What causes frequent urination (polyuria)?

From the Guidelines

Frequent urination can be managed through several approaches, including ensuring adequate hydration to promote more frequent urination, as recommended by the most recent guidelines 1. To address frequent urination, it's essential to consider the underlying cause, which can range from overactive bladder to urinary tract infections.

• For overactive bladder symptoms, medications like oxybutynin, tolterodine, or mirabegron may help relax bladder muscles.
• If a urinary tract infection is suspected, consulting a healthcare provider for antibiotics is necessary.
• For men with prostate enlargement, alpha-blockers like tamsulosin or 5-alpha reductase inhibitors like finasteride may help.
• Pelvic floor exercises (Kegels) can strengthen muscles that control urination—contract these muscles for 5 seconds, relax for 5 seconds, and repeat 10-15 times, three times daily. According to the European Association of Urology guidelines on urological infections 1, uncomplicated cystitis can be diagnosed based on a focused history of lower urinary tract symptoms and the absence of vaginal discharge.
• The guidelines suggest that for females with mild to moderate symptoms, symptomatic therapy (e.g., ibuprofen) may be considered as an alternative to antimicrobial treatment in consultation with individual patients.
• Routine post-treatment urinalysis or urine cultures are not indicated for asymptomatic patients, but for women whose symptoms do not resolve by the end of treatment, and for those whose symptoms resolve but recur within 2 weeks, a urine culture and antimicrobial susceptibility testing should be performed 1. It's crucial to track symptoms, including frequency, urgency, and fluid intake, to help identify patterns and triggers, as frequent urination may indicate underlying conditions like diabetes, so consulting a healthcare provider if symptoms persist, especially if accompanied by pain, blood in urine, or excessive thirst, is essential 1.

From the FDA Drug Label

Tolterodine tartrate tablets are a prescription medicine for adults used to treat the following symptoms due to a condition called overactive bladder: • Frequency: urinating often

Tolterodine tartrate tablets are used to treat frequency, which is a symptom of overactive bladder characterized by urinating often. The medication is intended to help manage this symptom in adults. 2

From the Research

Frequent Urination

Frequent urination, also known as overactive bladder, is a common condition characterized by urinary urgency with or without urge incontinence, usually in combination with urinary frequency and nocturia.

• The clinical efficacy and safety of tolterodine compared to oxybutynin and placebo in patients with overactive bladder were studied in a 1999 trial 3.
• The results showed that both tolterodine and oxybutynin significantly increased volume voided/micturition compared to placebo, and both treatment groups evoked greater decreases in micturitions per 24 hours and incontinence episodes per 24 hours compared to placebo.
• Another study in 2001 compared the tolerability and clinical efficacy of tolterodine with those of oxybutynin in patients with an overactive bladder 4.
• The study found that patients treated with tolterodine had significantly fewer adverse events, notably dry mouth, as well as a lower incidence of dose reduction than those in the oxybutynin group.
• A 2012 systematic review compared the effects of different anticholinergic drugs for overactive bladder symptoms 5.
• The review found that tolterodine versus oxybutynin had no statistically significant differences for quality of life, patient reported cure or improvement, leakage episodes or voids in 24 hours, but fewer withdrawals due to adverse events with tolterodine.
• A 2002 trial compared the treatment of overactive bladder with once-daily extended-release tolterodine or oxybutynin 6.
• The study found that fewer patients prematurely withdrew from the trial in the tolterodine 4 mg group than either the oxybutynin 5 mg or 10 mg groups.
• A 1999 article described the pharmacology, pharmacokinetics, clinical efficacy, and safety of tolterodine for the treatment of overactive bladder 7.
• The article found that tolterodine has shown consistent reductions in the number of micturitions per 24 hours and less consistently decreased incontinence episodes in patients with detrusor overactivity.

Treatment Options

• Tolterodine and oxybutynin are two common treatments for overactive bladder.
• The choice of treatment depends on the individual patient's symptoms and medical history.
• Extended-release preparations of oxybutynin and tolterodine may have less risk of dry mouth compared to immediate-release preparations.
• Solifenacin and fesoterodine are other treatment options that may have superior efficacy to tolterodine, but with a higher risk of dry mouth.

Adverse Effects

• Dry mouth is a common adverse effect of anticholinergic drugs, including tolterodine and oxybutynin.
• The risk of dry mouth is dose-dependent and may be lower with extended-release preparations.
• Other adverse effects of anticholinergic drugs include constipation, cognitive impairment, and skin reactions.