, about 20% of patients in urology departments report periodic urinary frequency. Approximately the same number of patients who see other physicians report episodes of urinary frequency throughout the year. The average duration of episodic pollakiuria is 1-3 days.

Risks of developing pollakiuria correlate with sexual activity, aggravated heredity, and use of spermicidal agents.

One in two people with urinary frequency do not seek medical help, and the predominant method of treatment of this problem becomes antibiotic therapy.

Causes of the pollakiuria

Pollakiuria syndrome usually indicates the presence of problems with the urinary and sexual system. Pollycaemia is usually understood as an increase in the frequency (increased frequency) of urination. A person goes to the toilet more often than usual - that is, not 5-8 times, but much more often.

It is wrong to say that pollakiuria is always a pathology, because the frequency of urination is affected by many factors. For example, the problem can be provoked by a banal large consumption of water throughout the day, or the convergence of edema during pregnancy.

In addition, the cause may be hidden in recent hypothermia: freezing, prolonged stay in cold conditions negatively affects the state of the urinary apparatus. No less often pollakiuria appears as a result of stress.

Therefore, pollakiuria is of two types: physiological and pathological. In the absence of physiological reasons for the increased frequency of acts of urination, it is necessary to conduct a comprehensive diagnosis to determine the root cause of this disorder.

Pathologic underlying causes may be as follows:

• glomerulonephritis, pyelonephritis;
• cystitis;
• urolithiasis;
• urinary tuberculosis.

Increased frequency of urination is most often associated with inflammatory diseases. In particular, pollakiuria in cystitis is characterized by frequent urges, urination occurs in small portions and is accompanied by pain or lashes. In addition to cystitis, among the inflammatory processes are often diagnosed pyelonephritis, prostatitis in men, vaginitis and salpingitis in women.

In males, pollakiuria is often caused by prostatitis or adenoma of the prostate gland. This pathology is characterized by an increase in the frequency of urination at night.

In women, the problem can be seen in endometritis, salpingo-ophoritis, endometriosis (uterus or bladder).

Pollakiuria can be provoked in childhood:

• with inflammatory processes of the urogenital system;
• endocrine diseases (mainly diabetes mellitus or non-diabetes mellitus);
• ACUTE RESPIRATORY INFECTIONS, ACUTE RESPIRATORY VIRAL INFECTIONS;
• helminth infections;
• kidney disease;
• poor living conditions;
• taking diuretic medications.

Pollakiuria in pyelonephritis is as common as painful or difficult urination, low back pain, chills, fever, vomiting. In children, the symptomatology of the disease is much more scarce, and in women pyelonephritis can be mistaken for cystitis. That is why it is important to conduct a comprehensive diagnosis and do not engage in self-treatment.

Physiological pollakiuria disappears after limiting or ending excessive consumption of fluids (or, for example, juicy fruits - watermelons, etc.), or after normalization of the post-stress state provoked by neurosis, fear.

In some cases, pollakiuria develops as a result of CNS lesions, tumor processes in the urinary apparatus, venereal diseases. To find out the cause, the doctor must comprehensively examine the patient before prescribing treatment.

Risk factors

The physiological form of pollakiuria often develops against the background of the following factors:

• alcohol intoxication;
• drinking large amounts of fluids;
• pregnancy;
• hypothermia;
• psycho-emotional agitation, stress.

In addition, an obvious factor is the intake of diuretics, diuretics, including those of plant origin.

The following factors can provoke pathologic pollakiuria:

• Genitourinary tract:
  • Blockage of the ureter - e.g. In urolithiasis;
  • infections, inflammatory processes, urogenital tuberculosis;
  • Benign or malignant tumors, including adenocarcinoma and prostatic hyperplasia;
  • direct radioactive exposure;
  • autoimmune processes.
• Endocrine system:
  • diabetes mellitus;
  • non-sugar diabetes.
• Nervous system:
  • phobias;
  • neuroses and neurosis-like conditions.

Pollakiuria also occurs in old age due to multiple chronic disorders, or as part of the natural aging of the body.

