Frequent urination: Causes, symptoms, and treatment

Many people live with frequent urination, known medically as frequency. When one urinates more than 3 liters a day of urine, this is known as polyuria. Often, there is often a simple cause that can be put right through treatment.

Frequency is not the same as urinary incontinence, where there is leakage of urine.

Sometimes, frequent urination can indicate a more serious condition. Early identification of the problem can lead to a timely and effective treatment and prevent complications.

What is frequent urination?

Urination is the way the body gets rid of waste fluids. Urine contains water, uric acid, urea, and toxins and waste filtered from within the body. The kidneys play a key role in this process.

Urine stays in the urinary bladder until it reaches a point of fullness and an urge to urinate. At this point, the urine is expelled from the body.

Urinary frequency is not the same as urinary incontinence, which refers to having little control over the bladder. Urinary frequency just means needing to visit the bathroom to urinate more often. It can occur alongside urinary incontinence, but it is not the same.

Most people urinate between 6 and 7 times over a 24-hour period.

Urinary frequency can be defined as needing to urinate more than 7 times in a period of 24 hours while drinking about 2 liters of fluid.

However, individuals differ, and most people only see a doctor when urination becomes so frequent that they feel uncomfortable. Children, too, have smaller urinary bladders, so it is normalfor them to urinate more frequently.

Possible causes

Urination is a complex process, involving various body systems. A range of changes can make the urinary system more active.

Lifestyle-based causes include drinking a lot of fluids, especially if they contain caffeine or alcohol. At night, this can interrupt the sleep cycle with urges to urinate. Frequent urination can also develop as a habit.

However, it can be a sign of kidney or ureter problems, urinary bladder problems, or another medical condition, such as diabetes mellitus, diabetes insipidus, pregnancy, or prostate gland problems.

Other causes or related factors include:

• anxiety
• diuretics, such as chlorothiazide, that make you urinate fluid from your body
• food and drinks that act as diuretics
• stroke and other brain or nervous system conditions
• urinary tract infection
• tumor or mass in the pelvic area
• interstitial cystitis, a type of inflammation of the bladder wall
• overactive bladder (OAB) syndrome, which causes involuntary bladder contractions that lead one to feel a sudden urge to have to urinate
• bladder cancer
• bladder or kidney stones
• urinary incontinence
• urethral stricture
• radiation of the pelvis, such as during cancer treatment
• colon diverticulitis, where small, bulging outpouching sacs develop in the wall of the large intestine
• a sexually transmitted infection (STI), such as chlamydia

Symptoms

One of the main symptoms of polyuria is urinating frequently. If there are other symptoms, they may indicate another, possibly more serious condition.

Nocturia, for example, is the need to urinate at night, during the sleep cycle. This can be a symptom of diabetes insipidus or diabetes mellitus.

Other symptoms that may need further attention include:

• pain or discomfort while urinating
• urine that is bloody, cloudy, or of an unusual color
• gradual loss of bladder control, or urinary incontinence
• difficulty urinating despite the urge
• discharge from the vagina or penis
• an increase in appetite or thirst
• fever or chills
• nausea or vomiting
• low back or side pain

If other symptoms are present, or if urinary frequency is affecting quality of life, it is a good idea to see a doctor.

Frequent urination can indicate a kidney infection, for example. Untreated, this can permanently damage the kidneys. In addition, the bacteria that cause the infection can potentially enter the bloodstream, infecting other areas of the body.

This can become life-threatening, and it needs attention.

Diagnosis

A doctor will carry out a thorough history and physical examination, asking the patient about frequency of urination and other symptoms.

They may ask about:

• the pattern of frequent urination, for example when it started, how things have changed, and what time of day it occurs
• current medications
• how much fluid is being consumed
• any changes in the color, smell, or consistency of the urine
• how much caffeine and alcohol the person consumes, and whether this has recently changed

Tests may include:

• urine analysis to identify any abnormality in the urine
• ultrasound, for a visual image of the kidneys
• a plain film X-ray or CT scan of the abdomen and pelvis
• neurological tests to detect any nerve disorder
• testing for STIs

A man or woman may be referred to a urologist, or a woman may be referred to a gynecologist.

Urodynamic tests

Urodynamic tests assess the effectiveness of the urinary bladder in storing and releasing urine, and they examine the function of the urethra.

Simple observations include:

• recording the time it takes to produce a urinary stream
• noting the amount of urine produced
• gauging the ability to stop urinating mid-stream

To obtain precise measurements, the health professional may use:

• imaging equipment to observe the bladder filling and emptying
• monitors to measure pressure inside the bladder
• sensors to record muscle and nerve activity

The patient may have to change their fluid intake or stop taking certain medications before the test. They may need to arrive at the clinic with a full bladder.

Treatment

Treatment will depend on the underlying cause.

If the consultation leads to a diagnosis of diabetes mellitus, treatment will aim to keep high blood sugar levels under control.

For a bacterial kidney infection, the typical course of treatment is antibiotic and painkiller therapy.

If the cause is an overactive bladder, a medication known as an anticholinergic may be used. These prevent abnormal involuntary detrusor muscle contractions from occurring in the wall of the bladder.

If needed, medication therapy will be prescribed and monitored by a physician.

Training in behavioral techniques may also help.

Bladder training and exercises

Other treatments address frequent urination rather than an underlying cause.

These include:

Kegel exercises: Regular daily exercises, often done around pregnancy, can strengthen the muscles of the pelvis and urethra and support the bladder. For best results, perform Kegel exercises 10 to 20 times per set, three times a day, for at least 4 to 8 weeks.

Biofeedback: Used alongside Kegel exercises, biofeedback therapy enables the patient to become more aware of how their body functions. This increased awareness can help the patient improve their control of their pelvic muscles.

Bladder training: This involves training the bladder to hold urine longer. Training usually lasts 2 to 3 months.

Monitoring fluid intake: This may show that drinking a lot at certain times is the main cause of frequent urination.

Prevention

Eating a balanced diet and maintaining an active lifestyle can help moderate the output of urine.

This may mean limiting alcohol and caffeine intake and cutting out foods that can irritate the bladder or act as a diuretic, such as chocolate, spicy foods, and artificial sweeteners.

Eating high-fiber foods can also help reduce constipation. This may indirectly improve urine flow through the urethra, as a constipated rectum can put pressure on the urinary bladder, the urethra, or both.