Frequent urination, where you feel an urge to pass urine more often than usual, is not just a a nuisance and a cause of poor sleep, it can be a symptom of an underlying medical condition. Polyuria is a medical term that refers to the excessive passing of urine (frequent urination).
Unfortunately many people soldier on, perhaps accepting it as something they have to put up with, or they don't think it is worth bothering the doctor about, or maybe they are scared it might signify something serious.
But often, when they seek diagnosis and treatment, patients find the cause is not serious or harmful, and it is possible to return to normal urinary habits.
For instance, frequent urination can result from drinking too many fluids, particularly those containing caffeine or alcohol. Pregnant women often have the condition, due to the enlarged uterus pressing on the bladder.
However, should it be the case that frequent urination is a symptom of something more serious, then there is even more reason to seek medical attention, because the sooner it is diagnosed and treated, the greater the chance of successful treatment.
This article first considers the nature of urination, and then some of the symptoms, causes, and treatments of frequent urination.
Urine and Urination
1. Urinary system:
2. Kidney, 3. Renal pelvis, 4. Ureter, 5. Urinary bladder, 6. Urethra. 7. Adrenal gland
8. Renal artery & vein, 9. Inferior vena cava, 10. Abdominal aorta, 11. Common iliac artery & vein
12. Liver, 13. Large intestine, 14. Pelvis
Urine is a waste product made in the kidneys. The kidneys spurt urine into the ureters which then pass it into the bladder, where it collects ready to be expelled from the body via the urethra.
Normal urine is a clear, transparent, amber-colored fluid made of urea, uric acid, and water. Some diseases cause other substances to appear in urine, such as sugar (diabetes), albumin (kidney disease), and bile pigments (jaundice).
The average person probably excretes about 5 to 8 cups or 1 to 1.8 litres of urine every 24 hours.
Urination or micturition is the process of expelling urine from the body. The process is complex and involves muscles of the bladder and sphincter mechanism, controlled by various nerve centers in the central and peripheral nervous systems.
For example, the bladder itself is mostly an intricate mesh of interlaced bundles of smooth muscle, known as the detrusor, that relaxes to fill the bladder, while the sphincter mechanism keeps the exit tightly shut and comprises slow twitch muscle fibers in the walls of the urethra, and some muscles that are also part of the pelvic floor.
During urination, the detrusor contracts to squeeze urine out of the bladder, and the sphincter mechanism relaxes, allowing smooth outflow of urine.
In infants and very young children, the process of urination is involuntary, and then gradually, by around 3 to 5 years of age, they have learned to control it and make it voluntary.
The nerve circuitry that controls urination is highly distributed and far from simple, involving far-reaching pathways on several levels. These are in the brain, the spinal cord, and the peripheral nervous system, and interact with many chemical messengers or neurotransmitters.
Research using brain imaging has revealed that in humans, parts of the brain normally associated with thinking and planning of complex behaviours and expression of personality, have strong and direct connections with circuits involved in urination, such as those that relax the sphincter and empty the bladder.
Frequent Urination and Associated Symptoms
Frequent urination is where you pass urine more often than usual. This can sometimes occur with urgent urination: a sudden, compelling urge to urinate, along with discomfort in the bladder.
Most people can sleep for 6 to 8 hours without having to urinate, but many have to get up in the night to relieve themselves. This frequent need to urinate at night is called nocturia, and is common in both men and women. By disturbing sleep, nocturia can significantly affect quality of life.
It is important to assess the underlying cause of nocturia, because chronic conditions, such as diabetes, can present in this way.
Frequent urination is not the same as urinary incontinence, which is where there is no voluntary control of bladder function, reminiscent of the infant's involuntary reflex. However,urinary incontinence can be a cause of frequent urination, and/or the two can occur together.
When doctors assess urinary symptoms, they try to distinguish among several possibilities, such as nocturia, daytime frequent urination, urinary incontinence, obstructive symptom (such as poor, intermittent stream or terminal dribble), and irritative symptoms (such as urgency, burning sensation).
There are also other considerations, such as when is the symptom not something to worry about? For instance, in men it is so common to have a little "leakage" at the end of the stream (the post-micturition dribble), that it does not count as an abnormality. Also, many women leak a little urine on coughing.
So one of the ways to decide if a seemingly harmless urinary symptom is an issue, is to establish the extent to which it impacts quality of life.
If urinary frequency is affecting your quality of life, or you also have other unexplained symptoms such as back or side pain, vomiting, fever, chills, fatigue, bloody or cloudy urine, or discharge from the vagina or penis, or an increase in appetite or thirst, then it is important to seek medical attention promptly.
For instance, one cause of frequent urination is kidney infection, and this requires prompt attention. If not treated, a kidney infection can permanently damage the kidneys, or the bacteria can infect the bloodstream and become life-threatening.
Causes of Frequent Urination
Urination is a complex process involving different muscle groups and types, and an intricate nerve network located in the brain and spine, and in and around the bladder. It is no wonder therefore that frequent urination can be a symptom of so many different diseases, conditions and disorders, both physiological and psychological.
