Frequent Urination in Men -likely Causes

When discussing issues of urinary frequency, most individuals think of female problems.  In fact, men have just as many issues with urinary tract problems as compared to women. Urinary frequency can best be defined as having to void more than eight times in a 24-hour period.

 Some reasons for urinary frequency in men are identical to those seen in women, while others are unique to men.  Some common causes of urinary frequency in men include benign prostatic hypertrophy, urinary tract infections, neurological disorders, diabetes mellitus, bladder tumors, and prostate cancer.

Older men are particularly prone to urinary frequency, secondary to neurological problems such as a previous stroke, spinal cord trauma, multiple sclerosis, and autonomic diabetic neuropathy. In some cases, the cause is benign or easily fixable.  At other times, the problem stems from a serious illness, such as diabetes mellitus. In such cases, the urinary frequency is the result of a severe elevation in serum blood glucose levels, which affect the kidney’s output of water and glucose.  This can’t be treated easily using over-the-counter treatments but requires a trip to one’s primary care physician for further evaluation and management.

Types of Polyuria

There are four main types polyuria:

• Nocturnal polyuria. This involves urinating excessively mainly at night.
• Global polyuria. This involves urinating excessively during the day and night.
• Low nocturnal bladder capacity. This involves having a decreased urine volume in the bladder each night so frequent voiding is necessary.
• Mixed nocturia. This is a combination of any of the above types of polyuria.

Urinary frequency in men can happen all day long but tends to be more prominent and problematic when it occurs at night, causing disruption to sleep.  This type of urinary frequency is called nocturia and has basically the same causes as daytime polyuria, with the exception of congestive heart failure or CHF.  CHF causes nocturia by allowing fluid in the peripheral tissues to leach back into the bloodstream at night when the patient is lying down. The fluid flushes through the kidneys and bladder, leading to an increased frequency of urination at night.

Some simple causes of urinary frequency include the excess consumption of alcohol and caffeine.  Both of these have diuretic properties and not only provide extra fluid in the body, but have the ability to increase the activity of water collecting tubules so that the kidneys have more water to get rid of.  Other simple causes include a urinary tract infection which, in men, often reflects mild to moderate urinary obstruction secondary to enlargement of the prostate gland.  Stones in the ureter or bladder can also result in an obstruction and a secondary bladder infection. Rarely, tumors can obstruct the bladder outflow, leading to decreased emptying of the bladder and increased frequency of urination.

Polyuria and Diabetes

The most frequent cause of polyuria, or an increased frequency of urination in both adults and children, is diabetes that is not in good control.  This causes an osmotic diuresis, in which there is an excess of solute in the bloodstream—in this case, glucose—that pushes both glucose and water out from the bloodstream into the urine.

With this type of polyuria or frequent urination, the higher the level of glucose, the more the kidneys need to get rid of the glucose in the bloodstream.  The water is excreted by necessity with the glucose going into the urine. This is the basic mechanism behind osmotic diuresis seen in diabetic polyuria.

If diabetes is not the problem causing the diuresis, the patient may have an adrenal cortical tumor and primary polydipsia (excessive liquid intake), which is central to what is known as nephrogenic diabetes insipidus.  Alternatively, an adenoma can be in the pituitary gland or the hypothalamus, leading to an excess of mineralocorticoids and excessive urination.  Both diabetes mellitus and diabetes insipidus can be made worse by drinking too much alcohol, caffeine, or diuretics.

Testing for Causes of Polyuria

If urinating too frequently is the main problem, there are tests that can help determine the cause.  The evaluation starts with a complete history and physical examination.  A urinalysis is obtained as the problem could be due to a bladder infection and because a dipstick urinalysis can result in a positive glucose screening test in the urine.  A bladder scan may be necessary to see how much urine is left in the bladder after voiding.

In unusual cases, a cystoscopy can be performed, in which the patient has a microscopic camera attached to a tube inserted into the bladder.  The cystoscope can identify bladder stones that might be obstructing urine flow, or a tumor of the bladder that is either irritating the bladder or is causing a urinary obstruction.  Suspicious areas of the bladder can be biopsied and taken to the pathologist for further evaluation.

Having an Overactive Bladder

Sometimes the problem can be an overactive bladder or OAB.  This is a common bladder condition that causes frequent daytime and nighttime urination, a strong urge to urinate much of the time, and urinary leakage from the bladder. About 33 million people have OAB in the US, with the finding in at least 30% of men.  The main symptom is the persistent need to urinate with urination that occurs at least twice during the night.   Urge incontinence is a big problem, meaning that the individual continually feels the urge to void and sometimes can’t make it to the bathroom.

In men, OAB is usually from an enlarged prostate gland. The prostate gland enlarges gradually over age, so the problem is worse in men over the age of sixty years.  Bladder stones, bladder infections, and bladder cancer can also lead to an irritable bladder. Strokes, Parkinson’s disease, and other neurological problems can cause overactivity of the bladder.

Medical Treatments for Polyuria

There are several medications for polyuria when lifestyle measures fail.  Anticholinergic medications can be given for an overactive bladder.  Diuretics can be given during the morning hours so there is less urination at night.  Medications for better diabetic control can be given.  Nighttime polyuria can be treated with DDAVP nasal spray (desmopressin) to decrease urine production at night, Flomax (tamsulosin), Proscar (finasteride), Avodart (dutasteride) for prostatic enlargement, or antibiotics (to treat a urinary tract infection).

Complications of Polyuria

The main treatment for polyuria is to find and treat the underlying cause.  If diabetes is the cause, the goal is to keep the blood sugars in good control so that osmotic diuresis doesn’t occur.  If the underlying causes are untreatable, having nocturia and polyuria can be serious.  It is a risk factor for poor sleep quality, obesity, high blood pressure, glucose intolerance, and even a greater risk of death from all causes. The risk of death from polyuria and nocturia is higher in older men and the best treatment is to use medications, make relevant lifestyle changes, and possibly have surgery to correct the underlying problem.