Differential Diagnosis for Hourly Urination without Burning or Pain in a 47-year-old Female

Single Most Likely Diagnosis

• Overactive Bladder: This condition is characterized by a sudden, intense urge to urinate, often resulting in frequent urination. The absence of pain or burning during urination and the frequency of urination hourly make this a likely diagnosis.

Other Likely Diagnoses

• Polyuria: This refers to the production of abnormally large volumes of urine, which can be due to various factors including diabetes mellitus, diabetes insipidus, or excessive fluid intake. The lack of pain or burning suggests a possible issue with urine production rather than a urinary tract infection.
• Urinary Tract Infection (UTI) without typical symptoms: Although the question specifies no burning or pain, some UTIs can present atypically, especially in older adults or those with underlying medical conditions. However, the age of the patient and the absence of typical symptoms make this less likely.
• Hormonal Changes: Hormonal fluctuations during perimenopause or menopause can affect bladder control and lead to more frequent urination.

Do Not Miss Diagnoses

• Diabetes Mellitus: Uncontrolled diabetes can lead to polyuria due to high blood sugar levels causing the kidneys to produce more urine. Missing this diagnosis could lead to serious complications if left untreated.
• Diabetes Insipidus: A rare condition characterized by the inability to regulate fluids in the body due to problems with the antidiuretic hormone (ADH), leading to excessive thirst and urination.
• Pregnancy: Although less common at 47, pregnancy can still occur and is associated with increased frequency of urination due to hormonal changes and pressure on the bladder.

Rare Diagnoses

• Bladder Cancer: While rare, bladder cancer can cause frequent urination among other symptoms. It's essential to consider this in the differential diagnosis, especially if other symptoms are present or if the patient has risk factors.
• Neurogenic Bladder: A condition resulting from a lack of bladder control due to a brain, spinal cord, or nerve problem, which can lead to urinary frequency.
• Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which can lead to frequent urination. The absence of pain makes this less likely but still worth considering if other symptoms are present.