People usually urinate about four to eight times a day. When you’re feeling the urge more often, the cause could be obvious. Maybe you’re drinking a lot of water or too much alcohol. You might avoid drinking before bedtime if you’re waking up to pee.
But sometimes frequent urination becomes embarrassing or bothersome — and the fix isn’t obvious. You may have another health issue.
A “UTI” typically comes with pressure in the abdomen and a burning sensation when you urinate, and sometimes a fever. You may be able to flush out the bacteria by drinking lots of water; some people swear by drinking unsweetened cranberry juice. Others take D-Mannose, a simple sugar that occurs naturally in many plants, including cranberries. If your infection continues, you’ll probably need an antibiotic.
If you get a UTI twice in a year or more often, you may hear the advice to drink unsweetened cranberry juice regularly. There’s some evidence to support this for pre-menopausal women, and other evidence backing D-Mannose. Older women may need to take estrogen through the vagina (rather than an oral pill). Another approach is daily low-dose antibiotics, or taking antibiotics after sexual intercourse.
People who don’t have an active painful infection but urinate frequently may have an ongoing low-level imbalance in the bacteria in the vagina.
The body tries to dispose of extra glucose through the urine. When you’re urinating often and in great quantity, you may be seeing an early sign of either type 1 or type 2 diabetes. High blood-sugar levels have been linked to both bladder and vaginal yeast infections and erectile dysfunction.
Ask for a check of your blood sugar levels. For the fasting plasma glucose test you’ll give blood in the morning before breakfast. Normal blood sugar is up to 99 milligrams per deciliter (mg/dL). Blood sugar from 100 to 125 mg/dL is considered a sign of prediabetes, which should be taken seriously. If your blood sugar is 126 mg/dL or higher, you’re likely a diabetic.
Another measure is the hemoglobin A1C test, which looks at your average glucose level over three months. An A1C level of 6.5 percent or higher on two separate occasions indicates you have diabetes. A result between 5.7 and 6.4 percent is considered a sign of prediabetes. Estimates vary, but as many as 70 percent of people with prediabetes may become diabetic. The good news: improving your diet, losing weight, and exercising can lower your risk dramatically. For example, losing 11 pounds on average cut the risk of becoming diabetic 55 percent in one large study; even losing around 6 pounds made a difference. Exercising at least 150 minutes a week at moderate intensity cut the risk by 46 percent. Metformin, a common diabetes medication, can cut your risk by 40 percent.
Medications for high blood pressure or fluid buildup may cause frequent urination. Caffeine, alcohol, antihistamines like Allegra and Claritin, and other drugs, like diuretics, can make you urinate more.
An enlarged prostate, a condition called benign prostatic hyperplasia, may press against the urethra, which carries urine out the body, and block the flow. The bladder wall reacts by contracting even when the bladder contains only small amounts of urine.
This might be a tumor. You’ll need help from an urologist.
Mental decline may interfere with signals from the bladder to the brain.
Some people don’t just urinate frequently. They get involuntary bladder contractions that can interfere with their lives. They may feel the urge suddenly and leak urine before they reach a toilet. The urge may wake them up two or more times during the night.
If you can’t empty your bladder completely when you do urinate, it may become overactive. Constipation can trigger the problem as well.
Some women find that they pee involuntarily when they exercise, especially if they are overweight. Bladder problems can also be a complication of pregnancy.
Before you go to your primary care doctor, you might keep a diary for three or more days, noting when, how much, and what you drank; when you urinate; and any accidents.
A specialist might request an ultrasound scan of your bladder, a procedure in which you urinate into a “uroflowmeter” to measure the volume and speed, or a bladder-pressure test that involves a catheter that fills your bladder with warm water while another catheter records the pressure from your vagina or rectum.
Treatment can include pelvic floor exercises, often called “Kegels” after the doctor who invented them. If you can contract your muscles, you can work at “bladder training,” teaching yourself to delay urinating. You might start with a delay of a half hour after you first feel the urge. Another technique is to wait a few minutes after urinating and then try to urinate again — to make sure you completely empty your bladder. Some people use a catheter periodically.
You can also set up a schedule of going to the toilet every two or four hours, rather than waiting for the urge.
You may need to limit the fluids you drink and when you drink. Some people do best if they cut out all caffeinated beverages and alcohol. You may need to lose weight. Wearing absorbent pads or underwear will protect your clothing and avoid embarrassment so you can go to the gym and drink in a restaurant.
Medications, surgery, and nerve stimulation are possibilities for difficult cases.
May 18, 2016
Christopher Nystuen, MD, MBA