What is the role of nonprescription products in treating urinary tract infections? How effective and safe are they? What are the FDA regulations surrounding these products?

The Prevalence of Urinary Tract Infections

Urinary tract infections (UTIs) are much more common among women than men. Patients may experience symptoms such as frequent and intense urge to urinate, urethral or bladder burning, and pain during urination. In older patients and males, UTIs can also cause fatigue, shakiness, weakness, muscle aches, and pain in the abdomen. Patients may also notice cloudy, dark, or bloody urine with an objectionable odor. If the infection reaches the kidneys or prostate, fever is also common. Patients may complain of pain in the back or side (below the ribs), as well as nausea and vomiting.

The Risks of Untreated UTIs

If a bacterial UTI is left untreated, the causative organisms can ascend the ureter without being washed out, leading to pyelonephritis (kidney infection). At least 20% to 40% of women with asymptomatic bacteriuria will develop pyelonephritis. However, with appropriate treatment, the risk is reduced by 90%. This underscores the importance of pharmacists recommending physician visits in all cases of UTIs.

Nonprescription UTI Products

Several widely available nonprescription products promise relief of UTI symptoms. They include single-entity phenazopyridine products (e.g., Azo Standard) and a combination product containing methenamine and sodium salicylate (e.g., Cystex). Pharmacists may justifiably ask whether these products are safe and effective when used by a patient with a UTI who does not plan to see a physician for a prescription antibiotic or antibacterial.

The FDA’s Stance on Phenazopyridine

In 1983, the FDA published a Drug Efficacy Study Implementation (DESI) notice with conditions for approval and marketing of all phenazopyridine products. This included single-entity phenazopyridine products and combination products containing phenazopyridine. The FDA presented newly required statements for all phenazopyridine products intended to relieve symptoms associated with a UTI, including a critical statement about the length of dosing: “Treatment of a urinary tract infection with phenazopyridine HCl or a combination drug product containing phenazopyridine HCl should not exceed 2 days because there is a lack of evidence that the combined administration of phenazopyridine HCl and an antibacterial provides greater benefit than administration of the anti-bacterial alone after 2 days.”

Carcinogenicity Concerns with Phenazopyridine

The FDA also required a carcinogenicity statement on all phenazopyridine labels: “Long-term administration of phenazopyridine hydrochloride has induced neoplasia in rats (large intestine) and mice (liver). Although no association between phenazopyridine hydrochloride and human neoplasia has been reported, adequate epidemiological studies along these lines have not been conducted.”

The Puzzling Dual Marketing of Phenazopyridine

The 1983 DESI document did not refer specifically to the safety and efficacy of OTC single-entity phenazopyridine products. However, in 2003, the FDA did request data on the safety and efficacy of all nonprescription urinary antiseptics/analgesics, including phenazopyridine. The agency attempted to explain the seemingly incongruous situation of why tablets containing 95 and 97.5 mg of phenazopyridine are available without prescription, while tablets containing 100 mg are prescription-only. The FDA pointed out that the ingredient’s extensive U.S. marketing history as a nonprescription ingredient predated the 1951 Durham-Humphrey Amendment to the Food, Drug, and Cosmetic Act, which delineated the conditions that would require prescription status. On the basis of this marketing history alone, phenazopyridine was allowed to retain its nonprescription status for lower-dose formulations.

The Importance of Pharmacist Recommendations

Ultimately, the role of nonprescription products in treating UTIs is a complex issue. While these products may provide some symptomatic relief, they are not proven safe and effective for any nonprescription use at present. Pharmacists play a crucial role in recommending that patients with suspected UTIs seek medical attention and obtain a prescription antibiotic or antibacterial treatment, as untreated UTIs can lead to serious complications like pyelonephritis.

Urinary Tract Infections and the Role of Nonprescription Products

US Pharm. 2012;37(6):12-15.

For years, patients with urinary tract infections (UTIs)
have asked pharmacists what they can take without seeing a physician.
Several products promise relief of UTI symptoms and/or claim to have an
antibacterial effect that inhibits progression of the infection, but
they are not proven safe and effective for any nonprescription use at
present.

Patients and UTIs

UTIs are much more common among women than men.^1,2
Patients may ask the pharmacist about such symptoms as frequent and
intense urge to urinate, urethral or bladder burning, and pain during
urination.^3-5 In older patients and males, UTIs also cause
fatigue, shakiness, weakness, muscle aches, and pain in the abdomen.
Patients may notice cloudy, dark, or bloody urine that has an
objectionable odor. If infection reaches the kidneys or prostate, fever
is also common. Patients may complain of pain in the back or side (below
the ribs), as well as nausea and vomiting.

Untreated UTIs

If a bacterial UTI is untreated and the causative organisms ascend the ureter without being washed out, pyelonephritis (kidney infection) is possible.⁵ At least 20% to 40% of women with asymptomatic bacteriuria will develop pyelonephritis.⁶
With appropriate treatment, the risk is reduced by 90%. This
underscores the importance of pharmacists recommending physician visits
in all cases.

Nonprescription UTI Products

Several widely available nonprescription products promise
relief of UTI symptoms. They include single-entity phenazopyridine
products (e.g., Azo Standard) and a combination product containing
methenamine and sodium salicylate (e.g., Cystex).⁷
Pharmacists may justifiably ask whether these products are safe and
effective when used by a patient with a UTI who does not plan to see a
physician for a prescription antibiotic or antibacterial.

The Status of Phenazopyridine

In 1983, the FDA published a Drug Efficacy Study
Implementation (DESI) notice with conditions for approval and marketing
of all phenazopyridine products.⁷ These included
sulfameth-oxazole/phenazopyridine combinations (e.g., Azo Gantanol),
similar combination products, and single-entity phenazopyridine
products. (Phenazopyridine had traditionally been included in
sulfonamide combinations to provide relief of pain, burning, or urgency
caused by a sulfonamide-susceptible organism.) The FDA presented newly
required statements for all phenazopyridine products intended to relieve
symptoms associated with a UTI. One of the statements was critical in
determining the length of dosing: “Treatment of a urinary tract
infection with phenazopyridine HCl or a combination drug product
containing phenazopyridine HCl should not exceed 2 days because there is
a lack of evidence that the combined administration of phenazopyridine
HCl and an antibacterial provides greater benefit than administration of
the anti-bacterial alone after 2 days.”⁷

The FDA also required the following carcinogenicity
statement on all phenazopyridine labels: “Long-term administration of
phenazopyridine hydrochloride has induced neoplasia in rats (large
intestine) and mice (liver). Although no association between
phenazopyridine hydrochloride and human neoplasia has been reported,
adequate epidemiological studies along these lines have not been
conducted.”⁷

The 1983 document did not refer specifically to safety and efficacy of OTC single-entity phenazopyridine products.⁷ However, in 2003 the FDA did request data on safety and efficacy of all nonprescription urinary antiseptics/analgesics.⁸
This document discussed phenazopyridine in depth. The first issue the
agency reviewed was the strange dual marketing of the ingredient, a
situation that has long puzzled pharmacists. For decades,
phenazopyridine has been available as prescription single-entity 100 and
200 mg tablets (e.g., Pyridium), as well as in combinations, many of
which are no longer available (e.g., Azo Gantanol, Azo Gantrisin). The
core issue is why tablets containing 95 and 97.5 mg of phenazopyridine
are available without prescription, when tablets containing 100 mg are
prescription-only. In other words, how can the addition of a relatively
minor 2.5 mg cause a product to require a prescription? The FDA
attempted to explain this seemingly incongruous situation, pointing out
that the ingredient’s extensive U.S. marketing history as a
nonprescription ingredient predated the 1951 Durham-Humphrey Amendment
to the Food, Drug, and Cosmetic Act that delineated which conditions
would require prescription status. On the basis of this marketing
history alone, phenazopyridine was allowed to retain nonprescription
status, a situation that continues to this day.

The best known phenazopyridine nonprescription product is Azo Standard.⁹
Azo Standard contains 95 mg of phenazopyridine per tablet and Azo
Standard Maximum Strength contains 97.5 mg of phenazopyridine.¹⁰ The dosage of both is 2 tablets 3 times daily with or after meals as needed.

