Frequent urination

Your body gets rid of waste fluids through your urine. Urine is made of water, urea and uric acid, as well as toxins and waste that your kidneys filter out. Urine is stored in your bladder until your bladder is full and you have the urge to urinate.

Frequent urination is different to urinary incontinence. Urinary incontinence is when you have reduced control over your bladder. Urinary incontinence can occur alongside frequent urination. 

Depending on how much you eat, drink and sweat, most people, on average, urinate six or seven times in 24 hours. Frequent urination is when you: 

• Feel that you need to urinate when you have only just been
• Often have to urinate urgently 
• Suddenly need to urinate a lot more often for no obvious reason ie more than seven times in 24 hours having drunk around two litres of fluid

If you need to urinate more than seven times every day or have to wake up in the night to urinate, you may be drinking too many fluids and/or drinking too close to bedtime. 

If you pass more than three litres of urine every day, you have polyuria. Polyuria usually has a cause that can be easily treated, although sometimes it may indicate a more serious condition. The sooner you have a diagnosis and get treatment, the less likely you are to develop complications. 

Needing to urinate often is a symptom that affects both men and women and becomes more likely from middle age onwards.

In men, an enlarged prostate, prostate cancer or prostatitis (inflammation of the prostate gland) can cause frequent urination by pushing against the urethra. This blocks urine flow, which irritates the bladder, causing it to contract even when the bladder is not full, resulting in frequent urination.

In women, frequent urination can be caused by: 

• Anterior prolapse (cystocele) — when the bladder bulges into the front wall of your vagina
• Pregnancy — this puts added pressure on your pelvic floor muscles and can make it harder to control your bladder
• Uterine fibroids (non-cancerous growths in and around your womb)
• Vaginitis (inflammation of the vagina) 

Other underlying conditions that affect men and women which can cause frequent urination, include:

• Diverticulitis — the formation of pouches in the lining of your intestines that become inflamed 
• Hypercalcemia ie elevated blood calcium levels — causes include inactivity, overactive thyroid glands (hyperthyroidism), sarcoidosis, tuberculosis and cancer (eg breast, kidney and lung cancer, and multiple myeloma)
• Neurological problems, for instance, a stroke, Parkinson’s disease or multiple sclerosis can all affect your nervous system, including the nerves that control your bladder
• Radiation treatment of the pelvis eg to treat cancer
• Sexually transmitted infections (STIs) eg chlamydia 
• Type 1 diabetes or type 2 diabetes — an early symptom is frequent urination and a large volume of urine; this occurs because your body is trying to remove excess glucose in your blood

Diuretics (eg chlorothiazide) used to treat high blood pressure or to flush out excess fluid can also cause frequent urination. Caffeine and alcohol, which act as diuretics, can make you urinate more frequently too.

You may also feel the need to urinate more often if you are feeling anxious as your body’s natural stress response tries to eliminate waste to deal with a challenge.

Conditions affecting your urinary system

Sometimes frequent urination is caused by conditions directly affecting your urinary system instead of another health problem. Conditions include: 

• Interstitial cystitis — painful inflammation of your bladder
• Kidney stones or bladder stones
• Overactive bladder syndrome — when involuntary contractions of your bladder make you suddenly need to go to the toilet urgently and often, even when your bladder is not full; it can also wake you up at night to go to the toilet
• Problems with the detrusor muscles in your bladder wall that cause them to contract too often — this can be caused by certain medications, as well as:
• Bladder tumours or tumours in your pelvic area
• Constipation
• Drinking too much alcohol or caffeine
• Neurological conditions
• Not drinking enough fluids causing concentrated urine that irritates your bladder
• Urinary tract infections (UTIs) or other conditions affecting the urethra and bladder
• Urethral stricture
• Urinary incontinence

Urinary tract infections (UTIs), which can often cause frequent urination, can affect your bladder, kidneys or urethra (the tube that takes urine from your bladder out of your body). Other UTI symptoms include:

• Blood in your urine
• Cloudy or smelly urine
• Feeling unwell
• Pain in your lower abdomen or around your side or back
• Pain or burning when urinating

Frequent urination is often a symptom of polyuria (passing more than three litres of urine in 24 hours). If you frequently need to urinate at night (nocturia) you may have type 1 or type 2 diabetes.

Other urinary symptoms associated with frequent urination include: 

• Cloudy, bloody or unusually coloured urine
• Difficulty urinating even though you have the urge to urinate
• Pain or discomfort while urinating
• Urinary incontinence

You may also experience: 

• Discharge from your vagina or penis
• Fever or chills 
• Increased appetite or thirst
• Nausea or vomiting
• Pain on your sides or lower back

If you notice any of these symptoms or frequent urination is reducing your quality of life, see your GP. You may have a kidney infection, which if left untreated can permanently damage your kidneys. An untreated kidney infection could also spread to your bloodstream or other areas of your body. 

See your GP if you need to urinate more often than usual with no obvious explanation.

They will ask about your medical history, how often and when you urinate, when your symptoms started and whether they have changed. They will also ask you about any medications and supplements you are taking, any changes in the colour, consistency or smell of your urine, how much fluid you drink, including alcohol and caffeine, and if this has changed recently. 

They may also perform a physical examination. In men, this may include inserting a gloved finger into your bottom to check for a possible enlarged prostate.

They may also refer you for the following tests:

• A cystoscopy, which involves inserting a thin, flexible tube through your urethra and into your bladder to check for potential problems
• Blood tests to check the function of various organs
• Neurological tests to detect nerve disorders 
• Sexual health testing
• Urine tests to check for infections
• X-rays or scans to see inside your body — this may include an ultrasound scan of your kidneys

Treatments to stop frequent urination will vary, according to the cause of the problem. They may include:

• Antibiotics for bacterial infections
• Botulinum toxin injections into your bladder muscle to relax it — this will increase how much urine your bladder can hold and reduce urine leakage
• Changing a prescription medication if the cause is a side effect of a particular drug
• Drug or surgical treatments for specific conditions such as an enlarged prostate, diabetes, kidney stones, bladder stones, neurological problems or cancer
• Lifestyle changes and bladder training to improve control — bladder training can take two to three months
• Surgery to implant nerve stimulators under your skin — this can be used to stimulate the nerves that control your pelvic floor or control contractions of tissues within your pelvic floor

Exercises can also help, such as regular Kegel exercises, which are designed to strengthen the muscles of your pelvis and support your bladder. These exercises should be done in sets of 10-20, three times per day for four to eight weeks before you’ll notice an improvement. 

Biofeedback therapy can also help you become more aware of your bodily functions and improve your bladder control. 

Drug treatments include darifenacin, desmopressin acetate, imipramine, mirabegron, oxybutynin, oxybutynin skin patch, solifenacin, tolterodine extended-release and trospium extended-release.

To help maintain a moderate volume of urine so you don't need to urinate too frequently, it is important to: 

• Avoid drinking fluids just before bedtime 
• Avoid drinking too much alcohol or caffeine
• Avoid eating foods that are diuretics or irritate the bladder eg chocolate, foods containing artificial sweeteners and spicy foods
• Eat a balanced diet high in fibre to avoid constipation — if you are constipated, backed up stools in your rectum can apply pressure on your bladder and/or urethra
• Stay active