Frequent urination in adults is defined as voiding 8 or more times per day 1. The normal frequency of urination from the age 5 on is 4-7 times a day, including once at night 1,2.
Excessive urination or polyuria in adults is defined as passing more than 3 liters of urine per day 68. The normal daily (24-hour) urine volume in adults is 0.8-2 L 19.
Content: Causes of Frequent and Excessive Urination
A. FREQUENT URINATION
This section describes conditions with frequent urination (>7x/day) but the normal 24-hour urine volume (<2 L/day).
1. Clear Urine, No Pain
a) Conditions with increased pressure on the bladder:
- Abdominal bloating (intestinal gas) 3
- Abdominal tumors
- Abdominal adhesions (bands of scar tissue within the abdominal cavity), which can develop 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
- Medications: acetaminophen (paracetamol) 28, acetazolamide 31, amphetamine 32, chemotherapeutics 36, dopamine 30, gabapentin 34, ibuprofen 29
- Supplements: vitamin B3 8,24, vitamin C 25
- Illegal drugs: cocaine 33
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, carbonated and alcoholic beverages and certain food additives 15,17.
e) Incontinence due to neurological disorders (neurogenic bladder)
Neurological disorders that can cause incontinence and thus frequent urination include 18:
- Brain damage due to cerebral palsy, tumor, stroke, encephalitis, multiple sclerosis, Parkinson disease or Alzheimer disease
- Spinal cord damage due to birth defects, such as spina bifida, injury or spinal stenosis caused by herniated discs
- Damage to the peripheral nerves (polyneuropathy) due to long-term, heavy alcohol use, diabetes mellitus, vitamin B12 deficiency, pelvic surgery or syphilis
2. Cloudy Urine and Burning Urination
a) Urinary tract infections (UTIs) can cause frequent and burning urination, cloudy urine and other symptoms 7,8:
- Infection of the urethra (urethritis): smelly urine, 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
- 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
- Frequent urination, blood in the urine, cloudy urine or passing a stone
c) Kidney inflammation
Kidney inflammation (nephritis or glomerulonephritis) can present with frequent urination, foamy urine or blood in the urine (55).
d) Other causes of frequent and burning urination 6,15:
- Chemicals, for example, in soaps, bubble baths, scented toilet paper, tampons, contraceptive sponges and spermicides
- A foreign body, catheter or recent urological procedure
- Dehydration (frequent passing of small amounts of dark yellow or brown urine)
- Schistosomiasis (a parasitic disease common in Africa, South America and South Asia with fever, skin rash, blood and worms in the urine) 20
- Bladder cancer (lower central abdominal pain, frequent and burning urination and blood in the urine)
- Radiation therapy of the pelvic area 37
3. 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 the 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 avoid drinking in the evening.
4. Frequent Urination in Men
a) Prostate disorders
In men after 50, prostate enlargement (benign prostatic hyperplasia) can cause difficulty start to urinate (hesitancy), weak stream, feeling of incomplete bladder emptying, urine dribbling or sudden inability to urinate (urine retention) 39.
Prostate infection (prostatitis) or cancer can cause pain and tenderness in the area between the scrotum and rectum (perineum), lower back pain, burning urination, painful ejaculation, blood in the urine or semen and fever 65.
b) Sexually transmitted diseases (STDs)
Sexually transmitted diseases (gonorrhea, chlamydia) can cause itchy genitals, burning urination, rash on the penis, penile discharge or painful testicles few days or weeks after sex 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. Symptoms include 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) and epididymitis can cause 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 frequent urination, and blood in the urine or semen.
Interstitial cystitis, a rare inflammation of the bladder, can cause very frequent urination, bladder pain or pain in the scrotum or testicles.
5. Frequent Urination in Women
a) Common causes:
- Frequent douching (rinsing the vagina)
- Premenstrual syndrome (PMS) 64
- Menopause (atrophic vaginitis with the vaginal itch, painful sex) 60
- Vaginal yeast infection (vaginal thrush, candidiasis), often during treatment with antibiotics or steroids or taking birth control pills, or in diabetes mellitus (odorless, curd-like discharge) 49
- Sexually transmitted diseases, such as bacterial vaginosis, chlamydia, gonorrhea, trichomoniasis or genital herpes (vaginal discharge with strong odor, vaginal bleeding, blisters or red bumps on the vulva or in the vagina) 43,63
- Bladder or bowel endometriosis (pain in the lower abdomen during menstruation period) 66
- Ovarian cysts or cancer (irregular menstruation, vaginal bleeding, pain in the lower abdomen and pain during sex) 44,46
- Uterine cancer (vaginal bleeding between periods) 50
- Cervical cancer (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 on 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 the toilet or pelvic floor surgery. Symptoms may include urine leaking triggered by coughing, sneezing, rising, 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, discomfort, throbbing or spasms in the bladder.
e) Nonrelaxing pelvic floor dysfunction
Causes of nonrelaxing pelvic floor dysfunction include painful bowel or bladder conditions, such as irritable bowel syndrome (IBS), gait abnormalities, prolonged sitting and sexual abuse.
