I have a problem of having to urinate frequently. I consume ample amount of fluids. But I feel the frequency of nature’s call is not normal. Sometimes within 30 minutes I have to use the washroom 2 to 3 times every hour even if I did not take any fluids in between. This problem intensifies when I am in cold enclosures; like an air conditioned room or inside a vehicle. My blood sugar level is normal. I am experiencing this symptom for almost 8 years. I want to know if it is normal for certain body types or is it due to a particular health condition. I am a 27 years old male.
Frequently having to visit washroom can be a disabling symptom specially for people who travel often. Passing urine eight or more times within a day is considered abnormal. This could be due to a number of reasons. However, considering the questioner’s young age and long duration of symptoms this is most likely due to a condition known as Overactive Bladder (OAB). The hallmark symptom of OAB is “urgency”. Urgency is characterised by sudden onset of a desire to void that is difficult to put off. It is different from the simple urge to pass urine.
Understanding how the urinary bladder functions is essential to understand this condition. The kidneys produce urine throughout the day. Then it is passed on to the bladder, which can hold urine as long as the person feels comfortable to relieve. When the bladder fills beyond certain point, the nerve signals are sent to the brain which will trigger the feeling to urinate. Then the muscles making up the bladder contracts and pushes the urine out. Once the bladder is emptied those muscles relax.
In OAB, the muscles of the bladder start to contract involuntarily even when there is little bit of urine in the bladder. This involuntary contraction creates the urgent need to pass urine.
There are multiple causes for OAB. Some of them are listed below;
- Urinary tract infections
- Uncontrolled diabetes
- Excess consumption of caffeine or alcohol
- Neurological disorders – e.g. stroke, multiple sclerosis
- Certain medications – water pills, certain new diabetic medications
- Abnormalities in the bladder – e.g. tumours, bladder stones
- Incomplete emptying of bladder
In some situations, a specific cause may not be present.
Considering the long duration of symptoms given in the question, it is advisable to consult a Urologist (doctor specialised in the urinary system) for thorough evaluation and to determine the exact cause of your OAB symptoms. The doctor would require to take a thorough history, perform physical examination and order some urine tests (urine full report / urine culture). Sometimes an ultrasound scan would be required to assess the remaining urine after emptying the bladder.
Once all the secondary causes of OAB symptoms are excluded, there are few treatment options. The first-line treatment is behavioural modification. This includes the following:
- Dietary measures –Avoiding dietary caffeine can improve the symptoms. Some people benefit with avoidance of spicy food, nuts, chocolate, high potassium diet, carbonated drinks and alcohol. Experimenting with one food at a time might give an indication if that is benefitting or not. Adequate amount of fluid intake is also important, because concentrated urine can act as a bladder irritant.
- Bladder training involves scheduling voiding times. For instance, consciously urinating at an interval of 30 minutes and holding in between. Once skilled at waiting, then increase the interval by 30 minutes until an interval of 3-4 hours is achieved. This may take months to achieve.
- Pelvic floor muscle exercises (Kegel’s exercise) — Identify pelvic floor muscles. To do this; pretend you are trying to avoid passing gas or while urinating, try to stop your urine stream. You’ll feel the contraction of muscles in the pelvic area. Those are the pelvic floor muscles. Tighten (contract) those muscles, hold the contraction for 3-5 seconds and relax muscles for 3-5 seconds. Gradually increase the length of contractions and relaxations. Work your way up to 10-second contractions and relaxations. Repeat the contract/relax cycle 10 times. Perform this whole exercise at least 3 times a day.
- Bladder voiding diaries — This is a daily record of a person’s bladder activity. The patient has to complete this diary for 4-7 consecutive days before visiting the doctor. This is useful for evaluation of symptoms and for follow-up assessment. A sample voiding diary can be seen here: https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/daily-bladder-diary/Pages/facts.aspx
Certain medications are used in the second-line treatment. For instance, oxybutynin tablet/patches/gel. There are few other medications as well.
In patients who have failed behavioural and drug therapies or who is not a candidate for these treatment, the third-line treatment is considered. This includes injection of certain medication into the bladder wall or electrical stimulation of the nerves adjacent to the bladder.
Some experts consider that OAB is not a disease rather it is a symptom complex that is generally not life-threatening. It is important to note that there is no ideal treatment for OAB and no treatment will cure the symptoms of OAB in most patients. Therefore, if an acceptable level of improvement is achieved that is considered adequate.
You may refer to question 005. This article discusses about a condition found in elderly which can give rise to similar symptoms.
- American Urological Association. 2019. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: an AUA/SUFU Guideline (2019). Accessed October 05, 2019. https://www.auanet.org/guidelines/overactive-bladder-(oab)-guideline.
- Clemens, J Quentin, Michael P O’Leary, and Jane Givens. 2019. Urinary incontinence in men. July 08. Accessed October 05, 2019. https://www.uptodate.com/contents/urinary-incontinence-in-men.
- Ellsworth, Pamela I, and et al. 2018. Overactive Bladder. June 08. Accessed October 05, 2019. https://emedicine.medscape.com/article/459340-overview.