The FDA conducted an examination of nonprescription
phenazopyridine products prior to publication of the 2003 call for data,
reporting that one manufacturer did not place the required 1983
carcinogenesis warning on the outer package, but placed it on an insert
included in the package.⁸ In that case, a purchaser could not
be warned until after the product was bought and the tamper-proof
packaging destroyed. Should the purchaser subsequently decide against
using the product, his or her ability to return it for a refund would be
impaired.

The FDA addressed several questions to manufacturers
regarding the safety and efficacy of phenazopyridine in its 2003 call
for data⁸:

1. Is this condition (i.e., a UTI) appropriate for self-medication?

2. If the answer to the first question is yes, should the
product labeling mention the possible need for treatment with an
antibacterial drug also?

3. Is there a valid basis for having single-ingredient
prescription products with a 200 mg dosage and OTC products with a 190-
to 195-mg dosage? What data support these dosages? (Note that this
statement refers to the manufacturer-recommended dosages of 2 tablets of
Azo Standard, containing 95 mg per tablet, and 2 tablets of Azo
Standard Maximum Strength, containing 97.5 mg per tablet).

4-7. These items dealt with potential carcinogenicity. The
FDA asked whether any epidemiological studies since 1978 had addressed
the issue, whether the neoplasia findings were of sufficient concern to
restrict phenazopyridine to prescription status, and whether the
carcinogenicity label should be required to appear on the outer
packaging.

8. Provide updated safety data both from the literature and from adverse event reports for the last 20 years.⁸

Manufacturers Respond to the FDA

The FDA received at least three responses to its list of
phenazopyridine questions within a 6-month period. The Consumer
Healthcare Products Association (CHPA) asked the FDA to review
phenazopyridine, but completely sidestepped the issue of
carcinogenicity.¹¹ A submission from Polymedica
Pharmaceuticals (distributor of Azo Standard) asserted that urinary
discomfort should be self-treatable, and further argued against warning
patients on product labels that they may need a concomitant
antibacterial.¹² Polymedica also claimed that phenazopyridine
dosages of 190 to 195 mg are safe and effective, but did not submit
clinical dosage studies to support its assertions. Polymedica argued
against including any carcinogenesis statement. In short, the submission
was entirely laudatory about phenazopyridine, although it did not
report newly conducted clinical studies, as would have been required by
the FDA to establish safety and efficacy.

A brief submission from Johnson & Johnson (marketers
of the now-discontinued Uristat, a nonprescription phenazopyridine
product) made essentially the same arguments as Polymedica, denying the
need for carcinogenicity labeling.¹³ This submission also failed to include new clinical studies providing evidence of safety and efficacy.

The Status of Methenamine Combination Products

The FDA’s 2003 request for data and information also
targeted a combination product containing methenamine, sodium
salicylate, salicylamide, and benzoic acid.⁸ The FDA
mentioned that the manufacturer would be required to make a new
submission, as the old one from the 1970s was badly outdated. The
product most closely resembling this combination at present is Cystex.⁹
Each tablet contains 162 mg of methenamine and 162.5 mg of sodium
salicylate, with benzoic acid listed as an inactive ingredient. The
dosage is 2 tablets with a full glass of water 4 times daily.¹⁴
None of these ingredients as dosed in the nonprescription product is
proven to be safe and effective at preventing or treating UTIs at the
present time.

Potential Misuse of Nonprescription UTI Products

The danger of carcinogenicity with phenazopyridine
apparently remains open. However, the FDA and the manufacturers
overlooked a far more likely scenario that could cause patient harm. If a
woman has a UTI, she should make an appointment with a physician to
receive the appropriate antibacterial/antimicrobial prescription. If she
unwisely chooses to take an OTC product as her sole treatment, she may
experience relief of discomfort and assume that she does not need to see
a doctor. By doing so, she avoids the trouble of providing a urine
specimen and saves the associated costs of a physician office visit
(e.g., income loss from taking time off from work). Should she fail to
obtain a prescription, her UTI may continue, worsening as the days pass
without effective treatment.

Manufacturers responsibly urge purchasers on product
labels to obtain a diagnosis and use the product only for relief while
they are waiting to see their physicians or for the prescription to
begin to work. The labels also warn against use for more than 2 days.
Despite the presence of these warnings, research conducted by the
National Council on Patient Information and Education confirmed that
purchasers often disregard package labels.⁹ In this case, disregarding the label could lead to permanent kidney damage.⁶ Thus, the advice and assistance of the pharmacist is crucial when consumers request these products.

PATIENT INFORMATION

Types of UTIs

Many people refer to a urinary tract infection (UTI) as a
bladder or kidney infection, but it is more complicated than that. If
the infection occurs in the urine passage (urethra), it is known as urethritis. If it reaches the bladder, it is called cystitis. If the UTI moves to the kidney, it is known as pyelonephritis.

Are UTIs Serious?

Most UTIs are not serious if they are treated rapidly and
appropriately. But some can lead to dangerous problems, such as kidney
infections. You may lessen the risk of this by promptly seeing a
physician, getting your antibiotic/antimicrobial prescription filled,
and taking the medication exactly as directed to kill the organisms. If
you fail to do so, a kidney infection can occur and become chronic.
Chronic kidney infections can lead to permanent damage, such as scarring
of the kidneys, reduced kidney function, hypertension, and other
issues.

Nonprescription Products for UTIs

When you have a UTI, it is vital to make a doctor’s
appointment. You should never try to treat it on your own with home
remedies or nonprescription products. Some women purchase OTC products
without medical advice, such as those containing phenazopyridine (e.g.,
Azo Standard). Purchasers may believe that this ingredient alone can
cure the UTI. This is a common misconception, as the product may provide
only temporary relief of symptoms (e.g., burning, pain, urgency,
frequency).

After obtaining this relief, a woman may decide that the
UTI is gone and that she does not need to see her physician after all.
This is a mistake. Phenazopyridine does not act to kill bacteria, so any
relief obtained is probably short-lived. The label warns against using
the product for more than 2 days, and advises seeing a physician if
symptoms last more than 2 days. Of course, the safest course of action
is to see a physician first, and ask whether this product should be used
along with the antibiotic/antibacterial prescription product. Further,
no herbal product or dietary supplement is proven safe or effective for
preventing or treating a UTI.

Home Remedies

Some women attempt to prevent UTIs by drinking cranberry
juice. Cranberry juice is not proven medically to prevent UTIs. Neither
are cranberry tablets

(e.g., Azo Cranberry). A more dangerous practice is to rely on
cranberry juice to treat a UTI. Cranberry juice has no proven
antibiotic/antibacterial activity that would eradicate an existing UTI.
As described above, a physician visit is mandatory.

Preventing UTIs

There are some commonsense steps you can take to prevent
UTIs. Drink plenty of water every day. Urinate whenever you feel the
slightest urge and never try to hold it in. Urinate right after sexual
intercourse, as organisms can move from the bowel or vagina to the
urethral opening. If you have recurrent UTIs, switch to a different
method of birth control. Condoms, spermicides, and diaphragms may be
more conducive to the development of UTIs.

Remember, if you have questions, Consult Your Pharmacist.

REFERENCES

1. French L, Phelps K, Pothula NR, Mushkbar S. Urinary problems in women. Prim Care Clin Office Pract. 2009;36:53-71.

2. Drekonja DM, Johnson JR. Urinary tract infections. Prim Care Clin Office Pract. 2008;35:345-367.

3. Urinary tract infections in adults. National Kidney and
Urologic Diseases Information Clearinghouse.
http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult. Accessed April 29,
2012.

4. Urinary tract infections. MedlinePlus. www.nlm.nih.gov/medlineplus/urinarytractinfections.html. Accessed April 29, 2012.

5. Dielubanza EJ, Schaeffer AJ. Urinary tract infections in women. Med Clin North Am. 2011;95:27-41.

6. Thomas AA, Thomas AZ, Campbell SC, Palmer JS. Urologic emergencies in pregnancy. Urology. 2010;76:453-460.

7. Human drugs: combination drug containing
sulfamethoxazole and phenazopyridine hydrochloride and related
combination drugs; drug efficacy study implementation; conditions for
approval and marketing phenazopyridine-containing drug products;
labeling requirements. Fed Regist. 1983;48:34516-34519.