The main thing to bear in mind is that if frequent urination is unexplained and persistent, then it could be a symptom of something serious. Some drugs, such as diuretics, can also produce this symptom.
Drinking too much fluid before bedtime, especially if it contains caffeine or alcohol, can cause frequent urination at nighttime.
Or frequent urination could simply be a habit, in which case it may still be advisable to eliminate other potential concerns.
The most common causes of frequent urination are diabetes, pregnancy and prostate problems.
Other causes of frequent urination include:
- Medication, for example diuretics,
- Stroke, or other brain or nervous system condition,
- Infection of the prostate gland (prostatitis),
- Enlarged prostate,
- Kidney infection,
- Tumor or mass in the pelvic area,
- Interstitial cystitis (inflammation of the bladder wall),
- Overactive bladder syndrome (unexplained, uncontrolled bladder contractions),
- Cancer of the bladder,
- Dysfunction of the bladder,
- Bladder stones,
- Urinary incontinence,
- Abnormal opening (fistula) in the urinary tract,
- Radiation of the pelvis, eg to treat cancer, and
- Diverticulitis (inflammation of diverticulosis, small, bulging sacs or pouches that can develop on the inner lining of the large intestine).
Seeing the Doctor
Because of the complexity of the process of urination, the cause of frequent urination can be neurological, physical, or, even psychological, so your doctor will need to perform a thorough diagnosis. To do this, he or she will carry out a physical exam, and ask questions to establish your medical history and gather information about the symptoms you are experiencing.
They may ask about:
- The pattern of frequent urination (when did it start, how does it compare with what you consider to be normal, is it happening during the day only, or night time only, or both?)
- Current medications.
- Any other symptoms.
- How much fluid you drink: is it more or less than usual?
- Whether you have noticed any changes in your urine (eg color, smell).
- How much caffeine and alcohol you consume and whether this has changed recently.
After considering your medical history, and depending on what he or she discovers in the physical exam, your doctor may ask you to undergo some tests, such as:
Your Doctor may ask you for a sample of urine
- Urine analysis: to determine whether any abnormal compounds are present.
- Imaging tests: to look inside the body.
- Neurological tests: to see if a nerve disorder is present.
- Urodynamic tests: to examine how well the bladder, sphincters, and urethra are storing and releasing urine.
Urodynamic tests range from simple observation to precise measurements using sophisticated equipment. Simple observations include for example recording the time it takes to produce a urinary stream, noting the amount of urine produced, and the ability to stop mid-stream.
Precise measurements include, for example, using imaging equipment to observe the bladder filling and emptying, using monitors to measure pressure inside the bladder, and using sensors to record muscle and nerve activity.
Most urodynamic tests do not need special preparation, though some may require you to make a change in fluid intake, or stop taking certain medications. You may also be asked to arrive at the clinic with a full bladder.
Treating Frequent Urination
The importance of seeing your doctor and getting a diagnosis is to establish the underlying cause of frequent urination. That will then decide the treatment.
For example, if the cause is diabetes, then the treatment will be for diabetes, the aim of which is to keep blood sugar under control. If the cause is a kidney infection, then the treatment usually comprises a course of antibiotics and possibly painkillers too.
If the cause is an overactive bladder, then there are several recommended medications, which in conjunction with behavioral techniques, can increase the chances of successful treatment. The most common medications are anticholinergics, which target the overactivity of the detrusor muscle. They should only be used under the direction of the prescribing physician and they can have side effects, such as dry mouth, constipation, blurred vision and confusion (in the elderly).
Other treatments include:
- Kegel exercises: these regular daily exercises strengthen the muscles of the pelvis and urethra and support the bladder. It is important to learn the correct technique and practise at the recommended frequency (at least 30 to 80 times a day for at least 8 weeks).
- Biofeedback: Used with with Kegel exercises, this helps improve awareness and control of pelvic muscles.
- Bladder training: the aim is to train the bladder to hold urine longer and thus urinate less often. It involves increasing the period between visits to the toilet to empty the bladder and is done gradually over two to three months.
- Monitoring fluid intake: for instance, it could be that drinking before bedtime is the main cause of frequent urination.
- Changing diet: to avoid foods that irritate the bladder or act as a diuretic, for instance caffeine, alcohol, chocolate, spicy foods, artificial sweeteners. Eating high-fiber foods can help reduce the constipation that worsens an overactive bladder.
Frequent urination can protect from bladder cancer
Researchers from the University of Huelva, Spain, found a direct association between how often people get up at night to urinate and protection against bladder cancer.
Humans generally have their longest interval between urinations at night, when they are asleep. How long carcinogenic agents, such as those from tobacco, remain in the bladder, constitutes a major factor towards the risk of developing bladder cancer, the researchers explained. Their study was published in the International Journal of Cancer.
The authors emphasized that it is best to avoid exposure to carcinogenic agents altogether (e.g. stop smoking).
According to their study, those who get up at night at least twice to urinate, reduce their bladder cancer risk by 40% to 59%. The protective effect of frequent urination is the same for both men and women and was not related to whether or not they smoked or how much water they consumed.