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, groin, and pain during urination or sex 56.
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 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.
6. Frequent Urination in Infants
Newborns normally urinate at least once the first day, 3-4 times per day in the next few days and 6 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.
Common causes of frequent urination in infants are urinary tract infections and genetic disorders, such as vesicoureteral reflux 53.
7. 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 in boys or girls 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 and usually resolve completely within 7-12 months 41.
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. Associated features include repeated squatting position and pressing the heel into perineum or crossing the legs in the 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 Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS), which is a type of obsessive-compulsive disorder (OCD) with jerky movements, unusual behavior and frequent urination 47. The condition usually resolves when the throat heals.
B. MODERATELY INCREASED URINATION
Causes of frequent urination with somewhat increased daily urine volume (2-3 L/day):
- 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) 88
- Alcohol (ethanol) 89
- Licorice (a natural product, not the artificial flavor), when ingested in large amounts 61
- The start of fasting, starving or a low-carbohydrate (ketogenic) diet 90
- Cold weather or hypothermia, which leads to “cold diuresis” (increased urination) 79,80
- Swimming, which leads to “immersion diuresis” (due to the water that puts pressure on the limbs causes constriction of the arteries,) 120
- Hyperventilation in severe anxiety or panic attack 83 or after arriving at high altitudes 84
- Kidney failure, which usually results in decreased urination (oliguria), but sometimes in increased urination 122
- High doses of calcium 22, vitamin B2 (riboflavin) 104 and vitamin C 78 supplements
C. EXCESSIVE URINATION or POLYURIA
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 water drinking due to a habit, “water diet,” “juicing,” alcoholism, bulimia nervosa or psychogenic polydipsia.
Diabetes mellitus 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 96,99. Sometimes, excessive urination and thirst are the only symptoms of diabetes mellitus.
c) Diabetes insipidus
Diabetes insipidus means passing large amounts of clear, tasteless urine 72.
Neurogenic or central diabetes insipidus
Certain brain disorders (tuberculosis, injuries, tumors, multiple sclerosis), brain surgery or irradiation, and anorexia nervosa can inhibit the release of the antidiuretic hormone from the pituitary gland and thus cause excessive urination 8,71, 103. Other symptoms include headache and craving for ice-cold water 91,103.
Nephrogenic diabetes insipidus
Nephrogenic means arising from the kidneys. In nephrogenic diabetes insipidus, kidneys do not respond to the antidiuretic hormone (ADH) and therefore produce excessive amounts of urine. Other symptoms may include lower back pain arising from the kidneys, tiredness and foamy urine. Causes include treatment with lithium, hypercalcemia 97, hypokalemia 99, chronic kidney failure 103, chronic kidney infection, Sjögren’s syndrome and surgery 17,23,71,94,103.
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 include constipation, food craving and increased sensitivity to light.
f) Benign tumors and cancers
Tumors and cancers that can cause excessive urination include lung cancer 70, breast cancer 103, tumors in the brain 21,71, parathyroid glands 6 or adrenal glands 105, leukemia and multiple myeloma 103.
Drugs that can cause excessive urination:
- 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, Chinese medicinal herbal mixtures containing aristolochic acid
- Illegal drugs: ecstasy (MDMA), phencyclidine
- References: 26,36,54,72,77,81,82,93,96,100,103,106,107
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
- 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 children is defined as urine output greater than 2 L/m2 of body surface per day or >1 L/day in preschool and >2 L/day in school children 113. Causes include:
a) Diabetes mellitus
- Transient diabetes mellitus of the newborn (TDMN), which spontaneously resolves within 4 months 86
- Diabetes mellitus type 1:
- “Usual” type: rarely, in the first year of life; more often in puberty 76
- Diabetes associated with hereditary disorders, such as hemochromatosis 30, cystic fibrosis 30 and Wolfram’s or DIDMOAD syndrome (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, Deafness) 95
b) Diabetes insipidus
Diabetes insipidus in small children can result from the same conditions as in adults but also from:
- Hereditary nephrogenic diabetes insipidus 103
- The head tumor called craniopharyngioma 103
c) Other causes of excessive urination in children:
A type of heart arrhythmia called paroxysmal supraventricular tachycardia can present with occasional pounding heart (palpitations), rapid pulse, chest tightness, anxiety, shortness of breath, dizziness and excessive urination 70.
Essential fatty acid (omega-3) deficiency may cause, thirst, excessive urination, dry hair, eczema and attention-deficit hyperactivity disorder (ADHD) 11.
Congenital kidney disorders with excessive urination in children include cystinosis, galactosemia, hereditary fructose intolerance, tyrosinemia and Wilson’s disease 100.
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