8. Over-the-counter drug products; safety and efficacy review. Fed Regist. 2003;68:75585-75591.

9. Submission of the National Council on Patient
Information and Education (NCPIE) to the Food and Drug Administration’s
Nonprescription Drug Advisory Committee (risks of acetaminophen).
September 19-20, 2002.
www.fda.gov/ohrms/dockets/ac/02/briefing/3882OPh2_03_NCPIE-Bullman.pdf.
Accessed April 29, 2012.

10. Azo Standard. i-Health, Inc. www.azoproducts.com/products/azo_standard_facts. Accessed April 29, 2012.

11. Totman LC. Consumer Healthcare Products Association
letter to FDA. Re: Docket No. 2003N-0539: over-the-counter drug
products; safety and efficacy review. June 28, 2004.
www.fda.gov/ohrms/dockets/dailys/04/july04/070704/03N-0539_emc-000003-01.pdf.
Accessed April 29, 2012.

12. Collins PL. Polymedica Pharmaceuticals letter to FDA.
Comments of Polymedica Pharmaceuticals on the request for data and
information on the over-the-counter use of phenazopyridine hydrochloride
as a urinary tract analgesic. Docket No. 2003N-0539. June 25, 2004.
www.fda.gov/ohrms/dockets/dailys/04/july04/070704/03N-0539_emc-000001-01.pdf.
Accessed April 29, 2012.

13. Latyszonek G. Johnson & Johnson letter to FDA. Re:
Docket No. 2003N-0539: over-the-counter drug products; safety and
efficacy; request for information on the OTC use of phenazopyridine HCl
as a urinary tract analgesic. June 24, 2004.
www.fda.gov/ohrms/dockets/dailys/04/June04/062804/03n-0539-c000005-01-vol4.pdf.
Accessed April 29, 2012.

14. Cystex. DSE Healthcare Solutions. www.cystex.com/Pages/About%20Cystex_v3. Accessed April 29, 2012.

15. Azo Test Strips. i-Health, Inc. www.azoproducts.com/products/azo_test_strips. Accessed May 1, 2012.

To comment on this article, contact [email protected].

phenazopyridine | Michigan Medicine

What is the most important information I should know about phenazopyridine?

You should not use phenazopyridine if you have kidney disease.

What is phenazopyridine?

Phenazopyridine is a pain reliever that affects the lower part of your urinary tract (bladder and urethra).

Phenazopyridine is used to treat urinary symptoms such as pain or burning, increased urination, and increased urge to urinate. These symptoms can be caused by infection, injury, surgery, catheter, or other conditions that irritate the bladder.

Phenazopyridine will treat urinary symptoms, but this medication will not treat a urinary tract infection.. Take any antibiotic that your doctor prescribes to treat an infection.

Phenazopyridine may also be used for purposes not listed in this medication guide.

What should I discuss with my health care provider before taking phenazopyridine?

You should not use phenazopyridine if you are allergic to it, or if you have kidney disease.

To make sure phenazopyridine is safe for you, tell your doctor if you have:

• liver disease;
• diabetes; or
• a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency.

FDA pregnancy category B. Phenazopyridine is not expected to harm an unborn baby. Do not use this medicine without a doctor’s advice if you are pregnant.

It is not known whether phenazopyridine passes into breast milk or if it could harm a nursing baby. Do not use this medicine without a doctor’s advice if you are breast-feeding a baby.

How should I take phenazopyridine?

Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Take phenazopyridine after meals.

Drink plenty of liquids while you are taking phenazopyridine.

Phenazopyridine will most likely darken the color of your urine to an orange or red color. This is a normal effect and is not harmful. Darkened urine may also cause stains to your underwear that may be permanent.

Phenazopyridine can also permanently stain soft contact lenses, and you should not wear them while taking this medicine.

Do not use phenazopyridine for longer than 2 days unless your doctor has told you to.

This medication can cause unusual results with urine tests. Tell any doctor who treats you that you are using phenazopyridine.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking phenazopyridine?

Do not use this medication while wearing soft contact lenses. Phenazopyridine can permanently discolor soft contact lenses.

What are the possible side effects of phenazopyridine?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using phenazopyridine and call your doctor at once if you have:

• little or no urinating;
• swelling, rapid weight gain;
• confusion, loss of appetite, pain in your side or lower back;
• fever, pale or yellowed skin, stomach pain, nausea and vomiting; or
• blue or purple appearance of your skin.

Common side effects may include:

• headache;
• dizziness; or
• upset stomach.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect phenazopyridine?

Other drugs may interact with phenazopyridine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

Your pharmacist can provide more information about phenazopyridine.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2021 Cerner Multum, Inc. Version: 3.05. Revision date: 4/24/2014.

Need Relief From Overactive Bladder Symptoms?

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If you have an overactive bladder, do not despair. There are FDA-approved treatments that can help control your symptoms.

People with overactive bladder have a bladder muscle that squeezes too often or squeezes without warning. This can lead to troubling urinary symptoms such as:

• The need to urinate too often (urinary frequency), which is defined as urinating eight or more times a day or two or more times at night (nocturia).
• The need to urinate immediately (urinary urgency).
• The involuntary leakage of urine as a result of the need to urinate immediately (urge urinary incontinence).

These symptoms affect more than 33 million Americans. Many people don’t seek treatment, possibly because they’re embarrassed or don’t know about treatment options. In the United States, 30 percent of men and 40 percent of women live with overactive bladder symptoms.

The good news is that there are therapies for these symptoms. They include oral medications, a patch or gel applied to the skin, the first over-the-counter (OTC) treatment for women with overactive bladder, and bladder injections for patients with more severe symptoms.

Causes

Some known causes of overactive bladder include neurological disorders, such as spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke. Often, however, the cause is unknown.

“Some conditions—such as urinary tract infection, early pregnancy, uncontrolled diabetes mellitus, prostate disease and bladder tumors—have symptoms similar to overactive bladder and should be excluded before a proper diagnosis can be made. Also, certain medications, especially diuretics, may cause overactive bladder symptoms,” says Suresh Kaul, M.D, M.P.H., a medical team leader for urology in FDA’s Division of Bone, Reproductive and Urologic Products.

The risk of overactive bladder increases with age. “This condition especially affects elderly women,” says Olivia Easley, M.D., a senior medical officer with the FDA Division.

Options for Consumers

There are several treatment options for overactive bladder that help the bladder muscle relax and stop it from contracting at the wrong times. Easley says that anticholinergics are a widely used class of medications for overactive bladder. These drugs contain oxybutynin, tolterodine, fesoterodine or solifenacin, and are believed to work by inhibiting involuntary bladder contractions.

Recently, FDA approved Myrbetriq (mirabegron), a medication that improves the bladder’s ability to store urine by relaxing the bladder muscle during filling. (Side effects of Myrbetriq include increased blood pressure and urinary tract infection. In certain situations, Myrbetriq may increase your chances of not being able to empty your bladder on your own, for example, if you are also taking other medicines to treat your overactive bladder.)

For women 18 and older, there’s also a patch, called Oxytrol for Women, that is applied to the skin every four days. This over-the-counter patch is available without a prescription and delivers oxybutynin. For men, an oxybutynin patch is available by prescription only and is called Oxytrol. (Side effects of the Oxytrol patch include skin irritation, sleepiness, dizziness, confusion, hallucination and blurry vision.)

For adults who cannot use or do not adequately respond to anticholinergics, there are Botox (onabotulinumtoxinA) injections. Botox is injected directly into the bladder muscle under local or general anesthesia in a doctor’s office using a small camera that enables the urologist to see the inside wall of the bladder.

Botox causes the bladder to relax, increasing its ability to store urine and reduce urinary incontinence. When the effects of Botox wear off, more injections can be given, but no sooner than three months from the last set of injections.

(Botox may cause serious side effects that can be life-threatening, including problems breathing or swallowing, and spread of toxin effects. These problems can happen hours, days, to weeks after an injection. Call your doctor or get medical help right away if you have any of these problems after treatment with Botox. Less serious side effects of Botox include urinary tract infections and inability to empty your bladder on your own.)

