Frequent Urination

In most people the bladder is able to store urine until it is convenient to go to the toilet, typically 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 could mean you’re drinking too much and/or too close to bedtime. Or it could signal a health problem.

Frequent urination can be a symptom of many different problems. When frequent urination is accompanied by a fever, an urgent need to urinate, and pain or discomfort in the abdomen, you may have a urinary tract infection. Other possible causes of frequent urination include:

  • Diabetes
  • Pregnancy
  • Prostate problems
  • Interstitial cystitis
  • Diuretic use
  • Stroke or other neurological diseases

Less common causes include bladder cancer, bladder dysfunction, and radiation therapy.

Often, frequent urination is not a symptom of a problem, but is the problem. In people with overactive bladder syndrome, involuntary bladder contractions lead to frequent and often urgent urination, meaning you have to get to a bathroom right now – even if your bladder is not full. It may also lead you to wake up once or more during the night to use the bathroom.

Diagnosing the Cause of Frequent Urination:

If urinary frequency interferes with your lifestyle or is accompanied by other symptoms such as fever, back or side pain, vomiting, chills, increased appetite or thirst, fatigue, bloody or cloudy urine, or a discharge from the penis or vagina, it’s important to see your doctor.

To diagnose the cause of frequent urination, your doctor will perform a physical exam and take a medical history, asking questions such as the following:

  • Are you taking any medications?
  • Are you experiencing other symptoms?
  • Do you have the problem only during the day or also at night?
  • Are you drinking more than usual?
  • Is your urine darker or lighter than usual?
  • Do you drink alcohol or caffeinated beverages?

Depending on the findings of the physical exam and medical history, your doctor may order tests, including:

  • Urinalysis – the microscopic examination of urine that also involves a number of tests to detect and measure various compounds that pass through the urine.
  • Cystometry – a test that measures the pressure inside of the bladder to see how well the bladder is working; cystometry is done to determine if a muscle or nerve problem may be causing problems with how well the bladder holds or releases urine.
  • Cystoscopy – a test that allows your doctor to look at the inside of the bladder and urethra using a thin, lighted instrument called a cystoscope.
  • Neurological Tests – diagnostic tests and procedures that help the doctor confirm or rule out the presence of a nerve disorder.
  • Ultrasonography – a diagnostic imaging test using sound waves to visualize an internal body structure.

Treatment for Frequent Urination:

Treatment for frequent urination will address the underlying problem that is causing it.  For example, if diabetes is the cause, treatment will involve keeping blood sugar levels under control.

The treatment for overactive bladder should begin with behavioral therapies, such as:

  • Bladder retraining – this involves increasing the intervals between using the bathroom over the course of about 12 weeks. This helps retrain your bladder to hold urine longer and to urinate less frequently.
  • Diet modification – you should avoid any food that appears to irritate your bladder or acts as a diuretic. These may include caffeine, alcohol, carbonated drinks, tomato-based products, chocolate, artificial sweeteners, and spicy foods.  It’s also important to eat high-fiber foods, because constipation may worsen the symptoms of overactive bladder syndrome.
  • Monitoring fluid intake – you should drink enough to prevent constipation and over-concentration of urine, but you should avoid drinking just before bedtime, which can lead to nighttime urination.
  • Kegel exercises – these exercises help strengthen the muscles around the bladder and urethra to improve bladder control and reduce urinary urgency and frequency. Exercising pelvic muscles for five minutes three times a day can make a difference in bladder control.

Treatments may also include drugs such as tolterodine extended-release (Detrol LA), oxybutynin (Ditropan), darifenacin (Enablex), oxybutynin skin patch (Oxytrol), mirabegron (Myrbetriq), trospium extended-release (Sactura XR), imipramine (Tofranil), and solifenacin (Vesicare).  Oxytrol for women is the only drug available over the counter.

There are other options for those that do not respond to lifestyle changes and medication.  The drug Botox can be injected into the bladder muscle causing the bladder to relax, increasing its storage capacity, and reducing episodes of leakage.

PTNS (percutaneous tibial nerve stimulation) is a minimally invasive way to improve bladder control in men and women.  Patients sit comfortably  with a slim needle electrode temporarily placed near the ankle.  A device is attached to the needle and delivers mild electrical impulses which travel up the nerves in the leg to the nerves that control the bladder.

Several types of surgery are also available.