Frequent urination in the elderly
Urine formed in the kidneys passes through the two ureters which pulsate to promote passage of urine to the urinary bladder. The normal daily volume of urine in the elderly is affected by factors like weight, amount and type of fluid intake, and medications. It is usually in the range of 1,000 to 1,500cc per day, and the capacity of the urinary bladder ranges from 400 to 750cc.
We normally urinate every three to four hours or about six to seven times a day.
When filled to its capacity, the bladder sends signals to the brain that it is full, and that it should be emptied. How often a person normally urinates is determined by factors like:
Drinking lots of fluids;
Intake of coffee and other caffeinated drinks, intake of alcoholic drinks;
Inflammation of the urinary bladder;
Tumor or mass in the urinary bladder;
Presence of stones in the urinary tract;
Inflammation of the urethra;
Intake of medications that promote diuresis like diuretics;
Reduced level of antidiuretic hormone in elderly;
Neurological problems like neurogenic bladder;
Weakening of the muscles in the urinary bladder; and
High intake of fluids and intake of caffeinated drinks like coffee, tea, soda and energy drinks and alcohol-containing drinks can cause frequent urination.
Urinary frequency is a common manifestation of the so-called lower urinary tract infection or inflammation which involves the ureters, the urinary bladder, and the final passageway of urine to the urethra.
Cystitis is inflammation of the urinary bladder due to infection or unknown causes.
Bladder infection is common in women. This is usually due to ascending infection from the lower genital tract through the urethra to the bladder.
It is less common in men but it usually starts with infection in the urethra that tra-vels to the prostate gland and to the bladder. Persistent infection of the prostate is the most common cause of recurring cystitis in men. In cystitis, there is a frequent urgent desire to empty the bladder and is usually accompanied by burning or painful sensation during urination. Frequent urination at night (nocturia) usually occurs.
Urine may appear cloudy and sometimes may contain blood. The bladder wall may also become inflamed even in the absence of infection. Interstitial cystitis is characterized by frequent painful urination, and cloudy or bloody urine. The bladder may eventually shrink. The cause is unknown.
The presence of a mass or a tumor in the bladder can reduce its capacity and can cause inflammation of the delicate lining of the bladder.
Passage of small stones in the ureters or their presence in the bladder are also a cause of urinary frequency.
Urethritis means inflammation of the urethra where urine passes from the bladder out of the body. It may be due to infection caused by virus, fungus, or bacteria. Urinary frequency may be accompanied by painful urination (dysuria).
If blood sugar is elevated (especially when it is more than 170 mg/dl), excess sugar spills from the blood to the urine. Sugar acts as an osmotic diuretic – it attracts water as it moves inside the tubules of the kidneys and this leads to increased urine volume and urinary frequency.
As we age, there is less production of the ADH which promotes water retention in the body. With lower level of this hormone, we excrete more fluid, produce more urine, and urinate more often.
In Neurogenic bladder (or Neurogenic Lower Urinary Tract Dysfunction), a person lacks bladder control due to problems in the brain, spinal cord, or nerves. This may be due to disease associated with aging like diabetes mellitus, stroke, or other illnesses. Overactive bladder is a form of this disease. Muscles of the bladder may be overactive and contract more often than normal and before the bladder is full.
Elderly persons who experience frequent urination and associated symptoms should seek full medical evaluation. There are drugs that can alleviate the symptoms after the cause is identified. Delay in the management of treatable problems like infection especially if recurrent can lead to scarring in the urinary tract.
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