“There are many treatment options for patients with overactive bladder. Not every drug is right for every patient. Patients need to take the first step of seeking help from a health care professional to determine whether the symptoms they are experiencing are due to overactive bladder or another condition, and to decide which treatment is the best,” Easley adds.

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Urinary Tract Infection (UTI), When Your Child Has

 A urinary tract infection (UTI) is a bacterial infection in the urinary tract. The urinary tract is made up of the kidneys, ureters, bladder, and urethra. Children often get UTIs that affect the bladder. UTIs can be uncomfortable and painful. But with treatment, most children recover with no lasting effects.

What is the urinary tract?

The following body parts make up the urinary tract:

• Kidneys filter waste from the blood and make urine.
• Ureters carry urine from the kidneys to the bladder.
• The bladder stores urine.
• The urethra carries urine from the bladder to the outside of the body.

What causes a UTI?

Most UTIs are caused by bacteria that enter the urinary tract through the urethra. The urinary tracts of boys and girls are slightly different. The urethra is shorter in girls. This makes it easier for bacteria to enter. As a result, girls are more likely than boys to get UTIs.

What are the symptoms of a UTI?

• If your child has a UTI affecting the bladder (cystitis), symptoms can include:
  • Painful urination
  • Frequent urination
  • Urgent need to urinate
  • Blood in the urine
  • Daytime wetting or nighttime bedwetting when previously continent

• If your child has a UTI affecting the kidneys (pyelonephritis), symptoms are similar to those of a bladder infection. They can also include:
  • Fever
  • Belly (abdominal) pain
  • Upset stomach (nausea) and vomiting
  • Cloudy urine
  • Strong-smelling urine

How is a UTI diagnosed?

• The healthcare provider asks about your child’s symptoms and health history. Your child is examined.
• A lab test, such as a urinalysis, is done. For this test, a urine sample is needed. It is checked for bacteria and other signs of infection. The urine is also sent for a culture. This is a test that identifies what bacteria is growing in the urine. It can take 1 to 3 days to get results of a urine culture. If the provider thinks your child has a UTI, the provider will likely start treatment even before lab results come back.
• If your child has severe symptoms, other tests may be done. You’ll be told more about this, if needed.

How is a UTI treated?

• Symptoms of a UTI generally go away within 24 to 72 hours of starting treatment.
• The healthcare provider will prescribe antibiotics for your child. Make sure your child takes  all of the medicine, even if he or she starts feeling better. 
• You can do the following at home to ease your child’s symptoms:
  • Give your child over-the-counter (OTC) medicines, such as ibuprofen or acetaminophen, to manage pain and fever. Don’t give ibuprofen to a baby who is younger than 6 months old, or to a child who is dehydrated or constantly vomiting. Don’t give aspirin (or medicine that contains aspirin) to a child younger than age 19 unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder. It most often affects the brain and the liver.
  • Ask your provider about other medicines that can be prescribed to ease painful urination.
  • Give your child plenty of fluids to drink. Cranberry juice may help ease some pain symptoms.

• If a urine culture was done, make sure to get the results from the healthcare provider. Make an appointment to follow up about a week after your child has finished antibiotics.

When to call the healthcare provider

Call the healthcare provider if your child has any of these:

• Symptoms that don’t improve within  48 hours of starting treatment
• Fever, typically greater than 100.5 degrees, or as directed by your healthcare provider
• A fever that goes away but returns after starting treatment
• Increased belly or back pain
• Signs of fluid loss (dehydration, such as very dark or little urine, excessive thirst, dry mouth, or dizziness
• Vomiting or inability to tolerate prescribed antibiotics
• Child begins acting sicker

How is a UTI prevented?

• Encourage your child to drink plenty of fluids.
• Encourage your child to empty the bladder all the way when urinating.
• Teach girls to wipe from the front to back when using the bathroom.
• Don’t use bubble bath.
• Don’t allow your child to become constipated.
• If your child has a UTI, he or she may need ultrasound imaging of the kidneys and bladder. This helps the healthcare provider rule out possible anatomical problems that could cause a UTI. If problems are found, or if your child has repeated UTIs, more imaging tests may be helpful.

StayWell last reviewed this educational content on 6/1/2019

© 2000-2020 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Urinary Tract Infections in Children

Topic Overview

Is this topic for you?

This topic is about urinary tract infections in children. For information about these infections in teens and adults, see the topic Urinary Tract Infections in Teens and Adults.

What are urinary tract infections?

The urinary tract is the part of the body that makes urine and carries it out of the body. It includes the bladder and kidneys and the tubes that connect them. When germs (called bacteria) get into the urinary tract, they can cause an infection.

How serious are the infections in children?

Urinary infections in children usually go away quickly if they get medical care right away. But if your child keeps getting infections, your doctor may suggest tests to rule out more serious problems.

Urinary infections can lead to a serious infection throughout the body called sepsis. Problems from a urinary infection are more likely to happen in babies born too soon, in newborns, and in infants who have something blocking the flow of urine.

What causes the infections in children?

Germs that live in the large intestine and are in stool can get in the urethra. This is the tube that carries urine from the bladder to the outside of the body. Then germs can get into the bladder and kidneys.

What are the symptoms?

Babies and young children may not have the most common symptoms, such as pain or burning when they urinate. Also, they can’t tell you what they feel. In a baby or a young child, look for:

• A fever not caused by the flu or another known illness.
• Urine that has a strange smell.
• Vomiting.
• The child not being hungry.
• The child acting fussy.

Older children are more likely to have common symptoms, such as:

• Pain or burning when they urinate.
• Needing to urinate often.
• Loss of bladder control.
• Red, pink, cloudy, or foul-smelling urine.
• Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
• Lower belly pain.

How are the infections diagnosed?

The doctor will give your child a physical examination and ask about his or her symptoms. Your child also will have lab tests, such as a urinalysis and a urine culture, to check for germs in the urine. It takes 1 to 2 days to get the results of a urine culture, so many doctors will prescribe medicine to fight the infection without waiting for the results. This is because a child’s symptoms and the urinalysis may be enough to show an infection.

After your child gets better, the doctor may have him or her tested to find out if there is a problem with the urinary tract. For example, urine might flow backward from the bladder into the kidneys. Problems like this can make a child more likely to get an infection in the bladder or kidneys.

How are they treated?

Your child will take antibiotics for a urinary tract infection. Give this medicine to your child as your doctor says. Do not stop it just because your child feels better. He or she needs to take all the medicine to get better. The number of days a child will need to take the medicine depends on the illness, the child’s age, and the type of antibiotic.

Have your child drink extra fluids to flush out the germs. Remind your older child to go to the bathroom often and to empty the bladder each time.

Call the doctor if your child isn’t feeling better within 2 days after starting the medicine. Your doctor may give your child a different medicine. It is important to treat urinary infections quickly in children to prevent other serious health problems. Sometimes a baby younger than 3 months may need to get medicine through a vein (IV) and stay in the hospital for a while. A child who is too sick to take medicine by mouth or has trouble fighting infections also may need to stay in the hospital.

Cause

Most urinary tract infections (UTIs) in children are caused by bacteria that enter the urethra and travel up the urinary tract. Bacteria that normally live in the large intestine and are present in stool (feces) are the most common cause of infection. Sometimes bacteria travelling through the blood or lymph system to the urinary tract are the cause of kidney or bladder infections.

The ways that bacteria buildup can occur include:

• Not properly wiping the bottom after a bowel movement. Bacteria may get into the urethra and cause a UTI.
• Constipation.
• Not completely emptying the bladder. This can cause bacteria to build up in urine.

Problems with the structure or function of the urinary tract commonly contribute to UTIs in infants and young children. Problems that limit the body’s ability to eliminate urine completely include:

Symptoms

Urinary tract infections (UTIs) in children may not cause obvious urinary symptoms. Symptoms of a UTI in an infant or young child may include:

• Fever. This may be the only symptom in infants.
• Irritability.
• Lack of appetite.
• Failure to gain weight or develop normally.
• Foul-smelling urine.
• Crying during urination.
• Vomiting or diarrhea.

In an older child with a UTI, symptoms are usually easier to recognize and may include:

• Pain or burning when urinating.
• Urge to urinate frequently but usually passing only small amounts of urine.
• Loss of bladder control, new Bedwetting, or other changes in urination habits.
• Pain in the lower abdomen.
• Reddish, pinkish, or cloudy urine.
• Foul-smelling urine.
• Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.

