Frequent Urination

Infrequent urination may be caused by a number of different conditions

Most people typically urinate four to eight times a day. Needing to go more than eight times a day or waking up in the night to go to the bathroom more than once in the night is considered frequent urination. Though the bladder can often hold as much as 600 ml of urine (about 2 ½ cups), the urge to urinate is usually felt when the bladder contains about 150 ml of urine (just over ½ cup).

There are two different ways to look at frequent urination:

• either as an increase in total volume of urine produced (excessive urination, or polyuria) or
• a dysfunction in the storage and emptying of urine.

The many causes of frequent urination include prostate problems, diabetes, and pregnancy.

• Urinary tract infection (UTI) or bladder infection: The lining of the urethra (the tube that carries urine from the bladder out of the body) and bladder becomes inflamed and irritated due to byproducts of infection (blood, white blood cells, bacteria). This irritation of the bladder wall causes the urge to empty the bladder frequently (called frequency). The amount of urine during each emptying is often smaller than the usual amount.
• Diabetes mellitus and diabetes insipidus: An early symptom of both type 1 and type 2 diabetes can be frequent urination, as the body tries to rid itself of unused glucose (blood sugar) through the urine. Diabetes can also damage the nerves that control the bladder, causing frequent urination and difficulty controlling your bladder
• Diuretic use: Medications used to treat high blood pressure or fluid buildup work in the kidney and flush excess fluid from the body, causing frequent urination.
• Prostate problems: An enlarged prostate (benign prostatic hyperplasia, or BPH) can press against the urethra and block the flow of urine, causing the bladder wall to become irritated. The bladder contracts even when it contains small amounts of urine, causing more frequent urination.
• Pregnancy: Hormonal changes and the growing uterus place pressure on the bladder causing frequent urination, even in the early weeks of gestation. The trauma from vaginal childbirth can also cause damage to the urethra.
• Stress incontinence: This condition occurs mostly in women. The involuntary release of urine during physical activity, such as running, coughing, sneezing, and even laughing is characteristic of stress incontinence.
• Interstitial cystitis: This condition is characterized by pain in the bladder and pelvic region, often leading to frequent urination.
• Stroke or other neurological diseases: Damage to nerves that supply the bladder can lead to problems with bladder function, including frequent and sudden urges to urinate.
• Bladder cancer: Tumors taking up space or causing bleeding in the bladder may lead to more frequent urination.
• Multiple sclerosis (MS): Bladder dysfunction, including frequent urination, can occur in at least 80% of MS patients. MS lesions can block or disrupt the transmission of nerve signals that control the bladder and urinary sphincters.
• Overactive bladder (OAB) syndrome: Often frequent urination is itself the problem. Involuntary bladder contractions lead to frequent and often urgent urination, even if the bladder is not full.
• Drinking too much: Ingesting more fluids than your body needs can cause the body to urinate more often.
• Artificial sweeteners, alcohol, caffeine, and other foods: Alcohol and caffeine can act as diuretics, which can cause more frequent urination. Carbonated drinks, artificial sweeteners (such as Splenda or Equal), and citrus fruits are known to irritate the bladder, causing more frequent urination.

Other causes of frequent urination include anxiety, bladder stones or kidney stones, urethral stricture (narrowing of the urethra), radiation exposure of the pelvis (as part of cancer treatment), diverticulitis, and sexually transmitted infections (STIs).

If you urinate more than eight times a day, you may have frequent urination issues.

Even though there are numerous causes for frequent urination, the symptoms are generally the same. Below are some terms that are used to describe symptoms that may accompany frequent urination.

