Healthy people feel desire to urinate when about 300-400 ml of urine is accumulated in the bladder. But the people who have frequent urination feel desire to urinate even if only small amount of urine is accumulated in the bladder. Frequent urination is feeling desire to urinate even if only one third of urine is accumulated in the bladder.
Major cause of frequent urination is that aging decreases the blood flow around the bladder and the nerve around the bladder responds abnormally. It has been thought that the abnormal reaction of the nerve makes desire to urinate with small accumulation of urine in the bladder.
But it has turned out that there is a new cause of frequent urination other than the abnormality of the nerve.
New cause of frequent urination
Usually when urine starts to be accumulated, the upper part of the bladder extends first and then the lower part of the bladder extends afterwards, so the amount of the accumulated urine is detected by how much the lower part of the bladder extends (Fig. 2 and 3).
In the case of prolapsed bladder (Fig. 1), when urine starts to be accumulated, the lower part of the bladder extends instead of the upper part (Fig. 4). For that reason, even if urine is not accumulated so much, desire to urinate is transmitted to the brain.
Why is the bladder prolapsed?
Pelvic floor muscles support the bladder (and bowel, uterus), but if pelvic floor muscles become weak, the muscles become prolapsed because they can’t tolerate the weight of urine, and the bladder supported by pelvic floor muscles is also prolapsed (Fig. 5).
So it is important to strengthen pelvic floor muscles,
but for women, it is difficult to maintain pelvic floor muscles because:
(1) pelvic floor muscles are damaged during deliveries and
(2) decrease of female hormone due to menopause loosens pelvic floor muscles.
Another muscle important to prevent the prolapse of the bladder
There is another muscles that is important to prevent the prolapse of the bladder. The muscles are core muscles (Fig. 6). The core muscles are connected to pelvic floor muscles and if you can maintain core muscles, core muscles pull up pelvic floor muscles, preventing the prolapse of the bladder.
But core muscles also become weak with age so that it is important to train them regularly.
How to strengthen core muscles easily
According to a research in San Francisco, US, patients with urinary problems such as frequent urination tried this method for 3 months and 70 % of them were improved.
The method is Yoga.
Here 2 Yoga poses that were effective to improve frequent urination are introduced (Fig. 7-0).
1. Warrior Pose
(1) Open your legs wider than your shoulder width (Fig. 7-1).
(2) Rotate your right toes outward to 90 degrees (Fig. 7-2).
(3) Open your arms and shift your weight to your right leg (Fig. 7-3).
(4) At the same time, as you exhale, pull in your belly.
(5) Do this pose for right and left, 30 seconds each.
2 Bridge Pose
(1) Lie on your back and bend your knees (Fig. 8-1).
(2) Raise your low back slowly without strain (Fig. 8-2).
(3) Do deep abdominal breathing 10 times and slowly lower down your back (Fig. 8-3).
(4) Repeat this movement for 1 minutes.
If you do these two Yoga poses twice a day in the morning and at night, the improvement of frequent urination is expected.
According to a guide line, if you urinate more than 8 time during daytime, you are diagnosed with frequent urination. That is urinating about every one and a half hour. During night time, even if you urinate once, you are diagnosed with nocturia (night urination).
However, if you need to urinate because of drinking large amount of water, it is not regarded as frequent urination.
When it is cold, urinating frequently is caused by the stimulation of coldness.
Some of frequent urination are caused by brain disorders, but most of frequent urination is considered as being caused by aging.
Difference of bladder between people with frequent urination and people without frequent urination
People with frequent urination have a desire to urinate even if only small amount of urine is accumulated with aging (Fig. 1).
How to improve frequent urination
Bladder is a bag made of muscles. When urine goes into it, the bladder expands like a balloon and urine is accumulated. When a certain amount of urine is accumulated, the nerves around the bladder transmits a signal to the brain. The brain transmits a desire to urinate to the bladder and urination occurs.
However, aging makes the nerves around the bladder too sensitive and desire to urinate is caused by accumulation of small amount of urine. Therefore, frequent urination with aging is caused by the malfunction of the nerves around the bladder.
The nerves around the bladder controls not only the bladder but also the anus and the urinary tube, and they go down to the toes and control the movement of the muscles of the toes (Fig. 2).
The nerves run near the surface of the skin around the ankle, so massaging around the ankle can suppress the malfunction of the nerves (Fig. 3).
Massage to improve frequent Urination
Where to massage is 4 fingers above the inner ankle and beside the bone, where you feel tender when you press with your finger, which is an acupuncture point Spleen-6 (Fig. 4 and 5).
Press the point for about 1 minute with a little strong pressure. Do this massage 3 times a day, in the morning, at noon and in the evening.
