Frequent and Excessive Urination Definition
Frequent urination is defined as voiding 8 or more times per day 1. Frequent urination can be normal for someone who drinks a lot of fluid. When urination frequency increases despite the same amount of water consumed, it is often–but not always–accompanied by other symptoms, such as burning during urination or cloudy or smelly urine.
Excessive urination or polyuria in adults is defined as passing more than 3 liters of urine per day 68. Polyuria may be normal for someone who drinks a lot, but for someone who does not, it is usually a symptom of a serious health condition–in this case contact your doctor soon.
How often should you urinate?
From the age 5 on, urinating 4-7 times a day, including once at night, is considered normal 1,2.
A. FREQUENT URINATION
1. Clear urine without pain
2. Cloudy urine and burning urination
3. In men
4. In women
5. In infants
6. In toddlers and older children
7. At night (nocturia)
B. MODERATELY INCREASED URINATION (2-3 L/day)
C. EXCESSIVE URINATION or POLYURIA(>3L/day)
1. Causes of polyuria (>3 L/day)
4. Polyuria in children
A. FREQUENT URINATION
This section lists conditions with frequent voiding without the increase in 24-hour urine volume.
1. Clear Urine Without Painful Urination
a) Increased pressure upon the bladder:
- Abdominal bloating (intestinal gas) 3
- Abdominal tumors
- Adhesions–bands of scar tissue– after lower abdominal or pelvic surgery
Individuals with chronic anxiety may experience frequent urination “on and off” due to increased awareness of the bladder fullness 16.
c) Drugs and supplements
Examples of drugs that can trigger frequent urination without increase of daily urine volume: acetaminophen (paracetamol) 28 acetazolamide 31, amphetamine 32, chemotherapeutics 36, dopamine 30, gabapentin 34, ibuprofen 29, pilocarpine 23.
Illegal drugs: cocaine 33
Supplements: vitamin B3 8,24, vitamin C 25
Overactive bladder refers to a frequent urge to urinate without pain, sometimes also at night, without a known cause. Possible triggers include stress, smoking (nicotine), caffeine (tea, coffee, cola, energy drinks), acidic and spicy foods, fruit juices, chocolate, tomatoes, carbonated and alcoholic beverages and certain food additives, such as monosodium glutamate (MSG) 15,17.
e) Incontinence (neurogenic bladder)
Neurogenic bladder refers to urinary incontinence–inability to hold in urine–caused by neurological disorders.
- Underactive neurogenic bladder with stress incontinence, in which coughing, sneezing, laughing, lifting objects or exercise trigger occasional urine leakage.
- Overactive neurogenic bladder with urge incontinence, which means complete inability to hold in urine.
f) Migraine attack in a prodrome or headache phase 18,19
2. Cloudy Urine and/or Burning Urination
a) Urinary tract infections (UTIs)
- Infection of the urethra (urethritis); usually no fever
- Infection of the bladder (cystitis): central lower abdominal pain, fever and occasional blood in urine
- Kidney infection (pyelonephritis): fever, chills and flank pain 7,8
- Painful spasms in the right or left flank, abdomen or groin, which may last for several hours, often at night or early in the morning
- Blood in urine, cloudy urine or passing a stone 11,12,13
c) Kidney inflammation
Kidney inflammation–nephritis or glomerulonephritis–can present with frequent urination, foamy urine or blood in urine (55).
d) Other causes of frequent and burning urination:
- Chemicals, for example, in soaps, bubble baths, scented toilet paper, tampons, contraceptive sponges and spermicides
- A foreign body, catheter or recent urological procedures
- Dehydration — frequent passing of small amounts of concentrated–dark yellow or brown–urine
- Schistosomiasis–a parasitic disease common in Africa, South America and South Asia–can present with fever, skin rash, blood in the urine and stool, and worms in the urine 20.
- Bladder cancer can present with lower central abdominal pain, frequent and burning urination and blood in urine.