• Frequency: Urinating more than eight times during the day or more than once overnight
• Hesitancy: Uncomplete evacuation of the bladder during each episode of urination. There may be a sudden stoppage of the urine flow due to spasms in the bladder or urethra or there may be difficulty starting the flow of urine
• Urgency: The uncomfortable feeling of pressure in the bladder that makes you feel you have to go "right now"
• Urinary incontinence: The inability to control the flow of urine, leading to either constant or intermittent accidental leakage
• Dysuria: Pain or burning sensation during or immediately following urination. This may be a sign of a urinary tract infection
• Hematuria: Blood in the urine can be in small amounts, clots, or very bloody. This will usually cause the urine to appear darker in color
• Nocturia: This is having to wake up to urinate. It can also be associated with nighttime urinary incontinence. (In children, this includes wetting the bed)
• Pollakiuria: Frequent daytime urination (often with small volumes)
• Dribbling: After finishing urination, urine continues to drip or dribble out
• Straining: Having to squeeze or bear down to initiate the urine stream

If frequent urination includes incontinence, nighttime urination (nocturia), or it otherwise interferes with your lifestyle, consult your doctor.

Seek emergency medical care if the following symptoms or signs accompany frequent urination:

• Fever
• Abdominal pain
• Back or side pain
• Bloody, dark, or cloudy urine
• Vomiting
• Chills
• Increased appetite or excessive thirst
• Fatigue
• Discharge from the vagina or penis or painful ejaculation

Your doctor will ask several questions to determine the cause of your frequent urination.

Your doctor will perform a physical exam and will ask you questions about your medical history and any medications you may be taking. Your doctor may ask the following questions:

• How many times in the day and night are you urinating?
• Are there changes in the color of your urine? Do you have light or dark urine?
• Do you have frequent pain, discomfort, or a burning sensation while urinating?
• Have you made any recent dietary changes?
• Do you have other symptoms (increased thirst, weight loss, fever, back pain)?

Your doctor may order any of the following tests, depending on the findings of the physical exam and medical history.

• Urinalysis and urine culture: These tests detect and measure various components of the urine. A urine culture can detect bacteria that may be the cause of a urinary tract infection (UTI).
• Ultrasonography: This noninvasive imaging test is used to visualize your kidneys and bladder to detect any structural abnormalities or tumors.
• Cystometry: This test measures the pressure inside the bladder and checks for the possibility of muscle or nerve problems that may cause frequent urination.
• Cystoscopy: This is an invasive test that allows a doctor to look at the inside of the bladder and urethra using a thin, lighted instrument called a cystoscope.
• Neurological tests: Diagnostic tests such as urodynamics, imaging, EEG, and EMG are procedures that help the doctor confirm or rule out the presence of a nerve disorder.

You can retrain your bladder over time.

If there is no underlying medical condition that requires treatment by a physician, there are things that can be done to reduce urinary frequency.

• Bladder retraining: This treatment is helpful for overactive bladder syndrome. It involves holding your urine for a slightly longer time than you usually do. The intervals are lengthened, often over the course of about 12 weeks. This helps retrain the bladder to hold urine longer and to urinate less frequently.
• Kegel exercises: These are exercises in which you contract and release the pelvic floor muscles. These are the muscles you use when you voluntarily stop and then restart the flow of urine. Toning these muscles can help improve bladder control and reduce urinary urgency and frequency. Squeeze for three seconds, then relax for three seconds. Repeat 10 to 15 times per session, and do this at least three times a day. Kegel exercises are only effective when done regularly.
• Modify your diet: Avoid foods that appear to irritate your bladder or act as a diuretic, including caffeine, alcohol, carbonated drinks, artificial sweeteners, tomato-based products, chocolate, and spicy foods. Eat a high-fiber diet, because constipation can worsen the symptoms of overactive bladder syndrome.
• Monitor fluid intake: Drink enough to prevent constipation and over-concentration of urine. Drink as little as possible four to five hours before bedtime to reduce or eliminate nighttime urination.