A doctor’s evaluation can determine whether a UTI or another condition is causing your child’s symptoms.

What Happens

In a urinary tract infection (UTI), bacteria usually enter the urinary tract through the urethra. They may then travel up the urinary tract and infect the bladder (cystitis) and the kidneys (pyelonephritis). Most UTIs in children clear up quickly with proper antibiotic treatment.

The biggest concern over UTIs in children is that they can cause permanent kidney damage and scarring. Repeated scarring can lead to high blood pressure and reduced kidney function, including kidney failure. Infants and young children seem to be at higher risk for this complication.

The risk of irreversible kidney damage makes early medical evaluation and treatment of UTIs in infants and young children very important. Unfortunately, detecting UTIs in infants and young children can be difficult. Unlike symptoms in older children and adults, symptoms in the very young can be vague and inconsistent.

Serious short-term complications of UTIs are unusual but do occur. They include an abscess in the urinary tract, acute kidney injury, and widespread infection (sepsis), which can be life-threatening. These complications are more likely in premature infants and newborns and in infants with urinary tract obstructions.

Recurrent UTIs

Infants and young children often get another UTI during the months after their first UTI. If an infection comes back (recurs), it usually happens within the same year as the first UTI.

Recurrent UTIs in a child can mean that there is a problem with the structure or function of the urinary tract. Because repeated infections increase the risk of permanent kidney damage, your child’s doctor will evaluate and monitor any structural or functional problems. In some cases, your child may need surgery.

What Increases Your Risk

Risk factors (things that increase a child’s risk) of urinary tract infection (UTI) include:

• Abnormalities of the urinary tract, including kidney stones and other urinary obstructions. Structural or functional problems that limit the kidneys’ or the bladder’s ability to eliminate urine properly can increase the risk of UTIs. These problems may be present at birth or may develop soon after.
• Infrequent urination, incomplete emptying of the bladder, or constipation. These patterns are common during toilet training and make it easier for bacteria to build up in the urine.
• An uncircumcised penis. The foreskin can trap bacteria, which can then enter the urinary tract and cause infection.
• Catheterization, which is used in a hospital when a child is unable to urinate on his or her own. Bacteria can enter the catheter and start an infection.
• Previous UTIs. The risk for future infections increases with each additional infection.
• History of UTI or the backward flow of urine from the bladder into the kidneys (vesicoureteral reflux) in a parent or sibling.

Infants and young children who have UTIs often have vesicoureteral reflux (VUR).

When should you call your doctor?

Urinary tract infections (UTI) in infants and young children need early evaluation and treatment. Call your doctor to make an appointment within 24 hours if your child has:

• Unexplained fever.
• Vomiting.
• Urine that looks pink, red, brown, or cloudy or is foul-smelling.
• Burning pain with urination.
• Frequent need to urinate without being able to pass much urine.
• Pain in the flank, which is felt just below the rib cage and above the waist on one or both sides of the back.
• Vaginal discharge with urinary symptoms.
• Symptoms similar to those of a previous UTI.

Call the doctor if your child isn’t feeling better within 48 hours after starting an antibiotic.

Watchful waiting

Watchful waiting is not appropriate if you suspect your child has a urinary tract infection. Untreated UTIs in children can lead to permanent kidney damage, high blood pressure, and other serious complications.

Who to see

Your family doctor, general practitioner, or your child’s pediatrician can diagnose and treat urinary tract infections (UTIs) in children. Your child may be referred to a urologist for follow-up.

Examinations and Tests

Initial tests

If your child has symptoms of a urinary tract infection (UTI), the doctor’s first evaluation will probably include:

• A medical history and physical examination.
• Urinalysis, which measures different parts of urine to help detect a UTI.
• Urine culture, which identifies the bacteria that are causing a UTI.

If the doctor suspects that your child has a UTI, a urinalysis will help point to a diagnosis. A urine culture can confirm the diagnosis and identify what is causing the infection. But the results usually are not available for a couple of days. Rather than delay treatment to wait for the results of the urine culture, the doctor probably will start your child on antibiotics if your child’s symptoms, history, and urinalysis show that a UTI is likely.

A urine sample will be collected.

• Older children may urinate into a container.
• In babies and young children, the doctor may:
  • Insert a catheter through the urethra and into the bladder to collect urine.
  • Collect urine by attaching a bag around the child’s genitals until the child urinates. The risk of having other substances get into (contaminate) the urine sample is extremely high with this method.
  • Insert a needle through the abdomen directly into the bladder (suprapubic aspiration) to get the sample.

If your child is younger than 2 years, has a UTI, and has a fever, your doctor may order a kidney and bladder ultrasound test.

The doctor may do other tests if your child has a UTI and:

• Does not improve after 4 days of medicine.
• Has a known abnormality of the urinary tract or a history of certain kidney or bladder problems that could make the infection harder to treat.
• May be infected with unusual bacteria that won’t respond to the usual treatment.
• Shows signs of kidney injury.

Other tests

Other common tests include:

• Kidney (renal) ultrasound. The doctor may order a renal ultrasound or may review a fetal ultrasound that was done during the mother’s third trimester of pregnancy, if available.
• Cystourethrogram, also called a voiding cystourethrogram (VCUG). This is an X-ray test that takes pictures of your child’s bladder and urethra during urination.

If an ultrasound shows problems, then a VCUG may be done. VCUG can identify vesicoureteral reflux, abnormalities of the urinary tract, and other conditions that may make your child more prone to kidney infections. If the test finds any of these conditions, the doctor can watch and give preventive treatment, if needed, to your child.

The doctor may do a kidney scan (renal scintigram) to evaluate persistent kidney infection or to evaluate kidney scarring or damage caused by previous infection.

Treatment Overview

Antibiotic medicine and home care are effective in treating most urinary tract infections (UTIs) in infants and children. The main goal of treatment is to prevent kidney damage and its short-term and long-term complications by eliminating the infection quickly and completely. Early evaluation and treatment are very important. Do not delay calling a doctor if you think your baby or young child may have a UTI.

Initial treatment

Infants and young children with urinary tract infections (UTIs) need early treatment to prevent kidney damage. Your doctor is likely to base the first treatment decision on your child’s symptoms and urinalysis results rather than waiting for the results of a urine culture.

Treatment for most children with UTIs is oral antibiotics and home care.

If your child is younger than 3 months, is too nauseated or sick to take oral medicines, or has an impaired immune system, the doctor may give your child a shot of antibiotics. Or your child may need a brief hospital stay and a short course of intravenous (IV) antibiotics. After your child’s fever and other symptoms improve and your child is feeling better, the doctor may prescribe oral antibiotics.

The number of days a child will need to take these medicines depends on the illness, the child’s age, and the type of antibiotic.

Treatment if the condition gets worse or recurs

If your child’s urinary tract infection (UTI) does not improve after treatment with antibiotics, your child needs further evaluation and may need more antibiotics. Your child may have a structural problem that is making the infection hard to treat. Or the cause of the infection may be different from the types of bacteria that usually cause UTIs.

If the infection spreads and affects kidney function or causes widespread infection (sepsis), your child may be hospitalized. These complications are rare, but they can be very serious. Children with impaired immune systems, untreated urinary tract obstructions, and other conditions that affect the kidneys or bladder are at higher risk for complications.

If tests show a structural problem in the urinary tract (such as vesicoureteral reflux) that increases your child’s risk for recurrent UTIs, the doctor may consider preventive antibiotics.

Prevention

Urinary tract infections (UTIs) are hard to prevent in children who seem to get them easily. The doctor may prescribe antibiotics to prevent repeat infection while waiting for test results after your child’s first UTI. If test results show abnormalities of the urinary tract that raise the risk for repeat infections, the doctor may recommend long-term antibiotic treatment.

Some evidence suggests that breastfeeding may help prevent UTIs during the first 6 months of life.^{footnote 1, footnote 2}

After learning to use the toilet, some children may not empty their bladders often enough. Without regular bladder emptying, which flushes out the germs in urine, children may be more likely to get a UTI. Encourage a schedule of bladder emptying to help lower this risk.

