Let’s Get to Know About Frequent Urination – Part 2

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This is an article from our “Doctor’s Corner” series, brought to you by Samitivej Hospital. Dr. Nanthiya Pravitsitthikul, M.D. is a pediatric nephrologist at Samitivej Sukhumvit hospital. Make sure to read the entire series!

This is the second article in a two-part series on frequent urination. You can find the first article here.

Frequent Urination Part 2

Causes of abnormally frequent urination that are not due to Pollakiuria are as follows:

Abnormalities of the urinary bladder on voiding

  • Abnormalities of the nervous system which controls the release of urine are usually present since birth or are the result of damage or an injury to the parts of the spine and spine cord that control urination. Children suffering from this syndrome experience dribbling urine or a weak flow urine stream. Some urine will also remain in the urinary bladder over the limit. A physical examination, the urination record and additional diagnostic test can help screen out diseases that are not related to this condition.
  • Abnormalities in the urinary bladder that are not related to the nervous system, a functional disturbance of the normal voiding cycle, may be caused by the muscles of the urinary bladder or a lack of inhibitory cerebral control over bladder contraction.

Infection

  • Enterobius infection
  • Urinary tract infection
  • Infection or wounds in the vicinity of the sexual organ in girls or urethra or urethral opening, the distal part of urinary tract in boys

Other Diseases contributing to urine volume

Diseases that contribute to an unusually large volume of urine include diabetes, diabetes insipidus, or the accumulation of stones in the kidney tissue or the urinary tract (the possibility of stones in the urinary tract in children are rare and far lower when compared to adults). In case there is any reliable indication of the presence of this condition, a urine test and a blood test are required.

Drug interactions and frequent urination

Intake of drugs or substances that stimulate frequent urination including diuretics or some groups of bronchodilators, some types of anti-allergic drugs, and some types of psychotropic drugs.

Other causes

  • Overly frequent and overly high consumption of water
  • Intake of food or drinks that contains caffeine such as tea, carbonated drinks, cocoa and chocolate, and in some cases, the consumption of drinks that contain acid or oxalate including black tea, iced tea, orange juice, apple juice, grape juice, grapefruit juice , or tomato juice
  • Constipation
  • Sexual assault in children which causes wounds, irritation, or infection of the sexual organs and other nearby organs, and also has a psychological impact on the children

Screening for pollakiuria

To confirm the diagnosis of Pollakiuria, it is important to screen out the above mentioned conditions. However, in certain cases, it is very difficult to isolate some conditions which are believed to trigger Pollakiuria. These include:

  • Viral infection of the urinary tract
  • Irritation or inflammation of urethra and urethral opening, caused by chemical substances
  • Abnormally high amounts of calcium, oxalate or acid found in the urine
  • The urinary bladder being over-sensitive to cool temperatures
  • Children having mental stress as a result of the environment they live in or unknown internal trigger from their own minds

Suggestions and treatment approaches for pollakiuria

  • Boosting children’s confidence and giving support for treatment.
  • If the cause is not overconsumption of water, liberal fluid intake is recommended with adequate water consumed for his/her age.
  • Avoid caffeinated drinks and foods or food that contains high calcium, oxalate or intense acid such as black tea, iced tea, bottled tea, coffee, carbonated drinks, chocolate, and juices such as orange, apple, orange grapefruit, grape and tomato.
  • Medication can be used to treat cases when the symptoms are serious resistant to behavioral therapy or bowel training and affects the everyday life of the children.
  • Bowel training, enlarging the bladder and conducting biofeedback therapy which will be advised from the doctor who is in charge of the treatment.
  • In case the child is having mental problems, it is advisable to have a psychiatrist in the team.

A diagnosis of  Pollakiuria is benign and there is a good prognosis for treatment. While the condition generally resolves itself, some children can take a very long time to return to normal. On average, it takes 2-6 months, although the longest recovery period is 2-3 years. Of the children who go for biofeedback therapy, more than 85% take four months to recover. To treat this syndrome, it is important to really understand it, as well as to have the cooperation of parents and children. What children need most is moral support and their parents standing by.

Looking for a doctor for your pediatric nephrology questions? We recommend:
Nanthiya Pravitsitthikul, M.D.Nanthiya Pravitsitthikul, M.D.
Pediatric Nephrologist, Samitivej Hospital
Questions about your pregnancy, child birth or life with an infant? Ask the Doctor!

The primary causes of abnormally frequent urination and stimulating factors of pollakiuria

Cause: Abnormalities in urination caused by the muscles of the urinary bladder or the nervous system

Stimulating Factor: Infection in the urinary bladder that is not caused by bacteria


Cause: Enterobius

Stimulating Factor: Inflammation or irritation in the urethra or urethral opening caused by chemical substances


Cause: Unusually large volume of urine (diabetes, diabetes insipidus, stones in the kidney tissue)

Stimulating Factor: Masturbation


Cause: Urinary tract infection

Stimulating Factor: The urinary bladder being over-sensitive to cool temperatures


Cause: Intake of drugs or substances that stimulate frequent urination

Stimulating Factor: Children having mental stress as a result of the environment or from their own minds (trouble in school, study issues and being bullied in school, feeling that they are being hurt by their loved ones or they are a victim of sexual assault, parental divorce, loss of family members, going to a new school, having a new-born younger sibling)


Other Causes:

  • Over consumption of water
  • Constipation
  • Infection or wounds in the vicinity of the sexual organs, urethra or urethral opening

Samitivej, We Care!
Nanthiya Pravitsitthikul, M.D.
Pediatric Nephrologist
Samitivej Srinakarin Children Hospital

For further information, please contact:

Samitivej Srinakarin Children’s Hospital
Samitivej Srinakarin Hospital, 4th floor
Tel: 66 (0) 2378-9082-83
Call Center: 66 (0) 2378-9000
E-mail: info.srinakarin@samitivej.co.th
Facebook: www.facebook.com/samitivej

Photo Credit: John-Morgan via Compfight cc

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