The treatment for frequent urination depends upon underlying cause:

• Urinary tract infection: The doctor will prescribe antibiotics to treat a UTI. Drinking plenty of fluids is recommended.
• Diabetes: When blood sugar levels get very high, frequent urination is often one of the first symptoms. Treatment for frequent urination in diabetics involves close management of blood sugar levels.
• Diuretic use: Ask your doctor if you can take your diuretics in the morning, or less frequently. This may cause fewer trips to the bathroom at night (nocturia).
• Prostate problems: Problems with the prostate are usually treated by a specialist called a urologist. There are two common drug types prescribed for enlarged prostate: 5ARIs (5-alpha-reductase inhibitors), which reduce the level of the hormone that causes the prostate to grow, and alpha-blockers, which relax the smooth muscle cells, including the bladder. Surgery may also be considered to treat prostate problems.
• Pregnancy: Frequent urination often accompanies pregnancy. There may not be much that can be done to reduce frequent urination, especially later in the pregnancy. Reduce consumption of diuretic fluids that contain caffeine, such as tea, soda, or coffee, however, do not reduce overall fluid intake, as it is important to stay hydrated while pregnant. Consume most fluids during the day to reduce nighttime trips to the bathroom. When using the bathroom, it may help to lean forward slightly to help completely empty out the bladder.
• Stress incontinence: Treatment includes behavior modifications such as weight loss and quitting smoking. Other treatment options include pelvic floor muscle exercises, pelvic floor stimulation, biofeedback, radio frequency energy treatment, topical estrogen, and in severe cases, surgery.
• Interstitial cystitis: This condition usually requires treatment by a urologist who specializes in interstitial cystitis. It may be treated medically with medications, including the drug pentosan polysulfate sodium (Elmiron), tricyclic antidepressants, pain medications, or antihistamines. Surgical treatment may be necessary.
• Stroke or other neurological diseases: Depending upon the cause, the urinary frequency may be treated with medication or behavioral therapy, such as bladder retraining (see below).
• Bladder cancer: Treatment for bladder cancer should be directed by a urologist. It may involve surgery, chemotherapy, and radiation.
• Multiple sclerosis: Treatment for urinary frequency that accompanies MS includes diet modifications, reducing fluid intake up to a few hours before bedtime, bladder training or planned voiding, medications, pelvic floor physical therapy, percutaneous tibial nerve stimulation (PTNS), intermittent self-catheterization (ISC), and other surgical interventions.
• Overactive bladder syndrome: The first-line treatment for overactive bladder syndrome usually involves bladder retraining (see below). Treatment also may include drugs such as tolterodine (Detrol LA), oral oxybutynin (Ditropan), darifenacin (Enablex), transdermal oxybutynin (Oxytrol), trospium (Sanctura XR), solifenacin (VESIcare), mirabegron (Myrbetriq), or onabotulinumtoxinA (Botox). Treatments that involve nerve stimulation include percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS).
• Artificial sweeteners, alcohol, caffeine, and other foods: Avoid foods and beverages that irritate your bladder or act as a diuretic.

Continued problems with frequent urination should be evaluated by your doctor and possibly a urologist.

• If medications are recommended, follow instructions given to you by your doctor.
• Report any problems or side effects from the medication to your doctor.
• If you are advised to do bladder retraining or modify your diet or other behavioral changes, follow all instructions from your doctor.

Because there are so many different causes for frequent urination, there is no one way to prevent it.

• Proper diet and avoiding excess fluids and foods that act as diuretics can reduce urinary frequency.
• Kegel exercises can keep the pelvic-floor muscles well-toned and may help stave off urinary frequency as you age
• Discussing any concerning symptoms with your doctor as soon as they appear may allow for early treatment or may prevent the worsening of symptoms.

Many of the causes of frequent urination are temporary and treatable. Treating the cause will reduce or eliminate the symptom of frequent urination.

American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090
Toll Free (U.S. only): 1-866-RING AUA (1-866-746-4282)
Phone: 410-689-3700
Fax: 410-689-3800
http://www.auanet.org/

Interstitial Cystitis Association
7918 Jones Branch Drive, Suite 300
McLean, VA 22102
Phone: 703-442-2070
Fax: 703-506-3266
http://www.ichelp.org/