Frequent Urination With Pain | Kidney Disease and Other Causes

Kidney pain and frequent urination: What do they mean?

Kidneys are paired organs under the lower ribs at the back, one on each side of the spine. Kidney pain is a dull pain in your back (left or right side), stomach region, or lateral side (1). Kidney pain results from various diseases. Most of these diseases also result in frequent urination (2). Frequent urination is the urge to urinate more than usual, compelling you to go to the washroom once every two hours (3).

Why am I urinating every 2 hours? Possible causes

Feeling the urge to urinate every two hours comes under frequent urination (3). There are multiple reasons for frequent urination. These can be due to kidney or bladder problems or non-renal diseases, as discussed below:

• Urinary tract Infections (UTI): The Urinary tract is the pathway from the kidneys to the urethra, which is responsible for draining urine from its place of formation (kidneys) to the outside of the body through the opening of the urethra (4). Infection of any part of the urinary tract is one of the most common reasons for frequent urination and is associated with kidney pain. It can be kidney infection (pyelonephritis), bladder infection (cystitis), and urethra infection (urethritis) (5). Other than frequent urination, other symptoms of UTI are pain in the groin or lower abdomen, bloody or cloudy urine, pain while passing urine (dysuria), nausea, fever, or chills (6).
• Kidney diseases: if you think that you need to urinate more frequently, especially at night (nocturia), this may indicate there is some problem with the filtration system of the kidney, and you have a kidney disorder (21).
• Vaginitis: an infection of the vagina with bacteria or yeast, can also cause an increased frequency of urination (5).
• Bladder pain syndrome (Interstitial cystitis): a chronic condition where there is weeks-long lower abdominal pain associated with frequent urination. Its causation is not exactly known but may be due to a defect in the immune system (autoimmune) or allergic conditions (7).
• Benign prostatic hyperplasia (BPH): The prostate is a gland present in males just below the bladder that helps formsemen (male fluid containing sperm). It is common for this gland to get enlarged and produce urinary symptoms in elderly people. The most common symptom of BPH is an increase in the frequency of urination and difficulty controlling or retaining urine (8).
• Stones in the bladder: when there are stones in the urinary bladder, they cause multiple symptoms such as difficulty urinating, pain while urinating, lower abdominal pain, and frequent urge to go to the washroom to pass urine (9).
• Prostatitis: infection of the prostate also makes you run for urination frequently along with pain with urination (10).
• Bladder cancer: bladder cancer can present with frequent urination, lower abdominal or back pain, and blood in urine (11).
• Urethral stricture: the urethra is the last part of the urinary tract responsible for draining urine out of the body. Narrowing of the urethra can occur due to injury or infections and is known as urethral stricture. Urethral stricture can present with difficulty urinating and running to urinate again and again because you cannot completely pass the urine out in one go (5, 12).
• Pregnancy: pressure on the bladder by a growing fetus in the uterus results in increased frequency of urination (5).
• Diabetes: people with type 1 and type 2 diabetes urinate more frequently to get rid of excess glucose (5).
• Medications: some medicines, such as diuretics, increase the urine output and frequency of urination (5).
• Neurological disorders, stroke, and spinal cord injuries disrupt the nerves responsible for urination and often result in frequent urination and loss of control in holding urine (5).
• Alcohol and caffeine also increase the frequency of urination, while there is no exact limit yet at which urinary frequency gets disturbed (5).
• Vaginal prolapse: anterior vaginal prolapse, also known as cystocele, is a condition where the bladder pushes on the vagina due to weakness of the pelvic floor in adult women. The reason for this displacement and pelvic floor weakness is chronic constipation, multiple childbirth, or heavy weight lifting. Cystocele causes recurrent urination and pressure symptoms in the pelvis (13).
• Increased fluid intake: Occasionally, you may end up drinking more than usual, resulting in frequent urination and wondering if there is any problem with your kidneys (5).

The link between kidneys and muscle spasms

Most of the time, muscle spasms or strain in the back muscles make people think of kidney pain (14). It can, but it doesn’t have to be kidney pain, as pain due to kidney stones also feels like intense muscle spasms. Kidney stone pain does not cause spasms of back muscles, however (15).

When kidney stones get stuck in ureters (tubes that take urine from the kidney to the bladder), ureters try to contract to push that stone forward. This spasm of the ureter against the stone causes throbbing pain that comes in intervals and feels like a muscle spasm in the back (14, 15).

When to see your doctor?

Not every time frequent urination is of concern. Worrisome features associated with frequent urination are (5, 16):

• If increased frequency is associated with high-grade fever and chills
• If you have hematuria (blood in urine) along with recurrent urination
• Vaginal or penile discharge, especially the one that looks like pus 
• Lower abdominal pain or lower back pain
• Dysuria (pain while passing urine)
• If frequent urination does not let you sleep
• You cannot see the obvious cause, such as a change in fluid intake or alcohol or caffeine intake. 
• Pain on one side.