Pathogenesis

Frequent urination is said to occur more than once every 2 hours, more than 8 times during the day and more than once during night rest. The frequency of urination is determined by two factors: urine volume and bladder capacity. An increase in urine volume in the absence of changes on the capacitance side, or a decrease in bladder capacity with normal urine volume, will equally manifest as pollakiuria.

Real pollakiuria has nothing to do with increased daily diuresis. Such a condition is called polyuria, it is accompanied by many pathologies of organs and systems of non-urological profile. Therefore, the symptom complex, which includes false pollakiuria, polyuria and polydipsia (thirst), indicates the need for a comprehensive study of the patient, excluding diabetes mellitus and non-sugar diabetes and chronic renal failure.

True pollakiuria may be related to a decrease in bladder volume due to a chronic inflammatory response. This condition is manifested by decreased single portions of urinary fluid. The urges are noted at well-defined bladder fullness, and the frequency is approximately the same at any time of day. Upon reaching the limit of the stretching boundary, pain appears, it becomes difficult for a person to hold the urge. In such patients, the medical history may contain information about interstitial cystitis, or a prolonged course of renal tuberculosis.

In patients with tumor processes, pollakiuria is often found simultaneously with hematuria. In such cases, urine should be tested for Mycobacterium tuberculosis and cancer cells, cystoscopy and cystography should be performed.

True pollakiuria may be related to a decrease in functional bladder capacity, which is associated with increased irritability of bladder receptors in cystitis, the initial stages of tuberculosis, tumor processes. A characteristic sign of such pathology is a urinary syndrome like hematuria or pyuria. Among the most common causes of cystitis: hypothermia, transferred gynecological diseases in women. Pollakiuria due to cystitis is manifested by urinary lashes, severe pain at peak bladder fullness. With primary female cystitis, a short course of antibacterial drugs of fluoroquinolone or nitrofuran series is successfully used. If the problem does not disappear for 14 days, an additional urine culture and cystoscopy are prescribed.

Often pollakiuria is of neurogenic origin, which occurs with increased excitability of cortical, subcortical and spinal centers of bladder innervation, with overactivity of the bladder (more common in children and women). Neurogenically determined problem is rarely accompanied by a urinary syndrome, but there may be pathological manifestations on the part of spinal and conducting structures. Such a condition requires the intervention of a neurological specialist.

Pollakiuria is no less rare when associated with internal bladder irritation, such as stones, foreign bodies, ureterocele, or external irritation (pathologically altered prostate gland, urethra, kidney and ureter, rectal tumors, neoplasms of the internal genitalia in women).

In children, starting from the moment of birth and up to one and a half years of age, there is an impulse closure at the subcortical and spinal level, so urination is carried out reflexively, uncontrollably, which is not a pathology.

Symptoms of the pollakiuria

Pollakiuria itself is a symptom of many pathological conditions. The problem is characterized by frequent urination - more frequent than the average norm (5-8 times a day, where one time is the period of night rest). Specialists point out that due to physiological factors, men may visit the toilet somewhat less frequently, and women - more often.

Pollakiuria can be caused by a number of reasons, which we discussed above. Depending on this, the first signs of the disorder also differ:

• Tumor processes are characterized by:
  • emaciation;
  • blood in the urine;
  • slight increase in temperature (not always);
  • increased fatigue;
  • mild, pulling pains;
  • enlarged lymph nodes.
• In hormonal disorders, you may notice:
  • stool changes (constipation, diarrhea);
  • dyspepsia;
  • kidney stones, bladder stones;
  • change in appetite;
  • feeling of fatigue, impaired memory and concentration.
• Endocrine disorders are characterized by:
  • thirst;
  • dry mouth, dry skin;
  • itchy skin;
  • increased fatigue, daytime sleepiness, impaired performance.

Men should be wary and visit a doctor when these signs appear:

• increased urge to urinate;
• frequent nighttime trips to the bathroom;
• tension of the anterior abdominal wall before urination;
• sluggish urine stream;
• the onset of urges.

Women should consult specialists in such situations:

• when you change your menstrual schedule;
• when you feel a foreign body in your vagina;
• if there is pain during sexual intercourse;
• in the appearance of pulling pains in the lower abdomen, lower back, sacrum;
• for frequent cystitis, urinary incontinence, feeling of incomplete emptying of the bladder.