- Radiation therapy of the pelvic area can cause damage of the bladder lining followed by frequent urination 37.
- Other references: 6,15
3. Frequent Urination in Men
a) Prostate enlargement (benign prostatic hyperplasia)
In men after 50, prostate often enlarges and irritates the urethra. Symptoms can include difficulty start to urinate (hesitancy), weak stream, feeling of incomplete bladder emptying, urine dribbling or sudden inability to urinate (urine retention) 39.
Symptoms of prostate infection (prostatitis) or cancer: pain and tenderness in the area between the scrotum and rectum (perineum), lower back pain, burning urination, painful ejaculation, blood in urine or semen and fever 65.
b) Sexually transmitted diseases (STDs)
In sexually transmitted diseases (gonorrhea, chlamydia), symptoms can appear few days or weeks after sex and include itchy genitals, burning urination, rash on the penis, penile discharge or painful testicles 43,63.
c) Reactive arthritis or Reiter’s syndrome
Reactive arthritis usually develops in young men within 2-4 weeks after an infection of the urethra (chlamydia), intestine (food poisoning by salmonella) or respiratory tract, and can cause frequent urge to urinate, redness of the glans penis, red eyes, pain in the back, hip or knees due to the joint inflammation, low-grade fever, fatigue, rash and heel pain 48.
d) Other causes of frequent urination in men:
- Testicular torsion or inflammation (orchitis) or epididymitis can present with scrotal pain, tenderness, swelling and blue discoloration 9,48.
- Urethral scars (strictures) after an injury, surgery, bladder catheterization, irradiation or repeated infections may result in blood in semen or urine.
- Interstitial cystitis, an inflammation of the bladder, which is rare in men, can cause very frequent urination, bladder pain or pain in the scrotum or testicles.
4. Frequent Urination in Women
a) Common causes:
- Frequent douching (rinsing the vagina)
- Premenstrual syndrome (PMS) 64
- In menopause, estrogen deficiency can cause atrophic vaginitis with vaginal itch, painful sex, burning urination or urinary incontinence 60.
- Vaginal yeast infection (vaginal thrush, candidiasis), often during treatment with antibiotics or steroids or taking birth control pills, or in diabetes mellitus, can cause odorless, curd-like discharge and frequent urination 49.
- Sexually transmitted diseases, such as bacterial vaginosis, chlamydia, gonorrhea, trichomoniasis or genital herpes can cause symptoms within few days or weeks after sex: vaginal discharge with strong odor, vaginal bleeding, blisters or red bumps on the vulva or in the vagina, painful intercourse and burning urination 43,63.
- In bladder or bowel endometriosis, pain in the lower abdomen during urination and urinary urgency usually occur only during menstruation period 66.
- Ovarian cysts or cancer can cause irregular menstruation, vaginal bleeding, pain in the lower abdomen and pain during sex 44,46.
- Uterine cancer (endometrial cancer or uterine sarcoma) can present with vaginal bleeding between periods 50.
- Cervical cancer can cause pain and vaginal bleeding during or after sex 58.
NOTE: Ovulation by itself does NOT cause frequent urination.
- Frequent urination can be one of the early signs of pregnancy 45.
- The pressure of the uterus upon the bladder, especially in the 3rd trimester, can trigger frequent urination 8.
- Ectopic pregnancy can present with a missed period, lower abdominal pain and vaginal bleeding 52.
c) Loose pelvic floor muscles and stress incontinence
Loose pelvic floor muscles can result from multiple vaginal deliveries, menopause, chronic straining on toilet or pelvic floor surgery. Symptoms may include urine leaking triggered by coughing, sneezing, rising up, lifting objects, exercise or sexual intercourse, tampons falling out and reduced sensation in the vagina 62.
Loose pelvic floor muscles may result in slipping of the uterus down into vagina–uterine prolapse–with a sense of fullness in the vagina or tissues protruding out, which can further increase the urinary frequency 14.
