Urinating Frequently

WHEN TO SEE YOUR DOCTOR

* Frequent trips to the bathroom are still necessary even though you've cut back on liquids and bladder stimulants.

* The number of bathroom visits you need interferes with normal work, travel or sleep.

* Frequency is accompanied by an almost constant urge to urinate.

* You have pain or burning when you urinate.

What Your Symptom Is Telling You

You guzzled a cup of coffee to wipe the sand from your groggy eyes when you awakened. You gulped another along with orange juice and milk before you left for work. Then there was that diet soda later that morning, along with some sips of water every time you passed the fountain. You chased down lunch with a can of soda and had another java jolt later in the afternoon as a pick-me-up. During dinner, maybe you had a large glass of milk or water. And don't forget that evening beer in front of the TV.

Do you still wonder why you go to the bathroom so often?

There's no standard for how frequently you should go to the bathroom, urinary experts say. Urinary frequency varies from person to person, even from day to day.

Kidney stimulants and bladder irritants are the most common cause of frequent urination, according to Allen D. Seftel, M.D., an assistant professor of urology at University Hospitals of Cleveland. Caffeine and alcohol top the list. That's because they are natural diuretics, making your body produce urine more quickly than it normally would. Certain medications, such as diuretics for high blood pressure, also force your body to put out more. They don't call them water pills for nothing.

Urinary tract infections (UTIs), which are extremely common, cause frequent trips to the bathroom because they irritate the kidneys, bladder or urethra. Nephritis, a potentially serious kidney disease, also causes frequent urination. The mysterious condition called interstitial cystitis that creates almost constant urinary discomfort also causes frequent urination.

Women are much more likely than men to be affected by all these ailments, which may also produce pain in the abdomen or back and a burning sensation when they urinate, Dr. Seftel says. In men, a prostate infection brings on similar symptoms. Undiagnosed or poorly controlled diabetes also causes you to urinate more often. In addition, blockages anywhere in the urinary system (like stones in the kidney or bladder) can prevent you from emptying your bladder completely, so it's filled up more quickly and you have to urinate more often. That's a particular problem for older men: An enlarged prostate can squeeze on the urethra, dam up the plumbing and cause frequent urination during the night while they're lying down.

If you're urinating more at night, it may simply be a part of aging. Aging transfers the body's production of urine to the night shift. "Older people produce two-thirds of their urine during the night and one-third during the day," notes Margaret M. Baumann, M.D., asso-ciate chief of staff for geriatrics and extended care at the Veterans Administration West Side Medical Center in Chicago. "That's the reverse of what you do when you're younger."

Symptom Relief

If you feel no pain, burning or discomfort on your many visits to the water closet, little reason exists to worry about frequent urination. But if it's constantly inconvenient, you have a couple of options.

Don't drink like a fish. Why act like a bedouin who has just encountered his first oasis in weeks? Just cut back on your fluid intake. "The vital importance of drinking eight glasses of liquids a day has been overstated to some extent," says Dr. Baumann. "And it's not really true that you're flushing out toxins by drinking more. You won't be healthier if you produce more urine."

Build a bigger bladder. You may have to knock your knees together or jump up and down a bit at first, but you can expand the capacity of your bladder, says Joseph M. Montella, M.D., an assistant professor and director of the Division of Urogynecology in the Department of Obstetrics and Gynecology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. The trick is to not give in to the urge as soon as you feel it. In fact, you actually can shrink your bladder's capacity if you give in to every slightest urge.

To practice bladder training, try staving off the urge to go for, say, 15 minutes. After a week or so, Dr. Montella says, endure a little longer, maybe another 15 minutes. Over the following weeks and months, continue to lengthen the time between urge and surge until you're going to the bathroom about every three or four hours. But don't try to get into The Guinness Book of World Records with an endurance record. Years of continually suppressing your urine for hours on end can lead to bladder infection and incontinence.

Don't pop that pill in the p.m. If you're taking diuretics and sleep is interrupted by frequent trips from pillow to potty, ask your doctor about changing your medication schedule, says L. Lewis Wall, M.D., Ph.D., an assistant professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. Because many drugs stimulate the urinary tract, ask your doctor whether other substitutions might help, too.

Act as if infected. If you're a woman and you frequently have UTIs, follow the tips in Urination, Burning, on page 570. Men can try the hints, too, but because they're so much less likely to contract a simple UTI, they should see a doctor.

Have your prostate checked. If you're an over-40 male and none of these techniques seem to help, you may have an enlarged prostate that interrupts the flow of urine. See a urologist for tests, Dr. Seftel says. The right medication may help alleviate your symptoms. Surgery is also a simple solution. The doctor can remove the obstruction without incisions and restore control.

See also Incontinence