Pollakiuria in children

From the time of birth until the age of six months, the form of infant urination is classified as immature. The process of urination occurs reflexively as urinary fluid accumulates. Around six months, the baby begins to feel the fullness of the bladder: this may be manifested by restlessness, crankiness followed by calmness at the end of the urinary act. Urinary function is finally formed by 3-4 years of age. It is considered that the formation of control over this function has taken place if the child begins to wake up at night when the bladder is full.

The most common problem of childhood is considered incontinence and incontinence of urine, which is often associated with psychological traumas, childhood stress. Another possible problem is urinary tract infections, which at an early stage are often accompanied by frequent urination.

The peculiarity of diagnosis in pollakiuria in childhood is the mandatory exclusion of congenital defects of the genitourinary system, which can create favorable conditions for the development of such disorders. For many cases, it is relevant to conduct a comprehensive nephrourological examination (especially in recurrent course of dysuric disorders).

Pollakiuria in men

The most common cause of pollakiuria in males is mechanical compression of the urinary tract due to prostatic hyperplasia, which surrounds the prostatic segment of the urethra. In addition, urinary disorders can be associated with increased activity of smooth muscle structures in the lower urinary tract, which is combined with constant or episodic hypertonus. Due to the diverse pathogenetic mechanism, the severity of pollakiuria is not always correlated with the degree of prostate enlargement.

The benign form of hyperplasia affects about 20% of middle-aged men and almost 90% of elderly patients over 70 years of age. Symptomatology is most often represented by pollakiuria, stranguria, nicturia, urinary retention and urinary incontinence. Disturbance of urodynamics often leads to the accession of secondary infection, the formation of urinary stones.

Other pathogenetic factors include: urethral strictures, urolithiasis, chronic prostatitis, prostate cancer, and the consequences of surgery.

All men with pollakiuria and other dysuric disorders should always be examined by a specialist urologist.

Pollakiuria in women

In adult women, the incidence of dysuria is 40 times higher than in adult men. At the same time, more than 50% of women can confirm at least one case of pollakiuria in their lifetime. One in four women of childbearing age indicates repeated episodes of urinary dysuria during the year.

In elderly patients and elders, the incidence of pollakiuria is comparable, which is largely due to the increased prevalence of prostate pathologies.

The urogenital apparatus is often completely involved in the pathological process. For example, pollakiuria is observed in many gynecological patients and complements the symptomatology of inflammation of the genital system, tumor processes, some variations of genital endometriosis. Weakness of the pelvic floor muscles, a problem diagnosed in a third of all women of childbearing age, is equally often combined with pollakiuria. About every second woman who gives birth at term has internal reproductive organ prolapse of varying intensity. In this case, urinary disorders are quite common symptoms of this condition.

Women of late childbearing and menopausal age often suffer from functional dysuria against the background of normal laboratory tests. It is difficult to establish a diagnosis in this situation. This is largely due to the influence of the fall in estrogenic activity, as well as atrophic changes in the urothelium and vascular network of the urethra. Therefore, the diagnosis of pollakiuria in female patients should necessarily be combined with a gynecological examination.

Forms

Depending on the nature of the disorder, distinguish such forms of pollakiuric disorders:

• nocturnal pollakiuria (frequent urination in small amounts mostly at night);
• daytime pollakiuria (frequent urination with relatively small amounts of urine during the day, but no such problem at night).

True pollakiuria happens:

• stressful or neurotic, which is characterized by increased urination with tension;
• Urgent, in which frequent urination occurs at the urgent urge;
• combined.

Neurotic pollakiuria is more common in women and people with a labile nervous system.

Complications and consequences

If the patient hopes that pollakiuria will disappear "by itself", he or she is wasting precious time, during which the underlying disease continues to progress. Urinary disturbance is always a symptom of another, original pathology, and if left untreated, the problem will worsen.

In general, pollakiuria significantly increases the risks of infection, the development of chronic inflammatory processes of the genitourinary apparatus.

Treating such complications is always more difficult than preventing their development. Therefore, experts advise you to follow preventive measures, seek medical advice and assistance from doctors in a timely manner.

