Frequent urination in middle-aged women

Frequent urination can occur in anyone. The causative factors are varied and can be mainly divided into physiological and pathological types, especially the latter which is the most harmful. Generally speaking, physiological frequent urination is easier to judge, but pathological frequent urination is difficult to judge. If the frequent urination in middle-aged women is pathological, it is most likely caused by urinary tract infection. We can roughly understand the symptoms and make judgments based on our own situation.

Clinical manifestations

1. Acute simple cystitis

The onset is sudden, and the onset in female patients is often related to sexual activity. The main manifestations are bladder irritation signs, namely frequent urination, urgency, pain when urinating, discomfort in the bladder area or perineum, and a burning sensation in the urethra; the degree of urinary frequency varies, and in severe cases, urge urinary incontinence may occur; the urine is turbid, there are white blood cells in the urine, terminal hematuria is common, and sometimes it is hematuria throughout the process, and even blood clots are discharged. Generally there are no obvious systemic infection symptoms, and the body temperature is normal or there is a low fever.

2. Acute simple pyelonephritis

(1) Urinary system symptoms include bladder irritation signs such as frequent urination, urgency, and pain during urination; hematuria; low back pain on the affected side or both sides; obvious tenderness or percussion pain at the costovertebral angle on the affected side;

(2) Symptoms of systemic infection such as chills, high fever, headache, nausea, vomiting, loss of appetite, etc. are often accompanied by increased white blood cell count and increased erythrocyte sedimentation rate.

3. Asymptomatic bacteriuria

Asymptomatic bacteriuria is a hidden urinary tract infection, which is more common in elderly women and pregnant women. Patients do not have any symptoms of urinary tract infection, and the incidence rate increases with age.

4. Complicated urinary tract infection

The clinical manifestations of complicated urinary tract infection vary greatly, and are often accompanied by other diseases that increase the risk of infection or treatment failure, with or without clinical symptoms (such as frequent urination, urgency, dysuria, dysuria, low back pain, costovertia angle tenderness, suprapubic pain and fever, etc.). Complicated urinary tract infections are often accompanied by other diseases, such as diabetes and renal failure; they also cause many sequelae, the most serious and fatal of which include urosepsis and renal failure. Renal failure can be divided into acute and chronic, reversible and irreversible.

1. Urinary tract infection in non-pregnant women

(1) A three-day therapy is recommended for the treatment of acute simple cystitis, which consists of taking oral co-sulfamethoxazole, ofloxacin, or levofloxacin. Because the efficacy of single-dose therapy is not as good as the three-day therapy, it is no longer recommended. In areas where the resistance rate of pathogens to sulfamethoxazole is as high as 10% to 20%, nitrofurantoin can be used for treatment.

(2) For the treatment of acute simple pyelonephritis, it is recommended to use antibiotics for 14 days. For patients with mild acute pyelonephritis, the course of treatment can be shortened to 7 days using high-efficiency antibiotics. For mild cases, oral quinolones can be used for treatment. If the pathogen is sensitive to trimethoprim-sulfamethoxazole, this drug can also be taken orally. If the causative bacteria are gram-positive, treatment can be with amoxicillin alone or amoxicillin/clavulanate potassium. For severe cases or those who cannot take oral medications, they should be hospitalized and treated with intravenous quinolones or broad-spectrum cephalosporin antibiotics. For those who are resistant to β-lactam antibiotics and quinolone antibiotics, aztreonam can be used for treatment. If the pathogen is a Gram-positive coccus, ampicillin/sulbactam sodium can be used, and combined medication can be used if necessary. If the condition improves, sensitive antibiotics can be selected for oral treatment based on the urine culture results. Regimen adjustment and follow-up are very important during medication. Urine culture should be performed every 1 to 2 weeks to observe whether the urine bacteria turns negative. Quantitative urine bacterial culture should be performed at the end of the treatment and 2 and 6 weeks after stopping the medication. It is best to review it once a month thereafter.

(3) Complicated urinary tract infection The treatment plan for complicated urinary tract infection depends on the severity of the disease. In addition to antimicrobial treatment, it is also necessary to simultaneously address anatomical and functional abnormalities of the urinary system and treat other underlying diseases. If necessary, nutritional support therapy is also required. If the condition is severe, hospitalization is usually required. First of all, the underlying diseases such as diabetes and urinary tract infarction should be controlled promptly and effectively. If necessary, joint treatment with relevant professional doctors such as endocrinologists is needed. Otherwise, it is difficult to cure the disease with antibiotics alone. Second, treat with broad-spectrum intravenous antibiotics empirically. During the medication period, the treatment plan should be adjusted in time according to changes in the condition and/or the results of bacterial drug sensitivity tests. Some patients may need combination therapy, and the course of treatment should be at least 10 to 14 days.

2. Catheter-related urinary tract infection

(1) Antibiotic treatment is not recommended for most asymptomatic bacteriuria. Some exceptions to this recommendation are the following: nosocomial infections caused by more virulent organisms; patients who may be at risk for serious concurrent infections; patients undergoing urologic surgery; infections with certain strains that cause a high rate of bacteremia; and older female patients who may require short-term treatment after catheter removal.

(2) For symptomatic infection, it is recommended to replace catheters that have been in place for more than 7 days before taking urine samples for culture and before using antimicrobial drugs, or to use other drainage methods such as condom drainage and suprapubic cystostomy drainage. If there is no need to continue the catheterization, it can be discontinued. It is recommended to select effective antibiotics based on the results of urine culture and drug sensitivity test. Broad-spectrum antibiotics can be used empirically initially, and antibiotic use can be adjusted based on culture results. For those with mild symptoms, oral medication can be used, usually for 5-7 days. Patients with severe symptoms, fever, positive blood culture, and difficulty in gastrointestinal administration can choose non-gastrointestinal medication, such as intramuscular or intravenous injection. For severe cases, medication is usually taken for 10 to 14 days. Occasionally, candidal infections may be treated with antifungal therapy. Long-term, unwarranted use of antibiotics is not recommended.