What your peeing frequency can say about your health

By Kristen Rogers, CNN

(CNN) — How often one should poop has been a hot topic, with experts saying the numerical range partly depends on several personal factors. But is there a similar prescription for how frequently you should pee?

The answer is yes, experts say — and veering too far outside of this range in either direction likely warrants a close look at your lifestyle habits and health status.

During the day, most healthy people pee about six to eight times, said Dr. Jamin Brahmbhatt, a urologist at Orlando Health and CNN contributor.

“For most, it’s reasonable to need to pee every (three to four) hours during the day,” Brahmbhatt added via email. “At night, ideally, you’re only getting up once or none. If you’re waking up more often, it could mean something’s off.”

What’s healthy versus excessive urination

Some people may pee up to 10 times per day, especially if they’re drinking a lot of water or other beverages that cause more frequent urination, Brahmbhatt said.

Those can include alcohol, tea and coffee, which have diuretic effects and irritate the bladder, said Dr. David Shusterman, a board-certified urologist at NY Urology in New York City. (If these effects of coffee or alcohol annoy you, try drinking less or making the coffee half strength with extra water, and the cocktail with less alcohol and more of the mixer ingredient, he recommended.)

“Honestly, everyone’s a little different, so there’s no magic number that works for everyone,” Brahmbhatt said. “If it’s hot and you’re sweating a lot, you might pee less. The important thing is knowing what’s normal for you. If you’re suddenly running to the bathroom way more — or way less — it might be worth checking out, especially if it’s messing up your quality of life.”

Excessive urination that’s not due to copious water or beverage consumption can have multiple causes, including overactive bladder syndrome, diabetes, a urinary tract infection or medications, Brahmbhatt said. Diuretic medications, often prescribed for blood pressure or heart conditions, are a common contributor.

Urination is controlled by a complex neurological system that involves signals sent between the bladder, urethra and brain, said Dr. Jason Kim, clinical associate professor of urology at the Renaissance School of Medicine at Stony Brook University on Long Island, New York. Accordingly, excessive urination can also be caused by stroke, spinal cord injuries and some neurological diseases, such as Parkinson’s disease, multiple sclerosis and central nervous system tumors.

Pregnancy is another factor, since it requires drinking much more water and thus more water metabolism happening, Shusterman said.

Stress or anxiety can also make someone need to pee more, Kim said, as the fight-or-flight response or release of adrenaline can cause the bladder to contract or increase urine production, respectively.

An overactive bladder can result from hormonal issues, too, such as genitourinary syndrome of menopause, Kim said, which is a collection of symptoms caused by decreased estrogen levels.

“Interestingly enough, it’s thought that there are estrogen receptors in the bladder,” added Kim, who is also director of the university’s Women’s Pelvic Health and Continence Center. “So, a lot of times we will add vaginal estrogen cream or suppositories to the patient’s regimen, and it’s been shown to help with overactive bladder.”

If your peeing pattern bothers you or if you’re regularly waking up at night to pee, see a urologist who can help you determine what’s going on and potentially start bladder training exercises. That specialist may refer you to a pelvic floor therapist if your problem seems to be due to pelvic floor dysfunction, Kim said.

There are several other minimally invasive treatments available, experts said, including medications, bladder Botox injections and types of nerve stimulation, Kim said.

The injections help weaken the bladder’s nerves so “the bladder wall doesn’t contract as much, therefore downregulating how much your body has to go to the bathroom,” Shusterman said. The procedural interventions tend to be much more effective than medications, Kim and Shusterman said.

Signs and reasons why you’re not peeing enough

On the flipside, peeing only every six to eight hours, or fewer than four times daily, could mean you’re dehydrated or that there’s an issue with how your bladder or kidneys are working, Brahmbhatt and Shusterman said.

Abnormally high levels of calcium can lead to bladder stone formation and block urine from exiting, Shusterman said.

Regarding hydration, the National Academy of Medicine recommends women consume 2.7 liters (91 ounces) of fluids daily, and that men have 3.7 liters (125 ounces) daily. This guideline includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12.5 cups for men.

Not peeing enough can increase your risk of harboring bacteria in your urethra and therefore developing UTIs, since peeing regularly is the body’s primary mechanism for preventing UTIs, Shusterman said.

If your infrequent peeing is because you’re holding it, that habit could harm your health by increasing your risk of multiple issues such as kidney infections or weakened bladder muscles from constant straining.

If you have your lifestyle habits down pat but still aren’t peeing enough, that also calls for seeing a urologist or subspecialist in voiding dysfunction, the medical term for issues with bodily functions that excrete waste. One thing a doctor would assess is whether the cause is obstructive or nonobstructive, Kim said.

“Urinary retention from obstruction is when, for example, the urethra is blocked and the urine can’t get out,” he explained. “Nonobstruction is more some kind of a holding behavior, when in men, as they age, almost invariably, every male’s prostate grows in size and oftentimes is a cause.”

For aging women, that retention may be from a tightening urethra, Shusterman said.

Reduced urinary function, too, can be the result of the same aforementioned neurological diseases or injuries.

Unfortunately there aren’t as many treatments for underactive bladder, Kim said, except for self-administered intermittent catheterization, long-term catheterization and sacral neuromodulation, a bladder pacemaker. These procedures can be life-changing, he added, so if you need help, don’t wait to seek it.

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