Babies younger than 4 months get all the fluids they need from breast milk or formula. But for older children, extra fluids may help. Offer your child drinks (such as water) throughout the day. Drinking enough fluids fills the bladder and can help your child empty the bladder more often.

Constipation can also put a child at risk of a UTI. Regular toileting habits and a non-constipating diet are the best ways to prevent constipation. For more information, see the topics Constipation, Age 11 and Younger and Constipation, Age 12 and Older.

Early diagnosis and early treatment are the most important steps in preventing UTI-caused kidney damage.

Home Treatment

Home care isn’t a substitute for medical care when it comes to treating a urinary tract infection (UTI). If you think your child may have a UTI, a doctor should see him or her right away.

But along with seeing the doctor, there are things you can do at home that may help your child.

• Encourage—but do not force—your child to drink extra fluids as soon as you notice the symptoms and for the next 24 hours. This will help make the urine less concentrated and wash out the infection-causing bacteria. Do not give your child caffeinated or carbonated beverages, which can irritate the bladder.
• Encourage your child to urinate often and to empty his or her bladder each time.

Note: Remember that home treatment is not a substitute for professional care and evaluation. If you think your child may have a UTI, a doctor should see him or her right away.

Medications

Oral antibiotic medicine usually is effective in treating urinary tract infections (UTIs). In many cases, if the symptoms and urinalysis suggest a UTI, the doctor will start medicine without waiting for the results of a urine culture.

The doctor may give intravenous (IV) antibiotics if your baby is:

• Younger than 3 months.
• Too ill or nauseated to take oral medicine.
• Very sick with a severe kidney infection.

The doctor will stop the IV medicine and begin oral medicine treatment after your child is stabilized and feeling better.

Preventive antibiotics

The doctor may consider preventive antibiotics if tests show a structural problem in the urinary tract, such as vesicoureteral reflux, that increases the child’s risk for recurrent UTIs.

Preventive treatment may last 3 months or longer. Some doctors are more hesitant about prescribing antibiotics for long-term use because of increasing concern about the growth of antibiotic-resistant bacteria.

Medication choices

Antibiotics are used to kill the bacteria that cause UTIs.

What to think about

Give your child the antibiotics as directed. Do not stop using them just because your child feels better. Your child needs to take the full course of medicine. Your child may begin to feel better soon after starting the medicine. But if you stop giving your child the medicine too soon, the infection may return or get worse. Also, not taking the full course of medicine encourages the development of bacteria that are resistant to antibiotics. This makes antibiotics less effective and future bacterial infections harder to treat.

Surgery

Surgery is not used to treat urinary tract infections (UTIs) in children.

If there is a problem with the structure of the urinary tract that is causing frequent, severe infections and increasing the child’s risk of long-term complications, the doctor may consider surgery to correct the problem. For instance, children with severe vesicoureteral reflux may benefit from surgery. For more information, see the topic Vesicoureteral Reflux (VUR).

Other Treatment

There is no other treatment for urinary tract infections (UTIs) in children at this time.

References

Citations

1. Shortliffe LMD (2012). Infection and inflammation of the pediatric genitourinary tract. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 4, pp. 3085–3122. Philadelphia: Saunders.
2. Elder JS (2011). Urinary tract infections. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1829–1834. Philadelphia: Saunders Elsevier.

Other Works Consulted

• Hannula A, et al. (2012). Long-term follow-up of patients after childhood urinary tract infection. Archives of Pediatric and Adolescent Medicine, 166(12): 1117–1122. Also available online: http://archpedi.jamanetwork.com/article.aspx?articleid=1378179.
• Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3): 595–610. DOI: 10.1542/peds.2011-1330. Accessed June 9, 2016.

Credits

Current as of:
August 22, 2019

Author: Healthwise Staff
Medical Review:
John Pope MD – Pediatrics
Thomas M. Bailey MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Avery L. Seifert MD – Urology
Susan C. Kim MD – Pediatrics

Supplements for Incontinence | Incontinence Institute

You take a multivitamin and maybe calcium or Vitamin D for your bones – but do you take anything for incontinence? Is that even possible?

If you are trying to live a more natural lifestyle, you are probably familiar with various vitamins and supplements. Millions of Americans take vitamins and supplements, from Vitamin C to ward off colds in the winter to melatonin to help them sleep. However, it is important to note that almost all vitamins and supplements are not tested or approved by the Food & Drug Administration (FDA).

The FDA states, “According to the American Academy of Family Physicians (AAFP), a doctor may recommend that you take them for certain health problems, if you eat a vegetarian or vegan diet, or if you are pregnant or breastfeeding.” The FDA continues, “The 2005 Dietary Guidelines for Americans advises that nutrient needs be met primarily through consuming foods, with supplementation suggested for certain sensitive populations.”

The FDA’s main gripe with over-the-counter vitamins and supplements is that many of them can interact with other medications including prescription medication. It can also be harmful to take many of the same supplement. Many people do get enough vitamins through a healthy diet, and certainly that is what’s recommended. But for targeting specific conditions or areas, there are vitamins and supplements available. It is vital, though, to speak with your physician before starting a vitamin regimen. You need to ensure that nothing will interact with your current medications.

Vitamin D

Recent studies found that women over the age of 20 with normal vitamin D ranges were much less likely to suffer from a pelvic floor disorder, like incontinence. If you suffer from a pelvic floor disorder it may be time to check your vitamin D levels through a simple blood test.

Gosha-jinki-gan

This is a Japanese blend of different herbs. It is actually one of the most-studied herbs used in treatment for overactive bladder syndrome. A study found that, “Gosha-jinki-gan could be a safe and effective potential therapeutic alternative in females with overactive bladder.” Another study said that its results “suggest that Gosha-jinki-gan inhibits bladder activity by maintaining the balance of the sympathetic and parasympathetic nervous systems at a low level.” This herb helps control overactive bladder symptoms by helping balance the nervous system transmission from the brain telling the bladder it has to go so often.

Buchu

Buchu extract, or Barosma betulina, is a shrub native to South Africa. The dried leaves and supplements made from them have been used to treat urinary tract infections. It is thought that Buchu helps to promote urine flow, and overall health of the urinary tract. According to an article in Reviews in Urology, no clinical trials have been done regarding Buchu and overactive bladder.

Cornsilk

Cornsilk is the fibers at the top of an ear of corn. In supplement or tea form, cornsilk has been used to treat bladder infections and prostate inflammation. It is thought to soothe the urinary tract, and was even used by the ancient Incas. There are no clinical studies on the effect of cornsilk and urinary incontinence or irritation.

Saw palmetto

Saw palmetto is a palm that grows in the southern United States. Its berries were used by Native Americans for their medicinal properties. Saw palmetto supplements are used to treat benign prostate hyperplasia (enlarged prostate) in men. This condition can lead to excessive urination, or only partial emptying of the bladder. Saw palmetto has been studied – a large analysis of multiple studies concluded that saw palmetto produced a similar benefit to finasteride, a drug for enlarged prostate, and was better-tolerated. Saw palmetto may also boost the quality of life for men with enlarged prostate.

Magnesium

Magnesium is important for proper muscle and nerve function. Some doctors believe better magnesium levels can reduce bladder spasms, a common cause of incontinence. Magnesium levels can be checked through a blood test at your next doctor’s visit.

Ganoderma lucidum

This mushroom has been used in Chinese medicine for over 2,000 years. Recently, a Japanese study showed that ganoderma lucidum helped people with urge incontinence after eight weeks of use. Why? The mushroom lowers the hormone levels associated with prostate growth, a lead cause of overflow incontinence in men.

Urinary Incontinence in Middle Tennessee

If you are suffering from urinary incontinence, overactive bladder syndrome, or enlarged prostate, it may be worth it to try natural supplements. Of course, you need to consult your physician before starting vitamins or supplements, to ensure they will not react with your medications or have any adverse effects. If you live around Nashville, Tennessee our team of expert physicians would love to help. Contact our discreet, dedicated Medical Concierge by phone or private message today.

Interstitial Cystitis | Condition | UT Southwestern Medical Center

Interstitial cystitis is a chronic inflammation of the bladder.

As your bladder fills with urine and expands, nerve endings send signals to your brain that it’s time to urinate. With interstitial cystitis, these signals are sent to the brain even though your bladder is not full. Thus, people feel the need to urinate small amounts more often.