Interstitial cystitis is an inflammation of the bladder without a known cause. Symptoms, usually in women after 30 (rarely in adolescent girls) can include extremely frequent (>50 x/day) or urgent urination, chronic lower abdominal pain, discomfort, throbbing or spasms in the bladder when it is filling and relief when it is emptying, pelvic pain, pain in the back, vulva (vulvodynia), groin or rectum, and pain during menstruation and sex.
e) Nonrelaxing pelvic floor dysfunction
Symptoms start insidiously at an early age, progress over the years and may include urinary urgency, constipation, pain in the pelvic floor, vulva (vulvodynia), clitoris, vagina, lower back, groin or upper thighs, pain during urination or during sex 56.
Causes include painful bowel or bladder conditions, such as irritable bowel syndrome (IBS), gait abnormalities, prolonged sitting and sexual abuse.
f) Pelvic congestion syndrome
In women 20-45 years of age, varicose veins in the pelvis due to repeated pregnancies or polycystic ovaries can cause pelvic congestion syndrome with frequent urination, pelvic pain that increases throughout the day when standing, or pain after intercourse, swelling and varicose veins in the vulva, buttocks and upper inner thighs and hemorrhoids (27).
5. Frequent Urination in Infants
Newborns normally urinate 3-4 times per day in the first few days and 10-15 times or more per day by the end of the first week 42. Infants (1-12 months) can normally urinate as often as 20 times per day 1,51.
Causes: urinary tract infections and genetic disorders, such as vesicoureteral reflux 53.
6. Frequent Urination in Toddlers and Older Children
Toddlers (1-4 years) normally urinate up to about 10 times per day and older children up to 8 times per day 1.
Frequent daytime urination or pollakiuria [Greek pollakis = often] refers to very frequent–every hour or even every 5 or 10 minutes–passing of small amounts of urine during the day and less often at night in boys or girls–most commonly around the age of 5 (the range: 3-14 years), usually WITHOUT pain or abnormal urine color or change in bowel habits. Symptoms usually disappear in few days or weeks, can reappear, but usually resolve completely in 7-12 months 41.
The cause is not known; triggers may include stress, bullying in school, increased bladder sensitivity in winter, chemical irritation of the urethra by soaps and increased calcium excretion with urine (hypercalciuria).
b) Overactive bladder
Overactive bladder in children can result from congenital disorders, such as cerebral palsy, spinal cord disorders or posterior urethral valves. In average, symptoms last for 2.7 years 67. Typical associated features include repeated squatting position and pressing the heel into perineum or crossing the legs in attempt to prevent urine leakage, constipation and fecal soiling 67.
c) Rare causes of frequent urination in children:
- Interstitial cystitis can cause pain in the bladder area and urinary urgency 57.
- A streptococcal infection of the throat (strep throat) can trigger PANDAS — Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus, which is a type of obsessive compulsive disorder (OCD) with jerky movements, unusual behaviour and frequent urination 47. The condition usually resolves after curing strep throat.
7. Urination at Night (Nocturia)
Nocturia means waking up at night more than once to pass urine 5,6. Most people with either frequent or excessive urination have to urinate at night more than once.
Enuresis is defined as bed-wetting after age of 5 in a child without any organic disease 1. Common causes include stress at home and school, night terrors, maturity delay and inappropriate toilet training 59.
Excessive Urination at Night (Nocturnal Polyuria)
In nocturnal polyuria, the 24-hour urine volume is normal, but more than 35% of it is produced during the nighttime resulting in frequent urination only at night 74.