A 52 years old woman needs to go to the bathroom for urination 23 times a day including an20 times during day and 3 times during night time. That means she has to go to the bathroom every 30 minutes to 1 hour during daytime and every 2 and half hour during night time.
In this experiment, she massages Spleen-6 for 1 minutes 3times a day after every meal for 7 days.
Day 1: 12 times
Day 2: 10 times
Day 3: 9 times
Day 4: 8 times
Day 5: 8 times
Day 6: 7 times
Before the experiment, she had a desire to urinate 47 minutes after drinking 500 ml of water, but after the experiment, it took 1 hour and 20 minutes.
Fig. 6 shows MRI image of her bladder before and after the experiment. It shows that her bladder became able to expand and accumulate large amount of urine before she had a desire to urinate (Before: 128 ml / After: 483 mil). That means, she became able to accumulate 4 times more urine before having a desire to urinate.
When the weather gets cold, people with frequent urination increase. But there are a lot of cases that heart diseases and blood vessel diseases are hidden behind frequent urination. So it is important to know the characteristics of your frequent urination.
Overactive bladder (OAB)
Because the nerves of the bladder become sensitive, frequent, sudden urges to urinate are caused even if urine is not accumulated.
The amount of urine at night is more than during daytime
Overactive bladder is the disease that the amount of urine at night is less than during daytime.
The diseases that the amount of urine at night is more than during daytime are heart diseases, sleep apnea syndrome, lifestyle related diseases such as diabetes and others.
Hyperparathyroidism is a disorder of the four parathyroid glands caused by the development of a benign tumor or others. These glands are about the size of a grain of rice and are located in your neck. The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning. the development of a tumor causes excess secretion of parathyroid hormone, causing abnormal activity of organs in whole body.
The kidney and muscles are easily affected by hyperparathyroidism.
If the kidney which regulates the amount of urine is affected, urine is produced too much.
If a pelvic floor muscle which supports the bladder is affected, frequent urination is caused by the decline of the function of the muscle.
Even if the test results of creatinine, calcium and blood pressure are within the range, they are a little bit high.
Swelling of legs and night urination
Water coming from swelling of legs leads to night urination.
People whose legs are obviously swollen have about 200-300 cc of water in one leg, more than 400 cc (2 glasses) of water for both legs.
The accumulated water in the legs comes back to the blood stream when lying down at night and the amount of water in the blood increases. The body tries to produce more urine to discharge the excess water, causing night urination.
Check the swelling of legs
When you press the inside of the shin with your finger, if the finger print stays there or a dimple doesn’t disappear, you have swelling of the leg and tend to have night urination (Fig. 1).
How to improve night urination by solving swelling of legs
The method is soaking in a bath tub.
The effect of water pressure and heat of warm water brings the water stored in the legs back to the blood. But it takes about 3-4 hours that the water returned to the blood becomes urine.
So it is recommended to take a bath 4 hours before going to bed.
If taking a bath 4 hours before going to bed is difficult, it is also recommended to massage legs, wear elastic stockings and lie down lifting legs up 4 hours before going to bed (Fig. 2).
Whether or not you had an experience that you failed in pee in the past.
If you have an experience of failure about pee such as you were scolded too much because you wet your pants in your childhood, or you stopped the bus on the trip because you wanted to pee, the desire to urinate is overstimulated. That makes you want to pee even if urine is stored only a little in the bladder. It is called Nervous Pollakiuria (Bladder Neurosis).
How to treat Nervous Pollakiuria
Since originally there is no dysfunction of the bladder, hold the pee for 5 minutes then 10 minutes even if you want to pee. That makes the expansion of the bladder better and you will have confidence, leading to normal desire of urination.
There is a statistic that people who have nocturia (frequent urination at night) have a lower survival rate than people who don’t. Also When waking up at night and going to the bathroom, there are people who sometimes fall down and break a bone, lowering the quality of life.
The main cause of nocturiais too much intake of water at night such as water, tea, coffee or alcohols.
Another cause that you have to pay attention to is swollen legs.
While spending daytime, blood tends to be accumulated in the legs by the influence of gravity. In addition to that, aging causes the power to push out the blood from the heart and the power to return the blood from the legs to the heart weaker, resulting in that water comes out from the blood accumulated in the legs. This is the cause of swollen legs.
Why do swollen legs become a cause of nocturia?
While sleeping at night, the level of the legs is equal to the heart’s, so blood containing a lot of water comes back to the heart easily without the influence of the gravity. There is a sensor in the right atrium, which detects the amount of water. The sensor orders the kidney to make more urine from the blood to prevent the heart from having too much water. To improve this type of nocturia, it is important to improve swollen legs.
How to improve noctruia caused by swollen legs
(1) Massage your legs from the ankle to the knee (Fig.1).
(2) Walk in the evening.