The likelihood of the development of certain complications depends on the accuracy of the diagnosis and the timeliness of treatment. In pathologies of the kidneys and urinary tract, it is important to timely "connect" antibacterial drugs and antispasmodics, sometimes steroid hormones, cytostatics (for example, in glomerulonephritis), antihypertensives to correct blood pressure, vascular drugs are also required.

In diabetes mellitus it is important to competently use sugar-reducing tablets, insulin when indicated, and antidiuretic hormone replacement drugs in non-diabetes mellitus.

Whatever the root cause of pollakiuria, it is necessary to visit doctors in time and undergo adequate diagnostic and treatment measures - even in the absence of pain and other acute phenomena.

Diagnostics of the pollakiuria

If pollakiuria is not physiologic, the patient should consult physicians to determine the causes of this disorder. Diagnostic measures may include:

• interviewing, collecting anamnestic data on previous illnesses, working and living conditions;
• examination by a specialist urologist, palpatory examination of the kidney and abdomen, in men - assessment of the sexual system, in women - gynecological examination;
• assessment of urinary function over a 24-hour period;
• obtaining information on urinary frequency and volume of urine output, possible leakage and abnormal urges.

Urine tests in pollakiuria are extremely revealing. In particular, the analysis of general and Nechiporenko help to determine the composition of urine, to assess possible deviations from the norm. In addition, blood tests for glucose tolerance are performed, determine the values of leukocytes, COE, hemoglobin, blood glucose - to detect inflammatory processes, diabetes, etc.

Additionally, it may be necessary to consult a neurologist, psychologist, nephrologist, andrologist, gynecologist, endocrinologist.

Instrumental diagnosis can be represented by the following methods:

• Urography is an x-ray of the urinary organs. It can be overview and excretory. In review urography, an X-ray image of the lumbar region is obtained, and in excretory urography, a contrast agent is additionally injected intravenously.
• Cystography is an X-ray of the bladder. The study is performed after filling the bladder with a special contrast agent.
• Urethrography is an X-ray of the urethra with a contrast agent (injected into the urethral canal).
• Computed tomography of the kidneys and urinary tract - X-rays in layer-by-layer, with or without contrast administration.
• Magnetic resonance imaging of the urinary organs (with or without contrast).

Differential diagnosis

Pollakiuria is distinguished from other urinary disorders (dysuric disorders).

In differential diagnosis, the doctor must confirm or exclude the presence of the following diseases:

• Nephro and uropathology: inflammatory and non-inflammatory diseases of the kidneys, ureters (including congenital defects, trauma, tumors), bladder, urethra.
• Gynecological and andronological pathologies: non-inflammatory disorders of reproductive organs (prolapse, congenital defects, tumor processes), inflammatory reactions, premenstrual syndrome in women, prostate problems in men.
• Neurological diseases: hysterical and psycho-emotional disorders, disorders of peripheral innervation of the bladder, degenerations and vascular problems in the CNS, alcohol and drug intoxication.
• Endocrine pathologies in the form of diabetes mellitus and non-sugar diabetes.

Pollakiuria and nicturia	Pollakiuria	Frequent urination more than 6-8 times a day, both day and night (day and night pollyakiuria).
	Nicturia	Frequent nocturnal urination (more than one act per night).
Polyuria and pollakiuria	Pollakiuria	Urine is excreted frequently, but in standard or small portions.
	Polyuria	The daily volume of urine is increased (urine is excreted in large volumes).
Pollakiuria and urges.	Pollakiuria	May be accompanied by peremptory urges, but is not a type of urges.
	Imperative urges	The appearance of intolerable (urgent) urges to urinate. Often the urges are so strong that the patient does not have time to run to the toilet.

Treatment of the pollakiuria

If pollakiuria is a consequence of inflammatory diseases - for example, cystitis - then treatment is carried out in outpatient settings. Antibiotics are the drugs of choice:

• second- or third-generation cephalosporins (Cefuroxime, Cefixime, Ceftibuten);
• nitrofurans (Furazidine, Nitrofurantoin).

The duration of antibiotic therapy is 5-7 days.

