Urination is an essential process by which the body rids itself of wastes and keeps bodily fluids in balance. Healthy men and woman typically empty their bladders about once every four to six hours. But some people—mostly overweight or obese people and older men—find themselves having to pee much more frequently. Those seemingly endless trips to the bathroom, especially at night (what doctors call nocturia) can be inconvenient and frustrating…and in rare instances, frequent urination is a symptom of serious illness.
To learn more about frequent urination—its causes and what can be done to stop it—Bottom Line Personal spoke with Aaron Katz, MD, chair of urology at NYU Langone Long Island.
Common causes of frequent urination and suggested treatments…
Enlarged prostate. For men, the problem typically arises when they reach their fifties or sixties, and in many cases, the cause of frequent urination is an enlarged prostate gland pressing against the bladder and urethra, the tube that carries urine through the penis and out of the body. The pressure makes it hard to fully empty the bladder, so the bladder quickly refills and the urge to go recurs.
An enlarged prostate often can be shrunk by the prescription drug finasteride or another of the 5-alpha reductase inhibitor drugs. These medications can cause side effects, including reduced sex drive and erectile dysfunction in addition to anxiety and depression. Other drug options include tamsulosin or another alpha blocker, medications that relax the prostate’s muscle tissue to lessen its pressure on the bladder.
When frequent urination is caused by an enlarged prostate and it can’t be controlled with medication, surgery may be needed. Depending on the severity and specific nature of the problem, different procedures may be used. In addition to surgical removal of the prostate, which can lead to urinary incontinence and a decline in sexual function, these include UroLift, a minimally invasive outpatient procedure in which clips are implanted in the prostate to widen the opening through which the urethra passes…and Rezum, another minimally invasive procedure in which water vapor is used to destroy excess prostate tissue. There’s also aqua ablation, in which high-pressure water jets inserted into the prostate are used to remove excess tissue—this procedure is done under anesthesia in a hospital setting.
The gold standard procedure in urology, used for more than 50 years, is a transurethral resection of the prostate (TURP). For the most part, the newer procedures have replaced TURP. Another procedure that could be used is a simple robotic prostatectomy, which is done under anesthesia using robotic technology to remove the part of the prostate that is obstructing the flow of urine.
Irritable, or overactive, bladder. An irritable bladder occurs when nerve damage, bladder stones (mineral deposits that form inside the bladder) or other factors cause a malfunction of the sheetlike muscle that controls urination. Injecting botulinum toxin (Botox) into the bladder often helps this condition. The FDA also has recently approved the use of posterior tibial nerve stimulation, a nonsurgical treatment in which an electrode positioned on the ankle helps retrain the bladder by stimulating the nerve that controls the release of urine. The treatment must be repeated periodically to maintain the effect.
Diuretics and other medications. Frequent urination also can be associated with the use of diuretics, often prescribed to treat high blood pressure, and certain other medications that increase urine production to rid the body of excess salt and water.
Overconsumption of water and other beverages—especially those with a diuretic effect, such as alcohol, coffee, tea and other caffeinated beverages. The solution here is obvious. Keeping a voiding or bladder diary also can help you and your doctor pinpoint the link between the volume and kinds of beverages you drink and your urinary frequency.
Urinary tract infection (UTI). The irritation and inflammation from the infection can cause the feeling that you need to urinate, even if the bladder is not full. UTIs are treated with prescription antibiotics.
Kidney stone lodged in the lower portion of one of the ureters, the twin tubes through which urine flows from the kidneys to the bladder. Kidney stones often pass on their own with the help of pain medication and extra fluids, although surgery sometimes is necessary.
Beware: In rare instances, frequent urination can be a symptom of stroke… Parkinson’s disease, multiple sclerosis or another neurological condition…or even neurological or bladder cancer. And especially when accompanied by extreme thirst, frequent urination can be symptomatic of diabetes.
Given all these possibilities, if you are urinating more often than usual, it’s best to be evaluated by a doctor. That’s especially important if you see blood in your urine or experience painful urination…or have a history of tobacco use or repeated exposure to organic solvents, diesel fumes and certain other chemicals. Medical evaluation of frequent urination commonly involves blood tests, ultrasound scans, rectal exams and urinalyses.
If you’re overweight or obese, weight loss can help ease urinary frequency by reducing pressure on the bladder.
Also helpful: Limit your consumption of liquids after supper…take an evening shower to warm the body and thereby curb the production of urine during sleep …and empty your bladder completely just before bedtime. Kegel exercises—contracting and releasing the muscles used to control the flow of urine—are sometimes recommended for curbing frequent urination, but they seem more effective for urinary incontinence, the involuntary leakage of urine. Saw palmetto and other herbal remedies are of limited benefit.