Symptoms of Interstitial Cystitis

• A persistent, urgent need to urinate
• Pelvic pain
• Bladder pain
• Pain during sexual intercourse

Interstitial cystitis is often misdiagnosed as chronic urinary tract infection, but with interstitial cystitis, urine cultures are free of bacteria.

Treatments for Interstitial Cystitis

There is no single treatment for interstitial cystitis, and people respond to different treatments.  

Oral medications

Oral medications that may relieve symptoms include:

• Ibuprofen (Advil, Motrin, others), naproxen (Aleve, Anaprox), and other nonsteroidal anti-inflammatory drugs to relieve pain
• Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax the bladder and block pain
• Antihistamines, such as diphenhydramine (Benadryl, others) and loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms

Nerve Stimulation

Transcutaneous electrical nerve stimulation (TENS) uses mild electrical pulses to increase blood flow to the bladder, which may strengthen the bladder muscles and block pain.

Bladder Distention

Bladder distention is the stretching of the bladder with water or gas. The procedure may be repeated if the response is long lasting.

Bladder Instillation

In bladder instillation, dimethyl sulfoxide – or DMSO (Rimso-50) – is placed into your bladder through a catheter inserted through the urethra. After 15 minutes, the solution exits the body through urination. This procedure may reduce inflammation and possibly prevent muscle contractions that cause frequency, urgency, and pain.

90,000 Frequent urination in women without pain: frequent urge, frequent nighttime urination

In healthy women, the frequency of urination is 6-10 times a day. An increase in the number of urges is not always a pathology. For example, when drinking alcoholic beverages, coffee, drugs that have a diuretic effect, the number of trips to the toilet may increase. However, in some cases, frequent urination in women without pain is a symptom of a number of medical conditions.

If you notice a similar symptom in yourself, seek advice from the doctors of the clinic “Promedika”.We will carry out a thorough diagnosis and prescribe treatment that will help you eliminate the problem and improve your well-being.

Causes of frequent urination in women without pain

An increase in the number of urge to use the toilet can be physiological and pathological.

Physiological manifestations of the symptom do not require medical supervision. These include:

• pregnancy. In later stages, the uterus presses on the bladder. Because of this, the woman feels the feeling of his overflow more often than usual;

• active fluid intake.Thirst can be caused by active physical training, summer heat, etc.;

• high blood pressure. More blood enters the kidneys of hypertensive patients. This leads to an increase in filtration volume and excreted urine. The same thing happens with spasms caused by mild hypothermia or stress;

• hormonal changes. Frequent urination in older women without pain is due to the onset of menopause.At this time, the tone of the pelvic day decreases and urine may leak drop by drop.

Pathological changes require detailed diagnostics and qualified medical care.

What diseases cause frequent urination in women without pain?

• Overactive bladder. With this disease, the muscles of the organ begin to react even to a small accumulation of urine.

• Urolithiasis.It is accompanied by the formation of hard calculi. Intermittent urination is observed. When a stone comes out, blood may appear in the urine.

• Diabetes mellitus. Endocrine pathology, in which the level of glucose in the blood rises. It is also observed in urine, due to which its acidity changes. In diabetes mellitus, the volume of urine increases, which causes frequent urge to urinate in women without pain.

• Glomerulonephritis.When the glomerular apparatus of the kidneys is damaged, edema, an increase in blood pressure, and an increase in the number of urges to urinate occur.

• Prolapse of the uterus. Occurs with late or traumatic childbirth. The displaced organ presses on the bladder, which causes frequent urge to urinate in women without pain.

• Tumors of benign or malignant nature.

• Myoma of the uterus.The increase in urge is due to the anatomical relationship of the bladder and uterus. With fibroids, its size increases, which is why the number of urges to the toilet becomes more.

• Endometriosis. It is an overgrowth of the endometrium in all directions, including towards the bladder. Excessive pressure may increase the number of urges to urinate.

Features of frequent urination in women without pain

Doctors distinguish:

• pollakiuria.This condition is characterized by an increase in the number of urges during the daytime;

• nocturia. Represents frequent nighttime urination in women without pain.

When a symptom appears, it is important to analyze all the circumstances of its occurrence. To establish an accurate clinical picture, you may also need:

• reception of a gynecologist;

• reception of an endocrinologist;

• reception of an oncologist.

Diagnosis of diseases accompanied by frequent urination in women without pain

When discomfort appears, it is important to visit a doctor in a timely manner and tell him in detail about all the symptoms. To clarify the clinical picture, you will be assigned:

• general analyzes of urine and blood. They help to identify the presence of inflammation;

• urine tests according to Nechiporenko and Zimnitsky;

• smears for genital infections;

• Ultrasound of the small pelvis.Visual examination, which helps to assess the general condition of the organs of the genitourinary system. The procedure is usually performed abdominal.

The list of studies can be supplemented at the discretion of the attending physician of the Promedika center.

Treatment of diseases in which the frequency of urination increases without pain

The tactics of therapy directly depends on the diagnostic results. Doctors of the center “Promedica” prescribe only effective methods of treatment and their combinations.For example, we perform surgical procedures for our patients, prescribe antibiotics, hormonal drugs, anti-inflammatory drugs, as well as a course of physiotherapy.

Where to go if the number of urge to urinate in women increases?

If you notice discomfort and an increase in the number to urinate, make an appointment with a urologist at the Promedika center in Belgorod. According to patients’ reviews, we managed to create a comfortable and trusting atmosphere in the clinic.We will establish the cause of the symptom and, in the presence of pathology, prescribe treatment. Strict adherence to the doctor’s recommendations will help you to get rid of discomfort, improve the quality of your own life, and also avoid complications.

Still have questions? To clarify the price of admission and make an appointment with a doctor, contact our administrator in a convenient way.

90,000 Frequent urination (pollakiuria)

Pollakiuria is a symptom characterized by urination more often than the established average rate (5-6 times a day, of which 1 time may occur during nighttime urination).However, it should be borne in mind that the volume of fluid you drink has a direct effect on this figure. Frequent urination can be as small (about 30-50ml) as normal portions (about 150-200ml).

Frequent urination does not always characterize a urological problem, for example, diabetes mellitus / diabetes insipidus is also accompanied by an increase in the volume and frequency of urination.

Reasons

• Inflammatory diseases of the genitourinary system.Acute cystitis is an inflammatory disease of the bladder of infectious origin, which is characterized by frequent, small portions, of varying intensity, often painful urination, regardless of the time of day. The main risk group for this disease is women. Acute prostatitis is an inflammatory disease of the prostate of an infectious origin, most characteristic of men of reproductive age.
• Urolithiasis Frequent urination is characteristic when a stone is located in the lower third of the ureter, while you may experience unpleasant painful sensations on the corresponding side of the abdomen, which can spread to the genitals, inner thigh.
• BPH (benign prostatic hyperplasia) or prostate adenoma is a disease characterized by nocturnal pollakiuria, that is, an increase in the frequency of urination per night (up to 5-6 times) in small portions. In addition, due to a violation of the outflow of urine by an enlarged prostate, the formation of bladder stones is possible, which irritate the neck of the organ, thereby provoking an increased urge.

Diagnostics

If you experience frequent urination, you need to contact a urologist who will offer you to perform the following laboratory and diagnostic tests:

• General urinalysis
• Antibiotic susceptibility urine culture
• Ultrasound of the urinary system

+ for men:

• Prostate secretion culture
• Ultrasound of the prostate

In addition to instrumental examination methods, it is important for men to have a PSA blood test for the early diagnosis of prostate cancer, which can also cause frequent urination.

In case you have noted the appearance of this symptom, you can make an appointment at LDO No. 4 of the Urology Clinic of the First Moscow State Medical University named after I.M.Sechenov to our specialists:

Taratkin M.S.

R.E. Klimov

Inoyatov Zh.Sh.

