Here, our first step is to rule out infection (UTI; or STD’s: See “Painful Urination” for either Women or Men). But if there is no pain, no suggestion of white blood cells in the Urinalysis (UA), STD tests are negative and no bacteria grow on Urine Culture, we address other conditions.
Urinary Frequency means urinating very often, in only small amounts. It’s usually accompanied by “Urgency,” i.e. having to go really bad. We distinguish it from:
- Urinating often, in large amounts (called Polyuria, see below)
- Urinating often, normal amounts, without “Urgency”. This is probably not due to a disease.
Determining the cause depends on how long it’s been present. Some of these (assuming we’ve ruled out UTI with a normal UA) include:
** Early Pregnancy — usually going on a few weeks at the most
- other likely possible symptoms: missed period, breast fullness, nausea, fatigue
- Diagnosis by pregnancy test
** Prolapse of Bladder or Uterus (laxity, causing a dropping into the vagina)
- usually more chronic symptoms
- older women, who’ve almost always had given birth at least 1 or 2 times
- Diagnosis by pelvic examination
** Anxiety, Cold Weather, Caffeine, etc… — usually a relatively recent symptom
- Urinary Frequency comes & goes, not consistent
- Diagnosis by ruling out other causes; treated with reassurance
- Urgency can increase subconsciously when nearing a bathroom!
** Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) — see Chronic Discomfort below
Urinating large amounts is defined by over 3 liters (L) per 24-hour day (2 L in children) [1 L = about 1 quart]. Most people who think there’s something wrong need only try to measure how much they really pee, and it’s almost always less than this. Hopefully if they’re drinking a lot of beer, it’s not every day. People with polyuria due to disease also urinate large amounts at night, which is a clue.
If a patient is truly measuring that much urine per day, the first step is to see if it’s Diabetes:
- Usually there’s also excessive thirst
- Diagnosis by simple Urinalysis (dipstick), showing high glucose (sugar)
- Blood glucose is always >200 to be causing symptoms, often much higher, and that much always shows up in the urine. Lower levels can still be Diabetes, so a negative test won’t completely rule out the disease, but does guarantee it’s not responsible for the symptom.
- Main concern is that there not be high ketones in the urine, which could mean life-threatening Diabetic Ketoacidosis (most common in thin patients, especially if young). That will also show up on the urine dipstick.
Occasionally, people may simply have excessive thirst, for a variety of reasons. It’s common among those who take certain medications that cause dry mouth. It occasionally happens from Schizophrenia. The urine in these cases will be very dilute, appearing almost as light as water, and is measurable by low specific gravity (<1.005) on the same dipstick Urinalysis.
Patients with true polyuria and normal glucose need to be ruled out for an uncommon condition called Diabetes Insipidus (D.I.), caused by a variety of diseases. It, too, results in a low specific gravity on Urinalysis. D.I. has nothing to do with the much more common disease we discussed above & simply call Diabetes, but is technically named “Diabetes Mellitus” (“mellitus” means “sweet;” in older days, it was diagnosed by tasting urine).
D.I. can be caused by diseases of either the kidneys or the brain (mainly the pituitary gland there). When it’s caused by brain disorders, it usually begins quickly, and the first symptom is urinating a lot at night even though the patient wasn’t drinking fluids then. D.I. from the kidneys begins more gradually. Diagnosis begins by testing the amount of sodium in the blood and urine. Sometimes it’s necessary to obtain repeated tests after not drinking for several hours, or after administering medication, or concentrated salt, performed by kidney specialists (Nephrologists, not Urologists).
CHRONIC URINARY DISCOMFORT
One out of thirty women in the U.S. may experience a variety of consistent urinary symptoms such as pain, and the urgent need to urinate frequently. If this condition has gone on over 6 weeks, it may be considered Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS). It occurs in men as well, but much less so.
The first step in diagnosis is a urinalysis, urine culture, and urine tests for gonorrhea & chlamydia. If all are negative, there’s no infection of any kind.
Diagnosis is then made simply by symptoms, & ruling out diseases like cancer (see below), benign tumors like fibroids (by ultrasound), or endometriosis (by symptoms, to begin with).
IC/BPS is problematic for patients and clinicians alike because:
- We don’t understand what causes it
- There is no sure way to diagnose it
- It may represent various different conditions lumped together
- There is no single satisfactory treatment
A variety of treatments exist, from simple to potentially dangerous. We begin simply in primary care, and refer women without relief to gynecologists or urologists. Invasive tests like cystoscopy (looking inside the bladder, mostly to rule out cancer) are not required for all patients, but should be performed for anyone over 50, and those with blood in the urine.
For Men >50
Other Very Common Symptoms: straining urinate, slow stream, frequent urination, urgent need to urinate small amounts, dribbling at end
Almost always due to Enlarged Prostate (BPH). Tests we might order or perform:
- Urinalysis (UA) — (to be sure there’s no infection)
- Digital Prostate Exam – (“digital” = “by finger,” not “electronic”)
- Maybe not so useful, see BPH
- Prostate Specific Antigen (PSA) — blood test
- Controversial (see Prostate Cancer)
- Bladder Ultrasound for “post-void residual” (urine left in bladder after urination)
- to see if the symptoms are dangerous
If UA is Negative, & no obvious cancer by exam or test — Diagnosis made by symptoms alone: