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Sudden Frequent Urination but No UTI or Diabetes?
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An_222079 posted:
Hello,

Within the last few weeks my 5-year-old son has developed this constant need to pee. He has been potty trained since age 2 and doesn't have some weird fixation of bathrooms...it is just the sudden thing.

He will get up to pee anywhere from 2-6 times in an hour, if not more. Of course it is only little dribbles because his bladder isn't full, but he feels like if he doesn't go NOW he'll pee his pants.

I first thought UTI and took him to his pediatrician where they did the clean catch urine and tested it for bacteria, ketones, and other stuff. It tested negative for everything. They sent a sample to the lab to see if it would grow any bacteria but it did not.

I am clueless. It doesn't hurt/burn when he pees and he can sleep through the night fine - he only deals with this constant urge while awake. He does drink plenty during the day, but nothing that remotely explains the frequency he's going.

The doctor did notice when examining his penis (he is not circumsized) that the tip was slightly red and seemed a little irritated, so they suggested a little bacitracin.

Other than this issue he's a healthy, active little boy. Any idea what this is???

Help would be greatly appreciated!!
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Roy Benaroch, MD responded:
Wow, this sure comes up a lot. I've been on this board for just a few months, and I think we've discussed this at least three or four times in other threads. I think I officially nominate "frequent urination" as "The Most Common Ordinary Condition that Doctors Aren't Handling Right." It's no fault of yours, Anonymous poster, but really the doctor should have explained and reassured about this when the urine tests came back negative.

I've written about this on WebMD here and here , and on my own blog here and here . I'm going to work on a good long organized response for you shortly on this thread, since this seems to come up so often as a concern.

First, there are some very clear clues here. He can sleep all the way through the night without wetting his bed or getting up to urinate. Any medical thing that would make him produce excessive urine would also keep him wet all night. Just from this one clue, we can be pretty sure that it's not some kind of infection or diabetes.

He's also had a urine examination that was normal. It usually is, in cases like these, but it's essentially to take that step to catch the 1% of children with urinary frequency who actually do have something that needs to be treated differently.

But 99% of the time, what kids like this have is called "dysfunctional voiding." It's a physical process that begins with a habit of holding urine in too long. Many children do this—they are having fun, they don't want to stop what they're doing. Or sometimes the bathroom at school is icky, or they're embarrassed to ask. Often (but not always), they also hold their stools. After a long time of habitual holding, the bladder starts to become less aware that it's full. Kids become so used to a full bladder that they just put up with it, until all of a sudden—BAM—it's just too much, and they have to run quickly to the bathroom. But the thickened bladder wall can't contract the way it should, and the bladder barely empties. They'll dribble just a bit, just enough to relieve the pressure, until a few minutes later when they have to run to the bathroom again.

Symptoms of dysfunctional voiding can include frequency (having to use the bathroom a lot), pain with urination (from bladder spasms), wetting the bed at night, and having little accidents during the day (especially with laughter). Not all of these symptoms have to occur at the same time.

Confirmation of this diagnosis is usually just based on the history and a normal urine exam. If necessary, a bladder ultrasound before and after emptying can demonstrate a thickened bladder wall and incomplete emptying—but I rarely have to look at that, honestly, to tell what's going on.

Next: how to treat dysfunctional voiding.
 
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Roy Benaroch, MD replied to Roy Benaroch, MD's response:
Treating dysfunctional voiding begins with dispelling some of the anxiety and worry. Do not keep asking your child why he has to pee, and do NOT discourage him from going to the bathroom—these steps will help him be less anxious about what's going on. One trip to the doctor is needed to check the urine, and (hopefully) the doctor can explain this to the child in a way that helps him feel better. I make sure to tell the kids that they're fine, it's just that their pee is tricking them because it's staying in too long (the language of the explanation depends on the age of the child, of course.)

