Urinary frequency means urinating more often than normal. So what is normal? No one knows for sure but the average is probably around 4 to 8 times per 24 hour day – so urinary frequency is urinating more than that. Frequent urination is influenced by three things – how much urine your kidneys produce, how much urine your bladder can hold (bladder capacity) and for lack of a better word, psychosocial considerations.
The volume of urine made by the kidneys depends almost entirely on intake of fluid and food (remember food is usually 60 – 90% water). Bladder capacity refers to the maximum volume that a patient can comfortably hold. Psychosocial factors also play a major role in the frequency of urination, especially in New York City, where we work. Many of our patients carry plastic water bottles with them all the time and drink an awful lot of water, sometimes voiding in excess of 4 liters a day. These patients also urinate very frequently! Other patients drink a lot because they are on diets and were told that it’s good to drink a lot when you are on a diet.
The evaluation starts with a careful medical history and questionnaire focusing on your diet and urinary patterns. You are also asked to keep a bladder diary recording the time and amount of each urination and any associated symptoms. This is best done with our diary app. On the first visit we perform an examination based on the specific set of symptoms and do tests on your urine to look for any signs of an infection. We also evaluate your urinary flow to look for a blockage.
If the urinalysis and culture are negative and there are no obvious causes of your symptoms, the next step depend almost entirely on your bladder diary. It’s always a surprise to see how much information can be gained simply by recording how much you urinate (you need a measuring cup), what time you urinate and why you urinate (for example, out of convenience or because you had a strong urge to go). We see many patients for second or third opinions who have had unnecessary surgeries or had been taking useless medications when a simple urinary diary would have sufficed to make a diagnosis and direct the appropriate treatment. The diary might show, for example, that you are urinating a lot because you drink too much fluid in which case the only treatment is to drink less! Or, it might show your bladder doesn’t hold a lot of urine, which might mean that you need further tests to figure out why.
If you are drinking too much fluid, drinking less may not be so easy. The easiest way to cut back is to drink according to thirst, but fill the glass half way up each time. If you are still thirsty after a half cup, you should fill the next one half way and so on. Then repeat your diary on this schedule to see if there has been improvement. If that is successful, you are done. If not, you might need an evaluation to look for other causes such as diabetes or other problems with hormones. Sometimes, patients who have been accustomed to drinking a lot can have a difficult time changing their behavior and a formal course of behavior modification might be necessary.
If the diary shows that your bladder does not hold enough, then you need an evaluation to know why. First a urine test to check for infection or blood cells should be done. Other causes include a dropped bladder (pelvic organ prolapse).
Women usually urinate more often during pregnancy because their bladders don’t hold as much, probably because of the weight of the uterus pushing on the bladder. Other conditions, such as radiation treatments to the lower abdomen, multiple operations on the bladder, and interstitial cystitis also greatly reduce the capacity of the bladder. Neurologic problems such as multiple sclerosis, stroke and spinal cord injury also reduce the capacity of the bladder.
The treatments for these problems are different but most of these conditions that cause a small bladder capacity can be either cured or substantially improved. If your urinary frequency bothers you enough you should start with a voiding diary then get an expert opinion with Dr. Blaivas at Urocenter.Request an Appointment