Most people do not think about how often they go to the toilet until it starts getting in the way of work, travel or sleep. Frequent urination during the day and getting up at night (nocturia) are among the most common urological complaints in both sexes, and they become more frequent with age.
Broken sleep leads to tiredness and poorer concentration, and in older people to a higher risk of falls. It is also often the first visible sign of a disease – of the prostate or bladder, but sometimes of the heart, kidneys or metabolism. That is why the cause deserves to be found, not hidden by drinking less water.
What frequent urination is
With a normal fluid intake most people pass urine about four to seven times a day and get up at night no more than once. Urination is considered frequent when the urges are clearly more than is usual for you and disrupt your daily life; nocturia is significant when you get up two or more times a night.
There are two mechanisms, and they often occur together. In the first, the bladder cannot hold a normal amount – its wall is irritated or overactive, or the outlet is narrowed and residual urine is left behind; the amounts passed are small. In the second, the body produces too much urine – around the clock (polyuria) or mainly at night (nocturnal polyuria); the amounts passed are large.
Symptoms
The accompanying signs point to the cause:
- small amounts, sudden urgent urges and sometimes leakage – typical of an overactive bladder;
- a weak stream and incomplete emptying in men – point to the prostate;
- burning, pain above the pubic bone and cloudy urine – signs of inflammation;
- large amounts and strong thirst – suggest polyuria, including from undiagnosed diabetes;
- swollen ankles in the evening and breathlessness when lying down – nocturnal polyuria can be linked to the heart.
You need emergency help, not a booked appointment, if you have a temperature with shivering and pain in the lower back together with the frequent urges (kidney inflammation), or if you cannot pass urine when your bladder is full. Painless blood in the urine, even once, means you should see a urologist as soon as possible, because it may be a sign of a bladder tumour.
Causes and risk factors
In men over 50 an enlarged prostate is checked first – it narrows the outlet and irritates the bladder, which then signals early. An overactive bladder is a common cause in both sexes. Cystitis causes a sudden increase in frequency with burning, while stones, tumours and chronic inflammation of the bladder cause persistent urges that do not respond to antibiotics.
Outside the urinary tract, frequent urination is caused by diabetes, by medicines (diuretics, especially when taken in the evening) and by drinking too much fluid, caffeine and alcohol. Nocturnal polyuria is typical in older people – with age the body releases less of the hormone that holds on to water at night, and fluid from swollen legs returns to the bloodstream when you lie down; heart failure, chronic kidney disease and sleep apnoea are also often behind nocturia.
Diagnosis
The most valuable tool is a bladder diary: for three days you write down when you pass urine and how much, and how much fluid you drink. This simple record shows whether the problem lies in the bladder’s capacity or in the amount of urine, and whether the night-time amount is excessive. You can read how to keep one in the tips on night-time urination.
During the consultation for urinary problems, Dr Penev goes through the diary, your medicines and any other conditions, and examines your abdomen and, in men, the prostate. A urine test rules out infection, blood and sugar, and blood tests rule out impaired kidney function and diabetes; PSA is tested when indicated. Ultrasound assesses the kidneys, bladder, prostate and residual urine, and in men with a weak stream uroflowmetry is added.
Treatment
Treatment is aimed at the cause, and there is no single medicine that works for everyone.
Changing habits
Cutting down on fluids two or three hours before bed, less caffeine, alcohol and salt, raising your legs for an hour in the afternoon or wearing compression stockings if you have swelling, treating constipation, regular sleep, and a time for taking diuretics agreed with the doctor who prescribes them. For an overactive bladder, bladder training is used – gradually lengthening the intervals between visits to the toilet – together with pelvic floor exercises.
Medicines and procedures
For an enlarged prostate, medicines are used that relax the bladder outlet or shrink the gland, and if they are not effective enough – endoscopic surgery at Kaspela University Hospital (UMBAL Kaspela), Plovdiv. For an overactive bladder, medicines that calm the bladder muscle are used, and in persistent cases botulinum toxin injections into the bladder wall. When nocturnal polyuria has been confirmed, in selected cases a medicine that reduces night-time urine production is prescribed, with strict monitoring of blood sodium, especially after the age of 65. Heart, metabolic and breathing causes are treated with the relevant specialist.
When to see a urologist
Seek a consultation if you have been passing urine much more often than usual for more than one or two weeks, if you get up two or more times a night, if the urges are sudden and hard to hold, or if you develop burning, blood in the urine, a weak stream, unusual thirst or weight loss.
Prevention
A balanced fluid intake during the day, moderate amounts of caffeine and alcohol, a healthy weight and normal blood sugar, treating constipation and a preventive prostate check after the age of 50 reduce the likelihood of urinary problems.
Frequent and night-time urination have a cause that in most cases can be found and treated. Book an appointment with Dr Penev in Plovdiv or Karlovo and bring a three-day bladder diary – this will make your first consultation more productive.
Frequently asked questions
Should I stop drinking water in the evening so that I don't get up at night?
It helps to drink most of your fluids by early afternoon and to cut down two or three hours before bed, but your total daily intake should not go down. Dehydration makes the urine concentrated and irritating, which also makes the urges stronger.
Can frequent urination be caused by nerves?
Yes, anxiety and stress make the urges more frequent even with a completely healthy bladder, and many people pass urine more often at stressful times. This is, however, a diagnosis of exclusion – the urine, the prostate in men and the residual urine must be checked first.
Why do I pass urine often but only a little at a time?
Small amounts show that the bladder signals it is full before it has filled up – typical of an overactive bladder, inflammation, a stone or an obstruction at the outlet. If the amounts are large, it is more likely that you are producing a lot of urine because of fluids, medicines or a metabolic condition.
Does nocturia only affect men?
No, it is just as common in women, but in women the causes are more often an overactive bladder, pelvic organ prolapse, the changes after the menopause and general factors such as swelling and poor sleep, while in men the prostate is the main concern.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.