If pollakiuria is the result of acute pyelonephritis, it is appropriate to prescribe the same cephalosporin drugs, and in case of coccal flora isolation Amoxicillin/Clavulanate is used. The duration of the treatment course is usually 1-2 weeks (on average - 10 days). If at the end of treatment the laboratory tests are unsatisfactory, or the insensitivity of microorganisms to the drug, the antibiotic is replaced, and the course of antibiotic therapy is prolonged. Among the possible drugs of choice in this situation: Ciprofloxacin, aminoglycosides, Linezolid.

Fluoroquinolone agents are used in the detection of multidrug-resistant Gram-negative pathogens, Pseudomonas bacillus, or for individual indications.

In acute cystitis, fosfomycin trometamol, nitrofuran agents are indicated, and alternatively, drugs of the fluoroquinolone series (Norfloxacin, Ofloxacin, Levofloxacin), as well as cephalosporin group of the second or third generation.

Acute pyelonephritis is a reason to prescribe fluoroquinolones with increased renal excretion. Alternative drugs: 2-3 generation cephalosporins, Trimethoprim with Sulfamethoxazole and Amoxicillin/Clavulanate. The duration of such treatment for adults is 1-2 weeks. After stabilization of temperature indicators on the 4th-5th day of antibiotic therapy, injectable administration of drugs is replaced by oral administration.

During pregnancy and when it is necessary to prescribe antibiotics to eliminate cystitis, the drugs of choice are Nitrofurantoin, Fosfomycin trometamol. In pyelonephritis in pregnant women use Cefepime, Ceftriaxone, Amoxiclav (alternative drugs - Aztreonam, Imipenem with Cilastatin).

In addition to etiotropic therapeutic measures, it is often necessary to use antipyretic and detoxifying agents, phytopreparations (in particular, Kanefron). The herbal remedy Kanefron contains such components as rosemary, lubistock, goldenseal. Due to its composition, the drug has a pronounced diuretic, antibacterial, antispasmodic, anti-inflammatory and antiproteinuric effect, enhances the effectiveness of antibiotic therapy, accelerates recovery.

Surgical treatment, depending on the underlying disease, may include periurethral injections, interventions for tumor resection and fixation of the bladder or internal genitalia, surgeries to correct congenital and acquired defects, simulation of artificial urethral sphincters, and so on.

Medicines that your doctor can prescribe

Amoxiclav	Adult patients and children weighing more than 40 kg are prescribed 1 tablet (500/125 mg) three times a day. Children with a weight of 25-40 kg take the drug from the rachset from 20 mg/5 mg per kilogram to 60 mg/15 mg per kilogram, divided into three receptions. The course of treatment is 5-7 or 10-14 days, at the doctor's discretion. Possible side effects: headache, thrombocytosis, dizziness, impaired hepatic function.
Cefuroxime	Adults take 250 mg of the drug in the morning and evening. Children with a weight of less than 40 kg take at a rate of 15 mg per kg twice a day, with a maximum dosage of 250 mg twice a day. The course of treatment can be 5-10 days. Children under 3 months of age are not prescribed the drug due to the lack of experience in its use. In early childhood, Cefuroxime is used in the form of suspension.
Furazidine	Take after meals: adults - 50-100 mg three times a day, children from 3 years - 25-50 mg three times a day. Duration of administration - 7-10 days. Possible side effects: diarrhea, dyspepsia, dizziness, drowsiness, allergies.
Kanefron	Adults and children over 12 years of age take 2 tablets or 50 drops of the drug three times a day, regardless of food intake. Possible side effects include: allergy to the drug components, nausea, diarrhea.

The use of nootropic drugs is indicated if the problem is due to neurogenic bladder dysfunction. In such situations, it is possible to prescribe Piracetam, Picamilon, Pantogam against the background of vitamin therapy, a course of anticholinergics, amino acids, sedatives. In particular, Pantogam in pollakiuria is prescribed 0.25-0.5 g three times a day. Neuroleptics are indicated much less often than nootropics, since they have antipsychotic activity and can be used as an additional remedy for patients with psychosis. Neuroleptics successfully eliminate psychomotor agitation, so drugs such as Quetiapine or Seroquel in pollakiuria can be used when indicated twice a day at 150-750 mg per day. The safety of Seroquel use in children has not been studied.