Moving the muscles in the calves promotes the dilation and contraction of the blood vessels, pumping the blood back to the heart. Walking in the evening makes urine before going to bed.
About 10 years ago, when she went hiking, she went to the bathroom and felt the sensation of residual urine for the first time and when she had a physical examination, she was diagnosed with bladder infection.
Bladder infection is a disease that bacteria goes into the bladder and causes inflammation, causing symptoms such as the sensation of residual urine or painful urination. If the inflammation is spread in the urethra, painful urination is caused. If the inflammation is spread in the bladder, the nerves controlling the desire to urinate are malfunctioned and even if there is no urine accumulated, they want to urinate, in other words, the sensation of residual urine is caused.
After taking prescribed medicine (antibiotics), her sensation of residual urine disappeared. But at this moment, she didn’t notice that her bladder infection was not the ordinary bladder infection but the bladder infection caused by a more serious problem.
She felt the sensation of residual urine again and this time she couldn’t urinate at all. So she went see a specialist of urology and had various kinds of tests. The result was bladder infection because there was no abnormality in the bladder and kidney, but there was inflammation in the bladder. While she was taking prescribed medicine, the symptoms were suppressed, but about a month later the bladder infection came back again. Every time the bladder infection came back, she had to take antibiotics without knowing what caused the bladder infection.
5 years after the first bladder infection, she started to feel pain on urination. She took prescribed medicine, but not only the pain didn’t go away but also the sensation of residual urine became stronger than before. She went see doctors other than the urologist including the internal medicine, a gynecologist and even a psychiatrist, but the cause was not found. So she had to keep taking antibiotics for about 10 years.
She happened to see a doctor who was a specialist of ultrasound. Her kidneys, urethra and bladder were checked with ultrasound, but no abnormality was found. So the doctor asked her if she noticed anything else and she mentioned that she sometimes had gas like a fart when she urinated. Her bladder was checked with ultrasound again and there were white dots moving around. The doctor checked the inside her bladder with a bladder endoscope. The inside of her bladder was cloudy with small floaters. Then CT scan for the large intestine was performed (Fig. 1).
Her disease turned out to be Colon diverticulitis.
Colon diverticulitis is a disease that a part of the wall of the colon sticks out and pouches are formed and stool is accumulated in the pouches, causing inflammation. This disease often happens to people with constipation or elderlies. Diverticulitis is not rare disease but in her case, the location of diverticulitis was very rare.
In her case, diverticulitis happened right next to the bladder, causing adhesion. The adhesion made a hole to the bladder. Stools in the large intestine went into the bladder. The floaters seen with colon endoscope were stools. The gas which was supposed to be eliminated from the large intestine was eliminated with urination (Fig. 2) (Fig. 3).
As stools always went into the bladder, germs increased even if she took antibiotics, causing repetitive bladder infection.
Her life was saved by the surgery to remove the adhesion.
Chronic Kidney Disease (CKD) includes IgA nephropathy, diabetic nephropathy, membranous nephropathy and nephrosclerosis. The kidneys filtrate the blood and excrete wastes and toxins as urine. But even if the function of the kidneys lowers down, there are few subjective symptoms. If you keep putting a burden on the kidneys by eating too much salt, the kidney function stops before you realize. If the kidney function becomes less than 10 %, the kidneys can’t filtrate wastes and toxins in the blood sufficiently, resulting in necessity of dialysis.
Dialysis is a cleansing process of the blood that uses a special machine to filter wastes and toxins from the blood and return the blood to the body. In general, dialysis needs 4-5 hours per treatment, 2-3 times a week so daily life can be restricted. Dialysis also have to be continued for life. So it is important to prevent chronic kidney diseases.
But if you improve the kidney function before it gets worse, you can expect the improvement of swelling, high blood pressure and frequent urination.
The methods to remove salt from the body are urination and sweat. Since sweat is difficult to control, urination is the only method to remove salt taken from the mouth. The organ doing the job is the kidney. So if the kidney works too much, the kidney becomes exhausted and the function lowers down.
The sense of the taste started becoming weak at the age of 65 in men and at the age of 60 in women. The insensitivity to the taste makes you take more salt.
People who have kidney diseases are insensitive to salty taste. If they continue eating lightly salted food for about a week, their sensitivity to salt returns normal.
How to reduce salt
(1) Choose seasonings which show “Salt Equivalent”. You can calculate about how much salt you are taking.
(2) Use a small measuring spoon, 1/8 tsp.
(3) Season with materials with strong smell such as ginger or garlic.
(4) Season with soup stocks or spices instead of salt.
(5) Eat from light seasoned food.
(6) Record what you ate and the amount of salt.
(1) Use juice of citrus fruits instead of salt.
(2) Use crushed nuts for salads instead of dressing.
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