Your healthcare provider will ask you questions about your fluid intake, medications you are taking, your drinking habits, if there is any swelling in your feet, for how long you have been experiencing this, associated symptoms such as burning or pain with urination, fever history and whether you snore or not (5).

After taking the history, a doctor may perform the following tests to diagnose the exact cause (17):

• Urine complete examination
• Urine culture and sensitivity (to see which microorganism is causing your symptoms)
• Ultrasound 
• Cystoscopy (directly visualizing your bladder with a camera-equipped machine at one end)
• Neurological examination to detect any problem in the brain or spinal cord level
• Urodynamic testing (to assess your bladder holding capacity and pressure changes inside the bladder

Possible treatments

Treatment depends upon the cause of frequent urination 

• Urinary tract infections (UTIs) are usually treated with antibiotics, and with the resolution of the infection, the frequency of urination also becomes normal (5, 17).
• Benign prostatic hyperplasia can be treated with medications that ease obstruction, and refractory cases require surgical excision of enlarged prostatic tissue (18).
• Bladder pain syndrome can be treated with lifestyle changes such as stress reduction, dietary changes, exercises, and bladder retraining techniques (7).
• Kegel exercises are pelvic floor exercises helpful in anterior vaginal prolapse (5).
• Fluid modification and tracking what kind of drinks you consume daily also help devise ways to reduce frequent urination (5).
• Diabetes management and proper glucose control if the cause of urination is uncontrolled diabetes (5).
• Bladder cancer and urethral stricture require expert opinion to provide you relief and may involve surgical intervention in most cases (12, 19).
• Frequent urination during pregnancy can be managed with pelvic floor exercises, high fiber intake, and limiting fluid after dinner (20).

Home remedies for frequent urination

Not much can be done at home to reduce the increased frequency of urination. Some tips are as follows (5):

• Avoid drinking water for a few hours before going to sleep.
• Try to reduce the intake of caffeinated beverages, alcohol, and sodas.
• Keep a diary to monitor the exact frequency of urination; this will also help find the cause.
• Bladder retraining techniques that involve gradually trying to hold urine for increasing intervals will help build bladder capacity.
• Pelvic floor exercises are particularly important for elderly women. It will also strengthen the muscles of the bladder and its holding capacity.
• In case of frequent urination owing to UTIs, some simple home remedies to get rid of them are increased garlic intake, cranberry juice, and probiotics, though more research is needed in this domain (22).
• Avoid citrus and acidic foods, which may irritate your bladder if you have an infection (22).

How to prevent kidney diseases?

Lifestyle changes can help to prevent kidney diseases as follows:

• Dietary changes: healthy food that protects your heart and kidneys from getting damaged include fresh fruits and vegetables, whole grains, fat-free dairy products, reducing added sugars to less than 10 percent of calories per day, and limiting sodium intake (abundant in salt) to less than 2.3 grams per day. You can use spices to replace salt to add taste to your food. Try to bake or broil your meat instead of frying (23).
• Keep yourself physically active; try to do at least 30 minutes of exercise per day (23).
• If you are obese or overweight, aim to reduce weight to save yourself from a lot of diseases, including kidney diseases (23).
• Reduce your alcohol intake and smoking habits; you should not drink more than one drink of alcohol per day if female and more than two drinks a day if you are a male. Try to seek help if you are having a hard time quitting smoking (23).
• Managing high blood pressure: high blood pressure (>120/80 mmHg) is one of the most common reasons for kidney damage. Get your blood pressure checked regularly and seek medical attention if found above the normal range. If it is in the normal range, some lifestyle tips can prevent it from getting higher, such as reducing salt intake, exercising, and dietary changes (24).
• Managing your blood sugar levels, complying with your diabetes medicines, lifestyle modification, and regularly monitoring your blood sugar can save you from kidney diseases, as diabetes affects the kidneys a lot (24).
• Avoiding excessive use of over-the-counter painkillers (OTC analgesics). Painkillers (NSAIDs) can damage the blood vessels of the kidneys, so use them cautiously and ask your doctor about the quantity that is allowed for your disease or pain (24).

To combat frequent urination at home, reduce fluid intake, especially at night, reduce alcohol and caffeinated drinks, learn bladder retraining techniques and pelvic floor exercises, and adopt dietary changes such as avoiding citrus and acidic foods. Preventing kidney diseases involves monitoring your blood pressure, managing diabetes, quitting smoking, eating a healthy diet, avoiding excessive use of painkillers, and keeping yourself physically active.