By Diana Chiu
Everyone’s urinary habits are different. People can pass urine up to six or seven times a day, and this is completely normal. Anything more frequent than this is called frequent urination, but many people live with frequent urination and it is only deemed problematic when it affects your day to day life, such as meaning you can’t carry out your daily activities, or if it’s associated with other symptoms such as tummy pain.
It’s not an exact science, and if you feel that you are passing urine more often than your usual habits, or it’s painful, then this may suggest there is a cause for your frequent urination. One common cause is a urinary tract infection (UTI).
A UTI can occur anywhere in the urinary tract, affecting anywhere from the bladder, ureters (tubes leading from the kidneys to the bladder), and the kidneys. It is often caused by bacteria, and in women this may be caused by normal bowel bacteria being introduced via the vagina, then entering the urethra into the bladder, which can occur during sex, or wiping after urination.
There are certain factors which then encourage the bacteria to grow. For example, people with diabetes have more ‘sugary’ urine, which is food for the bacteria, meaning people with diabetes are more prone to UTIs. In people who are taking medication or have conditions which weaken the immune system, this means they have less ability to fight off infection, so they would be more likely to have UTIs.
In addition to frequent urination, there may be other signs to suggest a UTI. This includes pain (often a ‘stinging’ sensation) on passing urine, feeling like you need to go to the toilet very quickly to pass urine (urinary urgency), pain over the bladder (in the lower tummy), and foul smelling or cloudy/bloody urine.
Sometimes, when foreign bodies are introduced into the urinary tract such as urinary catheters (plastic tubes inserted into the bladder to help pass urine), bacteria can cling to the plastic, and these individuals are more likely to have UTIs. The most common bacteria to cause UTIs is Escherichia coli, bacteria frequently found in the bowel flora, which causes 75-95% of cases.1,2
What are the signs of a UTI?
In addition to frequent urination, there may be other signs to suggest a UTI. This includes pain (often a ‘stinging’ sensation) on passing urine, feeling like you need to go to the toilet very quickly to pass urine (urinary urgency), pain over the bladder (in the lower tummy), and foul smelling or cloudy/bloody urine. In severe cases, there may also be fever, chills, shivers and loin pain.
The reason why UTIs cause urinary frequency is because the bacteria cling onto the bladder lining. This causes inflammation, where the body’s white blood cells trying to fight infection release chemicals that irritate the nerve endings supplying the bladder lining. The nerves feed this information back to the brain, which thinks, incorrectly, that your bladder is full and you need to pass urine, so you go to the toilet but may have little or no urine to pass.
Because the inflammation in the bladder is constantly going on, you feel a frequent urge to pass urine. It is also this inflammation that is responsible for the stinging sensation when passing urine in UTIs. Frequent urination does not necessarily distinguish UTIs as being the cause, however, as the frequent urination symptom can come on quickly or slowly, and you may or may not experience pain. There is no set pattern of urination that is a deciding factor for UTIs.
Although it is a nuisance, it is not necessarily harmful to keep going to the toilet. Generally bladder inflammation will settle with appropriate antibiotic treatment, so if you believe you have symptoms of a UTI you should visit your doctor.
Other causes of frequent urination
There are a lot of other causes of frequent urination, including sexually transmitted disease (STIs), caused by bacteria such as chlamydia and gonorrhoea. These bacteria could be introduced into the bladder via sexual intercourse and cause a UTI. This would cause frequent urination in the same way that E. coli does. However, with STIs there may be other symptoms suggestive that they are the cause, such as abnormal vaginal discharge (which can be grey and watery), and persistent lower abdominal pain with pain in the ovaries.
Anxiety can also cause frequent urination. When people are stressed or anxious, our sympathetic nervous system is activated. This is where sympathetic nerves and hormones, such as cortisol, are elevated. This sends messages to the brain to indicate we need to pass urine more frequently.
Pelvic inflammatory disease (PID), an infection of the Fallopian tubes and female reproductive tract can also be associated with UTIs. This is because the bacteria that cause PID can also be introduced into the bladder, causing UTIs. In general, these are the same bacteria that cause STIs, such as chlamydia and gonorrhea. Other symptoms to suggest PID would be persistent lower abdominal pain, abnormal vaginal discharge, and persistent fevers.
Anxiety can also cause frequent urination. When people are stressed or anxious, our sympathetic nervous system is activated. This is where sympathetic nerves and hormones, such as cortisol, are elevated. This sends messages to the brain to indicate we need to pass urine more frequently. Unlike UTIs, there would not be associated symptoms of fever or pain on passing urine. You may not necessarily be able to tell the difference between anxiety or UTI as the cause from pattern of urination alone, but with anxiety some people may find they have frequency during waking hours and at times of heightened stress only. However, with UTIs, frequent urination would happen at any time of the day or night, and not necessarily be associated with any emotions.
Other conditions, including diabetes, Parkinson’s, stroke, and MS can all cause frequent urination, so if you have been diagnosed with one of these or showing symptoms not related to UTIs alongside your frequent urination, do go and get checked out by a doctor.
What to do if you think you have a UTI
If you think you are experiencing symptoms of frequent urination in relation to a UTI you should see a GP, especially if you are pregnant, haven’t had a UTI before, blood is present in your urine, or your symptoms do not improve within a few days. Your GP may do a urine test to rule out other causes and confirm a UTI, and you may then be prescribed antibiotics. Once you start taking these, symptoms should start to clear up within five days. It is important to complete the antibiotic course.
Getting rest and drinking plenty of fluids may help the symptoms of UTI. In addition, if you have lower tummy pain, taking paracetamol and hot water bottles applied to the lower tummy may help. If you find your UTIs are associated with sexual intercourse, it may be helpful to pass urine immediately after sex to prevent this.
Symptoms that suggest it is important for you to have an urgent appointment to see GP or attend A&E include having a very high fever (more than 38 degrees), feeling hot and shivery, having pain in your sides or lower back, feeling sick or being sick, and having diarrhoea. This is because these symptoms may suggest an infection in the kidneys, which is more serious and often needs treatment with antibiotics through a drip. However, most UTIs don’t progress to the kidneys and are quickly resolved with lots of fluids and a course of antibiotics.
Featured image shows a women sitting on a chair, leaning forward with her elbows on her knees. The image is cropped so you can’t see her heard and shoulders or her feet.