Andrew Siegel MD 12/2/2017
Photo of Mannekin Pis in Brussels by Pbrundel (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons
Some Necessary Basic Science
The kidneys are the paired organs that regulate urine production. They function by filtering waste and excess volume from the blood and excreting these as urine. The volume of excretion by the kidneys is based upon several factors: One key factor is your state of hydration—for example, if you have not consumed enough liquid (state of dehydration) there will be scant urine production that is very concentrated appearing (amber color). On the other hand, if you have over-consumed fluid (state of over-hydration), there will be abundant urine production that is very dilute (like water). Another important factor determining volume of excretion is the effect of two hormones that regulate kidney function: Anti-diuretic hormone (ADH) is a pituitary hormone that restricts urine production (in order to maintain blood volume and blood pressure), whereas atrial natriuretic peptide (ANP) is a heart muscle hormone that increases urine production and inhibits ADH (in order to decrease blood volume and blood pressure).
ADH Trivia:
- It is also known as Vasopressin, since it causes arteries to contract
- It is sometimes used for shock (with severely low blood pressures) and also to stop gastro-intestinal bleeding
- Certain cancers and other disorders can cause a syndrome called Inappropriate Secretion of ADH in which excessive ADH is produced, resulting in the kidneys over-concentrating urine, causing fluid and electrolyte imbalance, muscle cramps, confusion and convulsions
- There is a biorhythmic pattern to ADH production, with less ADH production while sleeping, sometimes giving rise to frequent nocturnal urination. Some people have very suppressed ADH production while asleep and therefore do most of their urinating during sleep hours and minimal urinating during the day. This can be treated with administration of synthetic ADH.
- Bedwetting in children is often treated with synthetic ADH
6 Reasons You May Be Peeing Too Frequently
- Too Much Fluid Intake
As obvious as this one is, it is often overlooked by the over-zealous drinker. As mentioned above, the kidneys play a vital role in fluid regulation and blood pressure. If you drink excessive volumes of any fluid (this goes for consuming foods high in water content, especially fruit and veggies), you will be making frequent trips to the bathroom to relieve yourself, generally full volumes of dilute-appearing urine. All too often I see patients in the office with urinary urgency and frequency who are never without their water bottle…everything in moderation!
- Too Much Caffeine and/or Alcohol
Caffeine (present in coffee, tea, colas, many sports and energy drinks and chocolate) is a diuretic, meaning it makes you urinate. Similarly, alcohol has a diuretic-like effect (by inhibiting ADH). So, if you are running to the bathroom after drinking a Starbuck’s Venti or alternatively, after drinking 3 beers at the sports bar, it is not a shocker!
- Diuretics (water pills)
Many people are on diuretic medications, often for high blood pressure, fluid collection in the ankles and legs (edema) and congestive heart failure. These medications (some of which are very potent), are geared to make you pee a lot to reduce fluid volumes and blood pressure. So, if you are on Hydrochlorthiazide, Lasix, etc., and are peeing up a storm, it’s not a bladder or prostate problem, but simply the medication doing its job!
- Diabetes Mellitus (mellitus meaning sweet)
When diabetes is poorly controlled, high levels of blood sugar cause sugar to spill in the urine, which causes a diuretic-like effect. In fact, many undiagnosed diabetics present to the urologist with urinary frequency and a dipstick of their urine reveals the presence of glucose and makes the diagnosis of diabetes. Once diabetic control is achieved, the frequency dramatically improves. If you have diabetes that is not well-controlled and are peeing hourly, the first visit should be to the internist or endocrinologist to get the diabetes finely tuned.
Certain diabetic medications (SGLT-2 Inhibitors) function by eliminating excess blood sugar in the urine, causing the same diuretic effect and therefore have the side effect of inducing urinary frequency. These medications include Jardiance, Invokana and Farxiga.
5. Diabetes Insipidus (insipidus meaning tasteless)
This is a rare cause of frequent urination of large volumes of dilute urine caused by either the failure of production of ADH by the pituitary or alternatively, the ineffectiveness of this hormone in inducing the kidneys to restrict water excretion.
OSA is a chronic medical disorder that adversely affects sleep, health and quality of life. Repeated complete or partial interruptions of breathing during sleep occur due to mechanical obstruction of the upper airway passage.
Labored efforts to breathe against an obstructed airway result in negative pressures in the chest. This increases the volume of venous blood that returns to the heart, causing distension of the right heart chambers. The heart responds to this distension as a false sign of fluid volume overload, with the hormonal response of ANP secretion. As a result of the ANP secretion, high volumes of urine are produced during sleep, resulting in sleep-disruptive nighttime urination. There may be as many as 6 or more nighttime awakenings to urinate. When OSA is treated it results in a significant improvement, if not complete resolution of the frequent nocturnal urinating.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.
Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:
MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health
PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food
These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.
Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx
Tags: Andrew Siegel MD, anti-diuretic hormone, atrial natriuretic peptide, diabetes insipidus, diabetes mellitus, diuretics, frequent peeing, nocturia, obstructive sleep apnea, urinary frequency, urologist
Our Greatest Wealth Is Health 
June 23, 2018 at 6:47 AM |
[…] urination rids them of this. Another possibility is an abnormality in the nocturnal secretion of anti-diuretic hormone. This pituitary hormone causes the kidneys to concentrate urine and pull water back into the […]