- Excessive drinking or taking diuretics before bed
- Decreased secretion of the antidiuretic hormone at night 74 or high blood pressure 85 in elderly people
- Disorders with swollen legs (edema) in which the blood pooled in the leg veins during the day is redistributed toward the heart after lying down:
- Congestive heart failure 69
- Chronic kidney disease 74
- Low blood protein levels in liver or kidney disease 10
- Varicose veins 74
- Autonomic neuropathy in long-term diabetes mellitus, chronic alcoholism, systemic lupus erythematosus (SLE), multiple sclerosis or Parkinson’s disease 92,94
- Sleep apnea–repeated pauses in breathing during sleep–mostly in older obese men, and children with enlarged tonsils 35
- Alzheimer’s disease 74
To prevent or reduce urinating at night try to avoid drinking in the evening.
B. MODERATELY INCREASED URINATION (2-3 L/day)
Causes of frequent urination with somewhat increased daily urine volume:
- High-salt diet, mainly because of the associated high water intake 102
- Caffeine (in coffee, tea, cola, energy drinks), when consumed in single doses greater than 240-500 mg (for example, >2-5 cups of coffee) may stimulate urination in occasional but less likely in regular caffeine consumers 82,88.
- Alcohol (ethanol) 89
- Licorice–a natural product, not the artificial flavor–when ingested in large amounts 61
- In the first day or two of fasting, starving or a low-carbohydrate diet (ketogenic diet) 90
- In a cold weather or hypothermia, the arteries in the skin and limbs constrict, which leads to “cold diuresis” (diuresis means increased urination) 79,80.
- During swimming, the water that puts pressure upon the limbs causes constriction of the arteries, which leads to “immersion diuresis” 120.
- During pregnancy, glucose–even when its blood levels are normal–can get excreted into urine and pull water with it 187,101.
- Hyperventilation in severe anxiety or panic attack 83 or after arriving at high altitudes 84.
- Kidney failure usually results in decreased urination (oliguria), but sometimes in increased urination 22,122.
- High doses of calcium 111, vitamin B2 (riboflavin) 104 and vitamin C 110 supplements
C. EXCESSIVE URINATION or POLYURIA (>3L/day)
Excessive urination or polyuria in adults is defined as excreting of more than 3 liters of urine per day 68. A person who urinates excessively also urinates frequently.
Symptoms associated with polyuria:
- Excreting a large volume of urine each day, also at bedtime
- Excessive thirst, dry mouth and sudden weight loss due to dehydration
1. General Causes of Polyuria
a) Excessive drinking due to a habit, “water diet,” “juicing,” alcoholism, bulimia nervosa or psychogenic polydipsia.
Diabetes mellitus literally means passing large amounts of honey-sweet urine.
Excessive urination is an early symptom of diabetes type 1–usually with a sudden onset in childhood or early adulthood–or a late symptom of uncontrolled diabetes type 2–usually with a gradual onset after the age of 30 96. Other symptoms: increased or decreased hunger, fatigue, fruit-smelling breath and urine, itchy genitals and history of diabetes in the family 22,96,99. Sometimes, excessive urination and thirst are the only symptoms of diabetes mellitus.
c) Diabetes insipidus
Diabetes insipidus literally means passing large amounts of clear, tasteless urine 72.
Neurogenic or central diabetes insipidus
Certain brain disorders, such as tuberculosis, injuries, tumors, multiple sclerosis or brain surgery or irradiation, and anorexia nervosa, can inhibit the release of the antidiuretic hormone from the pituitary gland resulting in excessive urination that can develop overnight or gradually 8,71, 103. Other common symptoms include headache and craving for ice cold water 91,103.
Nephrogenic diabetes insipidus
Nephros in Greek means kidney. In nephrogenic diabetes insipidus, kidneys do not respond to the antidiuretic hormone (ADH) and therefore produce excessive amounts of urine. Other symptoms may include craving for ice cold water, lower back pain, tiredness and foamy or bloody urine.
Causes include treatment with lithium, hypercalcemia 97, hypokalemia 99, chronic kidney failure 103, chronic kidney infection, Sjögren’s syndrome and surgery 17,71,94,103,113.
