What is the treatment for increased urination (micturition) without a urinary tract infection (UTI) or diabetes?

Treatment for Increased Urination Without UTI or Diabetes

Behavioral and lifestyle modifications should be the first-line treatment for increased urination (micturition) without UTI or diabetes, including fluid management, bladder training, and pelvic floor muscle exercises. 1

Initial Assessment

• Evaluate for common causes of increased urination including overactive bladder (OAB), benign prostatic hyperplasia (BPH) in men, and stress or urgency urinary incontinence in women 1
• Rule out nocturnal polyuria (production of >33% of 24-hour urine output during sleep) which may require different management 1
• Consider completing a frequency-volume chart (FVC) to document voiding patterns, especially for patients with nocturia (≥2 voids per night) 1

First-Line Treatment: Behavioral and Lifestyle Modifications

For All Patients:

• Regulate fluid intake, especially reducing evening fluid consumption 1
• Avoid dietary irritants such as caffeine, alcohol, and highly seasoned foods 1
• Implement lifestyle changes including weight loss for obese patients 1
• Avoid sedentary lifestyle 1

For Patients with Urgency Symptoms:

• Implement bladder training (gradually extending time between voids) 1
• Practice pelvic floor muscle training (PFMT) exercises 1
• Consider combining bladder training with PFMT for mixed symptoms 1

Second-Line Treatment: Pharmacologic Options

If behavioral therapies are unsuccessful after 4-8 weeks, consider medication based on predominant symptoms:

For Overactive Bladder/Urgency Symptoms:

• Antimuscarinic medications (alphabetical order, no hierarchy implied):

  • Darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium 1
  • Consider tolerability profiles when selecting medication (tolterodine causes fewer adverse effects than oxybutynin) 1
  • Monitor for common side effects: dry mouth, constipation, blurred vision 1

• Beta-3 adrenergic agonists:

  • Mirabegron has demonstrated efficacy in reducing urinary frequency and urgency 2
  • May be better tolerated than antimuscarinics in some patients 2

For Men with Prostatic Symptoms:

• Alpha-blockers for 2-4 weeks if bladder outlet obstruction is suspected 1
• 5-alpha-reductase inhibitors for at least 3 months if prostate is enlarged 1
• Consider combination therapy with alpha-blocker and antimuscarinic if both obstructive and storage symptoms are present 1

Special Considerations

• Avoid antimuscarinics in patients with narrow-angle glaucoma, impaired gastric emptying, or history of urinary retention 1
• For postmenopausal women, consider vaginal estrogen with or without lactobacillus probiotics 1
• Measure post-void residual urine in elderly patients or those with risk factors for retention before starting antimuscarinic therapy 1

Follow-up and Monitoring

• Assess treatment success after 2-4 weeks for alpha-blockers or antimuscarinics 1
• For 5-alpha-reductase inhibitors, assess after at least 3 months 1
• If treatment fails or symptoms worsen, refer to a urologist for specialized management 1
• Annual follow-up is recommended for patients with successful treatment 1

Treatment Algorithm

1. Start with behavioral modifications and lifestyle changes for 4-8 weeks
2. If insufficient improvement:
   • For urgency/frequency: Add antimuscarinic or beta-3 agonist
   • For men with prostatic symptoms: Add alpha-blocker
3. If still inadequate response after 4 weeks:
   • Consider combination therapy
   • Refer to specialist for further evaluation