O.V. Snurnitsyna

Causes and treatment of frequent urination in women and men

The author of the article: KMN, urologist-andrologist, UZDS specialist A.IN.
Work experience: 13 years

Published: 05-08-2020

Updated: 15-06-2021

According to experts, there are no exact standards for determining the normal frequency of urination. For different people, this frequency may not coincide. Moreover, in the same person, the need to urinate may vary.In a separate category, urinary incontinence in women, as well as stress urinary incontinence, should be distinguished. If the urge to go to the toilet is uncomfortable, then most likely we are talking about a symptom of some disease. Consider what ailments frequent urination can talk about.

Contents of article

1. Prices for services
2. Symptoms

Prices for services

Initial appointment with urologist FOR MEN + ultrasound of the prostate gland (assessment of complaints, taking anamnesis, if necessary, rectal digital examination, ultrasound of the prostate gland in men)

Initial appointment – a visit to a doctor of a specific specialty for the first time.Includes a conversation with the patient, initial examination, history taking, if necessary, rectal digital examination, ultrasound of the prostate gland.
The price is valid from 01.02.2021
The price is not valid for reception at the branches near metro station Bolshevikov and metro station Prosveshcheniya

To make an appointment

Initial visit to urologist FOR WOMEN + ultrasound (assessment of complaints, taking anamnesis, ultrasound of the bladder and kidneys)

Initial appointment – a visit to a doctor of a specific specialty for the first time.

To make an appointment

Initial reception of the head. Department of Urology Rylchikov I.V. + Ultrasound (includes a conversation with the patient, initial examination, history taking, if necessary, rectal digital examination, ultrasound of the prostate gland)

Initial appointment – a visit to a doctor of a specific specialty for the first time.

To make an appointment

Although there are no clear standards for the normal frequency of urination, there are still some boundaries. It is believed that the urge to use the toilet more than 10-15 times a day is too much. And yet, for some, a large figure will be the norm.

In each case, several conditions must be taken into account:

• Is there pain or burning sensation while urinating?

• Is frequent urination accompanied by constant urge?

• Is there a small amount of urine excreted when urinating?

• Do you have frequent urination despite a decrease in fluid intake or discontinuation of diuretics?

• Does it disrupt your usual life – interfere with travel, sleep, work?

• If the answer to one of the above questions is yes, then you need to see a doctor.

The most common cause of frequent urination is urinary tract infections. The infection irritates and destroys the genitourinary system, hence the frequent urge to use the toilet. Moreover, the sites of localization of the infection do not affect the appearance of the urge. Among these diseases, damage to the kidneys, bladder, urethra, vagina or prostate gland. In addition, infectious diseases with frequent urination can cause a burning sensation.

Frequent urination and increased volume of urine is a symptom of diabetes insipidus. This disease is the result of disturbances in the neuroendocrine system, namely, damage to the neurohypophysis (one of the brain regions). With diabetes insipidus, the body loses its ability to concentrate urine in the kidneys and loses huge amounts of fluid. Therefore, patients with diabetes insipidus are constantly thirsty and drink a lot.

Frequent urination is also one of the signs of diabetes mellitus: In addition to it, diabetes mellitus has dry mouth, increased thirst and appetite, weight loss, general weakness, fatigue, in girls – inflammation of the external genital organs (vulvitis).

Chronic kidney failure can cause excessive and frequent urination. During this disease, kidney cells die and kidney function is impaired, which causes frequent, in many cases, nocturnal urge to use the toilet.

Frequent urination may indicate kidney or bladder stones. The stones prevent the bladder from emptying completely. Urine accumulates faster and, accordingly, urination becomes more frequent.

Frequent urination at night may indicate an enlarged or swollen prostate gland.The reason is that an enlarged prostate interferes with the normal outflow of urine, it presses on the urethra, disrupting its patency. At night, when a man is in a supine position, he has frequent urge to use the toilet.

To make an appointment

Often, taking diuretics is the cause of frequent urination. Moreover, we are not always talking about medicines. Diuretics are caffeine and alcohol, which have a natural diuretic effect, causing the body to produce more urine than normal.One of the sugar substitutes, Newtrasweet, is one of the substances that cause false urge to urinate. Frequent urination can also develop while taking certain medications, for example, urotropine, diuretics.

Menopause is one of the causes of frequent urination. The fact is that during menopause, some violations of the activity of the ovaries occur. These changes are normal, just part of the age-related changes. As a result of transformations, the ovaries cease to produce estrogens and progesterones, the woman loses the ability to give birth.This factor can cause discomfort, both physical and psychological, but it can be temporary. More than 40% of menopausal women suffer from frequent urination.

Pregnancy in the first and third trimester causes frequent urge to use the toilet in women. This is due, firstly, to the increased volume of fluid in the body and the good functioning of the kidneys, which quickly get rid of harmful products. Secondly, by increasing the pressure of the uterus on the bladder. Frequent urination is normal in pregnancy.

Frequent urination – especially at night – can be a common consequence of a person’s aging process. In older people, the production of most of the urine in the body is carried over at night. Thus, 2/3 of the volume of urine is produced at night and 1/3 during the day.

Everyone knows the so-called “bear disease”, when the urge to urinate increases and becomes more frequent from excitement. This is due to the fact that in a state of stress or anxiety in the chain of nerve cells responsible for the need to empty the bladder, disorders can occur that lead to frequent urination.

If frequent urination does not cause pain, burning, or discomfort, then there is no cause for concern. However, if certain inconveniences arise, then it is best to consult a doctor without waiting for the deterioration of the condition.

Other articles by this author

Doctors

All doctors

90,000 reasons, treatment ◈ Elena Malysheva’s clinic in Izhevsk

Frequent urination is not a disease, but a symptom of many urogynecological pathologies.Normally, the number of daily visits to the toilet is five to ten times during the day and once or twice at night. At the same time, the woman does not experience unpleasant symptoms and does not lose control over the urination process. If the urge has become too frequent and bring obvious discomfort, this should be taken as a reason to contact a female urologist.

In what cases is frequent urination not considered a pathology?

Physiological increased frequency of urination is observed in the following cases:

• taking medications and drinking and diuretic products;
• hypothermia of the body;
• stressful situations: fear, excitement.

Increased urination is not considered a pathology also with hormonal changes during menopause. Pregnant women also feel urge to go to the toilet more often than usual. At the beginning of the term, this is associated with intense hormonal changes, at the end – with the pressure of the growing uterus on the bladder. All of these changes are not considered pathology. But it will not hurt to consult a specialist in these cases.

When is it recommended to see a doctor?

Pathological causes of frequent urination can be:

• Diseases of the urinary system – cystitis, urethritis, urolithiasis, pyelonephritis.They can be accompanied by high fever, burning sensation in the urethra, and abdominal pain.
• Gynecological pathologies. Urination may increase with the development of uterine fibroids and prolapse of this organ. In this case, a woman is often disturbed by profuse menstruation, pain in the lower abdomen, metrorrhagia (uterine bleeding).
• Endocrine diseases. Excretion of urine can increase up to two to three liters per day in diabetes. At the same time, strong thirst and itching of the skin often appear.
• Diseases of the heart and blood vessels.Such pathologies are often accompanied by nocturia – active excretion of urine at night.

If frequent urination becomes constant, causes discomfort and pain, be sure to consult a doctor to find out the causes of this condition.

How is the examination carried out?

Diagnosis and treatment of this pathology depends on its causes. To identify them, studies such as:

• general, clinical, biochemical blood test;
• general and detailed urinalysis;
• Ultrasound of the pelvic organs;
• smear from the urethra and vagina with suspected urogenital infections.

The listed studies can be assigned separately or selectively.

Treatment of frequent urination

Inflammatory diseases of the urinary system, which are accompanied by frequent urination, are treated by a urologist. After the diagnosis, the specialist can prescribe a specific drug treatment to eliminate inflammation, pain, discomfort. In some cases, physiotherapy can be used in addition.

If frequent urination is associated with pathologies of other systems, examination and treatment are carried out by specialists of a different profile, for example, a nephrologist, gynecologist, endocrinologist.If you do not know which doctor to sign up for at the first manifestations of this ailment, consult a therapist first.

The medical center employs highly qualified doctors with extensive experience in diagnosing and correcting such conditions. The clinic has all the necessary equipment for high-precision diagnostics of diseases that can lead to increased urination. If you are suffering from this problem, do not tolerate discomfort. Make an appointment with the center’s doctor in order to find the cause as soon as possible and start treatment with an experienced specialist.

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