Make sure to treat any co-existing constipation. If there's hard stool pressed against the bladder, it can't empty well. And kids who habitually hold stool tighten the same muscles that hold in urine. Talk with your pediatrician about a good routine to treat constipation, if needed.

Use a timer to go off once a hour to remind a child to urinate, and (most importantly) encourage him to relax and take his time in the bathroom. Avoid the "quick squirt and run" routine. Boy can sit to slow themselves down. Bring a book or game boy. Relax. Make sure children know that during potty breaks all fun activities are going to be put on hold for five minutes, but they'll be right back afterwards (note: NOT on hold until you think you're done, on hold for a good long break so you can really finish!) It can even help to have children pee twice—urinate until you think you're done, wash your hands, then immediately try again.

Rarely, medication can help to relax the bladder muscle and allow full urination, but I rarely have to prescribe anything other than the instructions above. Once the child is allowed to relax, worry is dispelled, and Junior develops a new, slower habit to empty the bladder fully, things return to normal in just a few weeks.

If your pediatrician hasn't been too helpful about guiding you through this, consider visiting with a pediatric urologist.

Best of luck, and let us know how it goes!
 
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kfarry83 replied to Roy Benaroch, MD's response:
Hello. PLEASE any thoughts or words of wisdom for me.
I am dealing with this with my 4 year old daughter. She has been potty trained for over a year. She NEVER has accidents, the only time was twice at night when we first started potty training.
About a week and a half ago she started having to pee a lot. I noticed right away because she does not pee a lot. I would normally have to put her on the potty because she just doesnt want to miss anything. But she would never hold it all day or anything like that. I am usually on top of it, because I stay home with her.
She has NO other symptoms. No itching, burning or discharge. No fever either. She is eating and pooping normally. She is always hungry...but I think thats pretty typical for a 4 year old to always want a snack.
I just brought her to the doctors on Tuesday. Tested the pee there and it was inconclusive, so the doc sent it out. Came back today negative or a UTI.
With this test do they test for anything else or just UTI? I am now worried about diabetes. There is no family history. She does not drink any soda or juice..just water. No fruit snacks in the house. But she does have some candy and icecream..not a ton though.
She is peeing every 15-30 minutes and sometimes she sits to go, but can not go. Which is upsetting to us both.
She makes it through an hour nap no problem and about 6-8 hours at night without peeing or having any accidents.
Any thoughts on what I should do? Ask her doctor to test for? I am pretty freaked out!
Thank You!
 
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Roy Benaroch, MD replied to kfarry83's response:
kfarry, please read the posts above and the links, I think you'll find that your questions have already been answered here. If you have further or more-specific questions, post here again.

A simple urinalysis done at the pediatrician's office will rule out diabetes, and was probably already done.

Best of luck!
 
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kfarry83 replied to Roy Benaroch, MD's response:
I did read the above posts.
This is the second time my daughter 4 1/2 has had this in 2 months. It got better for about 3 weeks and came back. She has had another uti test and diabetes test. She has had her kidneys checked..They tested her for cancer and lymphoma. All these test came back negative.
Is it normal for these symptoms to reacure like this?
Also this time around it is worse. As in more frequent and she will have the urge to go and cant. I'm talking she pees and gets off the toilet and says she has to pee again right away! There is no burning and she is pooping every day.
What tests should she have done next? I am concerned that she may have something more serious going on? Like a cyst or something. Would X-Rays be the next step in finding this out??
Thank You.
 
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Elizabeth_WebMD_Staff replied to kfarry83's response:
Hi kfarry83 -

Have you tried setting the timer and using the verbal cues that Dr. Benaroch suggested?

A couple other things noted - "Symptoms of dysfunctional voiding can include frequency (having to use the bathroom a lot), pain with urination (from bladder spasms), wetting the bed at night, and having little accidents during the day (especially with laughter). Not all of these symptoms have to occur at the same time.