Physiotherapy treatment

Physiotherapy is often prescribed for chronic inflammatory phenomena, excluding the period of exacerbation of the disease. Procedures can be combined with medication. Depending on the underlying cause, the doctor may choose the following methods:

• Electrophoresis - is a targeted exposure to weak electrical currents in combination with the use of drug solutions, which allows to accelerate and enhance the penetration of active components of the drug into the tissues. Electrophoresis successfully copes with inflammatory processes, soothes pain syndrome, promotes antibacterial effect.
• Magnetotherapy - consists of exposure of the inflammatory focus to a magnetic field. This helps to inhibit the inflammatory response.
• Inductotherapy - involves heating the affected tissues with electrical impulses, which leads to the expansion of blood vessels, accelerating blood circulation, facilitating the work of the urinary apparatus.
• EHF therapy is an apparatus treatment that is based on cellular irradiation using extremely high frequencies. The procedure is successfully used to treat urinary tract infections, prostatitis, stones, and many gynecological diseases.

Herbal treatment

Doctors do not approve of the practice of self-medication of patients, so phytotherapy should be used only after consultation with a specialist. Often it occurs against the background of the main treatment prescribed by the doctor. Such a supplement can be the following recipes:

Dill infusion is prepared at home: pour boiling water 1 tbsp. Dill seed (it is convenient to do in a 400 ml thermos), insist for an hour. Drink 100-200 ml three times a day until the condition improves.

Broth of millet: 2 tbsp. Of millet groats pour 0.5 liters of water, bring to a boil and keep on low heat for five minutes, then cover with a lid and insist for another hour. After that, the decoction is filtered and drink 50-100 ml every hour. The course of treatment is one week.

Chamomile infusion: 10 g of dried flowers pour 200 ml of boiling water and insist under a lid for half an hour. Then take the infusion of 100 ml 30 minutes before meals 4-5 times a day, until a steady improvement in the condition.

Lingonberries, both berries and leaves are used to prepare morsels and infusions. Crushed leaves of 1 tbsp. Pour 200 ml of boiling water, insist for several hours, drink three times a day 100 ml. Berries are added to compotes (with inflammatory processes such a compote drink without sugar), or eat just so during the day.

In addition, in pollakiuria it is useful to take decoctions and infusions of birch leaves, horsetail and bearberry, plantain, flaxseed and licorice rhizome, any parts of parsley, currant leaves, celandine or sage, succession, linden and calendula. Phytopreparations can be purchased at a pharmacy or prepared on your own.

Prevention

Pollyakiuria occurs sporadically in many people throughout life. Although most often it is physiological in nature, in some cases the causes are acute inflammatory diseases of the genitourinary sphere, stress, etc. It is important to note that the absence of obvious provoking factors and timely treatment in most cases are the key to successful resolution of the problem. It is important to note that the absence of obvious provoking factors and timely treatment in most cases is the key to successful resolution of the problem.

It is even easier to think about the possible consequences in advance and prevent the development of pollakiuria and other dysuric disorders:

• women should systematically visit a gynecologist, and men - andrologist, proctologist;
• It is necessary to consult doctors in a timely manner, prevent the development of chronic diseases, do not self-medicate;
• Avoid hypothermia (particularly in the pelvic and lumbar regions);
• control body weight, prevent the development of obesity;
• eat a good diet, drink enough clean water;
• keep physically active, walk regularly, do simple gymnastic exercises.

It is advisable to have an annual routine checkup and visit your family doctor. If necessary, the doctor can refer the patient for additional examination or specialized medical consultations.

Forecast

The prognosis of pollakiuria depends on the primary pathology, timely diagnostic measures, adequacy of treatment, careful fulfillment of all medical recommendations by the patient.

Among the most unfavorable possible outcomes is the development of chronic kidney failure. In severe cases, hemodialysis procedures and kidney transplantation are prescribed, which is necessary to save the patient's life.

Pollakiuria can significantly worsen the quality of life of the patient. But it is important to understand that this disorder is not treated as a separate disease: frequent urination is a sign of various pathological processes, including quite serious ones. It can be urinary disorders, problems with the cardiovascular apparatus, neurological disorders, metabolic disorders, and so on.

Without determining the real cause and carrying out adequate treatment, pathologic pollakiuria will not disappear on its own, and the patient's condition often only worsens.