Gestational Diabetes Insipidus
Gestational diabetes insipidus with excessive urination can develop in the third trimester of pregnancy, especially in women who carry two or more babies; it resolves spontaneously after delivery 75,87.
d) Kidney inflammation (nephritis)
- Acute nephritis with excessive urination, flank pain, fever and rash can develop within days to months after exposure to bacterial, viral, fungal (candida) or toxoplasma infection or as a side effect of certain drugs 77.
- Chronic nephritis can develop in polycystic kidney disease, hypertension, sarcoidosis, chronic analgesic abuse or heavy metal poisoning 77.
Some migraineurs experience excessive urination within hours to days before the headache attack 4. Other symptoms of the migraine prodrome may include constipation, food craving and increased sensitivity to light.
f) Benign tumors and cancers
Tumors and cancers that can cause excessive urination: lung cancer 70, breast cancer 103, brain tumors 71,103,113,115, tumor of the parathyroid glands 6, leukemia, multiple myeloma 103, tumors of the adrenal gland 105.
- If you take diuretics (water pills) and pass more than 3 liters of urine per day, visit a doctor who may change the type of diuretic or adjust its dose.
- Other medications: acyclovir, allopurinol, amphotericin B, captopril, chemotherapeutics, cimetidine, ciprofloxacin, cyclophosphamide, cyclosporine, demeclocycline, diazepam, epinephrine (adrenalin), ethambutol, foscarnet, gentamicin, isoniazid, lithium, mesalazine, metronidazole, omeprazole, orlistat, phenytoin, prednisone (and other steroids), ranitidine, rifampin, expired tetracycline, theophylline, trimethoprim-sulfamethoxazole, vancomycin
- Long-term abuse of nonsteroidal anti-inflammatory drugs (NSAIDs): aspirin, diclofenac, ibuprofen, indomethacin, naproxen
- Vitamin D overdose
- Herbs overdose: foxglove, savin oil plant, white bryony 78, Chinese medicinal herbal mixtures containing aristolochic acid 72,77
- Illegal drugs: ecstasy (MDMA), phencyclidine
- References: 26,36,78,81,93,96,100,103,106,107,108,109
h) Medical procedures
Excessive urination can persist for up to 24 hours after:
- Injecting a contrast substance into a vein in X-ray or CT investigations 78
- Hysteroscopy and urologic procedures that require irrigation with large amounts of fluids 3
- Resolution of the urinary tract obstruction (excessive urination can persist for few days or weeks) 103
2. Excessive Urination in Infants and Children
Excessive urination in infants, toddlers and older children is defined as urine output greater than 2 L/m2 of body surface per day 1.
a) Diabetes mellitus
- Transient diabetes mellitus of the newborn (TDMN) spontaneously resolves within 4 months 86.
- Diabetes mellitus type 1 often develops in puberty or, rarely, as soon as in the first year of life when symptoms include constantly wet diapers, widespread diaper rash and poor weight gain 76.
- Other causes of diabetes mellitus type 1 in infants and children: hemochromatosis 30, cystic fibrosis 30 and Wolfram’s or DIDMOAD syndrome (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, Deafness) 95.
- Diabetes mellitus type 2 in childhood is rare; it usually develops in obese children 12-16 years of age with the family history of diabetes 2 21.
b) Diabetes insipidus
- Hereditary nephrogenic diabetes insipidus 103
- A head tumor called craniopharyngioma 103
c) Other causes of excessive urination in children:
- A type of heart arrhythmia called paroxysmal supraventricular tachycardia with occasional pounding heart (palpitations), rapid pulse, chest tightness, anxiety, shortness of breath, dizziness and excessive urination 70
- Essential fatty acid (omega-3) deficiency, often in children with attention deficit hyperactivity disorder (ADHD); symptoms typically include hyperactivity, thirst, excessive urination, dry hair and eczema 112.
- Congenital kidney disorders: cystinosis, galactosemia, hereditary fructose intolerance, tyrosinemia and Wilson’s disease 100.
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