From the Guidelines
Urinary urgency and frequency are commonly caused by several risk factors, including urinary tract infections, overactive bladder syndrome, and benign prostatic hyperplasia in men. The most recent and highest quality study 1 suggests that urinary tract infections are a significant risk factor for urinary urgency and frequency, with a lifetime risk of over 50% in women. Other risk factors include:
- Diabetes, which can increase urination due to high blood sugar levels
- Certain medications like diuretics, which can directly increase urine production
- Excessive fluid intake, especially caffeine and alcohol, which can stimulate the bladder and increase output
- Neurological conditions like multiple sclerosis or Parkinson's disease, which can disrupt normal bladder control signals
- Pregnancy, which can put pressure on the bladder
- Aging, which can cause decreased bladder capacity and weakened pelvic floor muscles
- Bladder stones or tumors, which can physically irritate the bladder
- Psychological factors like anxiety, which can heighten awareness of bladder sensations Addressing these symptoms typically involves identifying and treating the underlying cause, lifestyle modifications (reducing caffeine/alcohol, scheduled voiding), pelvic floor exercises, and sometimes medications like anticholinergics (oxybutynin, tolterodine) or beta-3 agonists (mirabegron) to relax the bladder, as recommended by the American Urological Association 1. It is essential to note that the choice of pharmacologic agents should be based on tolerability, adverse effect profile, ease of use, and cost of medication, as suggested by the American College of Physicians 1. In addition, self-care measures such as ensuring adequate hydration, encouraging urge-initiated voiding and post-coital voiding, and avoiding spermicidal-containing contraceptives can help reduce the risk of recurrent urinary tract infections 1.
From the Research
Risk Factors for Urinary Urgency and Urinary Frequency
- Age: increased risk with older age 2
- Use of certain antibiotics: trimethoprim use is associated with an increased risk of acute kidney injury and hyperkalaemia 2
- Underlying medical conditions: patients with compromised renal function or those taking renin-angiotensin system blockers may be at higher risk of adverse outcomes 2
- Resistance to antibiotics: increasing antimicrobial resistance among uropathogens may contribute to treatment failures and increased risk of complications 3, 4
- Bacterial infection: urinary tract infections (UTIs) caused by certain bacteria, such as Escherichia coli, may increase the risk of urinary urgency and frequency 5, 6, 3
Antibiotic Resistance and Urinary Tract Infections
- Trimethoprim-sulfamethoxazole resistance is common among uropathogens, particularly Escherichia coli 3, 4
- Fosfomycin may be a viable alternative for treating uncomplicated UTIs, especially in patients with resistance to other antibiotics 3
- Surveillance of antimicrobial resistance among uropathogens is essential for guiding empirical treatment of UTIs 4
Adverse Outcomes Associated with Urinary Tract Infections
- Acute kidney injury: increased risk with trimethoprim use, especially in older patients 2
- Hyperkalaemia: increased risk with trimethoprim use, especially in patients taking renin-angiotensin system blockers and potassium-sparing diuretics 2
- Sudden death: no increased risk with trimethoprim use compared to other antibiotics 2