Confirmation of this diagnosis is usually just based on the history and a normal urine exam. If necessary, a bladder ultrasound before and after emptying can demonstrate a thickened bladder wall and incomplete emptying—but I rarely have to look at that, honestly, to tell what's going on.

And, "If your pediatrician hasn't been too helpful about guiding you through this, consider visiting with a pediatric urologist."

Hoping you find answers and she is better soon,
Elizabeth
 
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bunchofthree replied to Roy Benaroch, MD's response:
im having the same problem but im sure my 8 year old dosnt hold her pee she has had all the testing and it has come back nneg. she is peeing every couple of minutes and its only later in the day i noticed what to do???
 
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misplacedcowgirl replied to Roy Benaroch, MD's response:
can this happen to young adults as well?
I'm 18 and Ive had this probem a few times it wi last afew months at a time then seem normal agian
when I was in jr high school locked the bathrooms at different times durring the day and some teachers also did not alow students to use the bathroom durrning class. I remember being in a class for 45 minutes, getting out the bathrooms being locked then having a 30 min bus ride home not including waiting for the bus to arive. In high school I used the bathrooms once a day because i hated missing notes and falling behind ove bathroom usage. I was also working in a small kitchen and thee scedual woud be made so that there was one person per shift making it hard to use the bathroom because no one could cover
 
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aujenn replied to Roy Benaroch, MD's response:
Thank you so much!! I just went through this with my 8 year old son, I took him to the doctor and the urine and blood showed nothing irregular...we have always noticed he would wait until the last min to go, which is what you said..I used your line about "pee tricking you"...he feels better, I feel better and we will quick talking about it and see what happens..again thankful I read this!
 
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cdobson82 replied to Roy Benaroch, MD's response:
Hello...I understand this conversation was a long time ago but I am at my wits end with my daughter and looking for some help. My daughter turned 4 at the end of February and is frequently peeing in her pants. She has to wear a pull up whenever she sleeps as well. She has Celiac Disease, Hypothyroidism, EE, and is completely growth hormone deficient. I have had her urine tested, have asked the dr's, etc...but this keeps happening and they don't seem worried...even her Endo? I am also now begining to feel that it is a source of anxiety for her. What else should I be doing or what am I doing wrong? Thanks!
 
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Roy Benaroch, MD replied to cdobson82's response:
Celiac, hypothyroid, EE, growth hormone deficient? Are those thought to be related somehow? I suppose Celiac and some kinds of hypothyroid could go together.... or the hypothyroid and GH deficiency is she has a pituitary disorder (though that wouldn't connect with Celiac.) If she has low-functioning pituitary overall, that could include something called "diabetes insipidus". which you can screen for with urine and blood tests. I imagine she's been tested for this. The ped endo would be the person best equipped to look for diabetes insipidus or pituitary problems.

I have no particular concerns about a four year old girl wearing pullups at night. And even the day accidents at four aren't that uncommon. It's all of these complex other issues that make me wonder if they're connected somehow. I'd guess that it's still likely that the dysfunctional habits discussed above are the cause, but with all that other stuff going on I would hesitate to diagnose those that without more information.
 
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alice17130 replied to Roy Benaroch, MD's response:
Hi, please help me out with my urine problem:

I am a 19 year old female who has been needing to go to the restroom 15-20 times a day for almost a year now.I need the restroom every hour (every 30 minutes when I drink lots of water).I drink around 5 glasses of water a day. I have been to my healthcare provider and done three urine tests. Only one has came out to have a little infection. After taking the antibiotics, I didnt find that I was better in any way.
The most recent urine test indicated no infection and so my doctor said theres nothing to worry about. However, I still have the problem. Once a week, I experience pain in my lower right and left sides (could this be the cause?)

Please help!
 
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fcl replied to alice17130's response:
Have you been tested for diabetes?
 
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alice17130 replied to fcl's response:
My doctor said that in my urine test the sugar came out negative. I have no family history of diabetes so my doctor eliminated diabetes.


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