Frequent Urge to Urinate—Causes and Treatment of an Overactive Bladder or Irritable Bladder

Urine produced in the kidneys accumulates in the bladder until it is full. It holds about 0.4 to 0.5 liters. As the bladder fills, a natural urge to empty it arises—the urge to urinate. Normally, this natural urge to urinate occurs in an adult

• up to six times a day and
• at most twice a night

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Frequent urination is defined as needing to urinate more than six times a day or twice at night © Satjawat | AdobeStock

Normal daily urine production and output depend on fluid intake. If you drink 2 liters a day, urine output is about 1.5 liters.

If daily urine output exceeds 2 to 3 liters, this is referred to as polyuria. This is a symptom of pathologically increased urine output.

Often, those affected then excrete only small amounts of urine

In general, one can speak of a pathologically increased urge to urinate if:

• you can no longer sleep through the night.
• you have to use the restroom significantly more often during the day than before.
• urination takes longer than usual.
• you notice that urine drips out afterward.
• you feel as though your bladder has not been completely emptied after urinating.
• You repeatedly feel a sudden and very strong urge to urinate.

Medical professionals distinguish between two forms of pathological, increased urinary urgency:

• Pollakiuria: Frequent urge to urinate, without an increase in the total amount of urine produced and excreted per day. Instead, there are frequent voids of small amounts of urine throughout the day.
• Nocturia: Increased urge to urinate, especially at night—that is, more than twice.

Increased urinary urgency primarily affects men aged 50 and older. For example, about one in three men over 50 complains of frequent and nocturnal urinary urgency.

In most cases, this increased urge to urinate is a sign of the onset of benign prostatic hyperplasia. It can begin as early as age 30 as part of the natural aging process.

Pathologically frequent urination can have various causes.

If the frequent urge to urinate is only occasional, possible causes include

• excessive fluid intake,
• excessive alcohol or coffee consumption, or
• taking diuretic medications—commonly known as “water pills.”

In addition, psychological strain and stress can also be the cause of an increased urge to urinate.

If the increased urge to urinate persists over the long term, it is often a sign of another underlying condition. Among the conditions that can cause an increased urge to urinate are, among others,

• diabetes mellitus,
• diabetes insipidus,
• Stage 3 acute kidney failure,
• prostatitis,
• uterine prolapse,
• an abnormally increased sensation of thirst (polydipsia), and
• impaired renal concentration ability (hyposthenuria).

Weak pelvic floor muscles can also lead to an increased urge to urinate. Childbirth or being overweight can weaken the pelvic floor muscles.

A frequent urge to urinate that occurs more frequently at night—that is, while lying down—may be caused by

• a bladder infection or
• benign prostatic hyperplasia (prostatic hypertrophy)

be responsible. Causes of an increased urge to urinate without increased urine production and output (pollakiuria) include

• prostate disorders,
• so-called overactive bladder, and
• the early stages of pregnancy

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To determine the appropriate treatment, the doctor must first identify the condition or cause behind the frequent urge to urinate. This begins with a medical history interview, during which the doctor asks the patient about their symptoms. It might go something like this:

• When and in what situations do you feel the urge to urinate?
• Does the urge to urinate occur only at night or also during the day?
• How often do you feel the urge to urinate?
• Has your daily urine output increased?
• What did you eat or drink beforehand?
• What medications did you take beforehand?

In addition, a voiding diary can help determine the causes. In the voiding diary, the patient records when and in what situations the urge to urinate occurs.

Furthermore, blood and urine tests are useful for diagnosing an increased urge to urinate. These tests measure, among other things, blood sugar levels, electrolyte concentrations, and creatinine levels.

Imaging procedures, such as

• ultrasound examinations of the urinary tract and the prostate, and
• a cystoscopy,

can be used to diagnose frequent urination.

The treatment of pathologically frequent urination depends on the underlying causes. If frequent urination is caused by another underlying condition, it is necessary to treat that specific condition.

If there are no organic causes, bladder training may help in some cases. In this approach, the patient consciously tries to suppress or regulate the urge to urinate. This allows the bladder to gradually readjust to larger volumes of urine.

Psychologically induced urinary urgency can be treated with psychotherapy or relaxation techniques. Possible therapies include

• autogenic training or
• progressive muscle relaxation.

Several effective over-the-counter medications are also available to treat frequent or nighttime urination. With their help, those affected can reduce, suppress, or better control the urge to urinate.

These include, among others,

• so-called anticholinergics and antispasmodics, which reduce the bladder muscles’ tendency to contract, or
• active ingredients derived from saw palmetto berries and stinging nettle roots, which both reduce the urge to urinate and improve control over it.

For men, alpha-blockers—which relax the muscle cells of the prostate—are also a good option. For women, taking estrogen can help suppress the urge to urinate.

What is frequent urination
? Frequent urination refers to the repeated need to urinate, both during the day and at night, even though the bladder is not yet fully filled or only small amounts of urine are passed.

What are the possible causes of frequent urination?
The most common causes include an overactive bladder, an irritable bladder, benign prostatic hyperplasia in older men, neurological disorders, diabetes mellitus, psychological factors, as well as the use of diuretics or increased fluid intake.

When should you see
a doctor for frequent urination? You should see a doctor if the urge to urinate occurs suddenly, is constant, disrupts sleep at night, is accompanied by pain or a burning sensation during urination, or if the symptoms are progressively worsening.

How is frequent urination treated
? Treatment depends on the specific causes and may include bladder training, adjusting fluid intake, medication, or, if necessary, targeted treatment of the underlying condition.