Dear Urologist: What Causes Frequent Urination in Men?

When it comes to what causes frequent urination in men, there are many possibilities. It could be something simple, like drinking too much coffee. Or it could be something more serious, like a prostate issue or a urinary tract infection. Ultimately, the best way to find the right treatment for frequent urination is to figure out the guiding cause.

Here, urologist Peter J. Stahl, MD, SVP of Men’s Sexual Health & Urology at Hims & Hers, answers a reader’s question about going to the bathroom a lot at night. Below, he offers intel about the common causes of frequent urination and what treatments are available.

Dear Urologist,

I'm a 53-year-old man, and lately I've been noticing that I need to urinate more often than usual — sometimes every hour, even during the night. While I’m not in any pain, these frequent bathroom visits are starting to mess with my sleep and daily routine. Could this be a sign of a serious health issue, or is it likely just a normal part of aging? Should I see a specialist?

—In Urgent Need

Dear In Urgent Need,

While frequent urination is definitely a more common symptom as men get older, it isn’t something to ignore. The cause may be very benign and simple to fix with lifestyle shifts, like drinking less coffee or water, but it could also be a serious medical issue that needs to be promptly diagnosed and treated.  

It’s important that you see your healthcare provider to figure out what’s going on, especially if you are experiencing  other worrying symptoms or signs, such as:

• Bloody or cloudy urine

• Inability to fully empty your bladder

• Insatiable thirst

• Fever

• Back pain

• Nausea and vomiting

• Discharge from the penis

Since you didn’t mention any of these symptoms, you may not have to rush to get medical attention, but you should make an appointment with your doctor or a urologist to try to figure out what is going on and how to best restore your quality of life.

For more ideas on what may be happening, I’ll share some of the potential causes of frequent urination at night.

Alcohol and Caffeine

One of the most easily avoidable causes of frequent urination at night (nocturia) is drinking too much fluid close to bedtime, especially alcohol and caffeine.

Alcohol and caffeine are diuretics, which make you pee more. This increase in urine production can lead to frequent urination as well as dehydration if you drink too much of either.

Bladder Conditions

Different bladder conditions can also cause frequent urination. These conditions include:

• Overactive bladder syndrome (OAB). OAB is a long-term condition that causes frequent and urgent urination and sometimes urinary incontinence. It can impact quality of life and lead to sleep disorders, anxiety, depression, and even social issues. Possible risk factors include obesity, mental health conditions, gastrointestinal disorders such as irritable bowel syndrome, sleep apnea, smoking, and drinking too much coffee.

• Interstitial cystitis. Also known as Bladder Pain Syndrome (BPS), interstitial cystitis is a less common chronic bladder health issue. It can cause a feeling of pain and pressure in the bladder area and a frequent need to urinate. Possible causes include defects in the bladder tissue, inflammation, and nerve disorders.

• Bladder stones. Bladder stones are rock-like deposits that form in the bladder and account for about 5 percent of all urinary stones. They usually occur due to pee not flowing out as it should, as seen in men with benign prostatic hyperplasia (BPH). However, bladder stones can also form in healthy individuals, sometimes as a result of dietary choices and lack of hydration. Besides frequent urination, bladder stones can cause blood in urine, pain, and urinary tract infections.

• Bladder cancer. A more serious potential cause of frequent urination is bladder cancer, though this often occurs alongside other alarming symptoms like blood in the urine (usually the first sign) and urinary urgency.

Diabetes

Diabetes mellitus (also called common diabetes) and diabetes insipidus are two separate conditions requiring different treatments, but they may cause some of the same symptoms, including frequent urination.

With diabetes mellitus (type 1 or 2), having higher levels of sugar (glucose) in your blood and urine pulls more water into your circulatory system and kidneys, resulting in polyuria, the term for making too much urine. This can lead to symptoms like increased urination and thirst.

Both type 1 and type 2 diabetes mellitus can damage blood vessels and nerves due to the effects of high blood glucose (blood sugar). This damage can lead to bladder problems like frequent and urgent urination, urinary retention, leaking urine, and bladder infections.

The damage caused by diabetes can also cause sexual problems like erectile dysfunction (ED), retrograde ejaculation, curved penis, and low testosterone.

If you have diabetes insipidus, your blood glucose levels are normal, but a specific hormone problem causes your body to make too much urine. While most healthy people make about one to three quarts of urine a day, people with diabetes insipidus can make up to 20 quarts of urine every day.

Prostate Issues

An enlarged prostate is probably the most common cause of urinary frequency in men, but other prostate issues can also cause frequent urination. The prostate is a donut-shaped organ that sits under the bladder. Since the urine channel goes straight through the middle of the prostate, prostate issues can have a major impact on how you pee. 

Here are a few common prostate issues associated with frequent urination:

• Benign prostatic hyperplasia (BPH). Also known as enlarged prostate, BPH is common in men, especially those over 50. As the prostate gets bigger, the hole in the middle of it gets smaller and starts to constrict the flow of urine.  This can cause symptoms like a slow urinary stream, urine flow starting and stopping while you pee, and a sense of incomplete emptying. Over time, the bladder trying to compensate for the blockage caused by the prostate can lead to frequent urination, waking up at night to use the bathroom, and urinary urgency. Although slow prostate growth is a normal part of aging, there are treatments available if it gets too large and interferes with your quality of life. This can include medication or surgery.

• Prostatitis. Prostatitis, or inflammation of the prostate, can be related to bacterial infections or nerve damage in the pelvic area. It can cause frequent urination, painful ejaculation, pain in the genital area, lower back, or abdomen, a weak urine stream, and more.

Certain cancer treatments, such as radiation therapy, chemotherapy, and surgery to remove the prostate, can also contribute to urinary and bladder problems.

Urethral Stricture

A urethral stricture is a scar that causes narrowing of the urethra, which restricts or slows the flow of urine. Some common causes include trauma to the urethra, infections (like STIs), and damage from surgical tools.

In addition to needing to urinate more often, a urethral stricture can also cause blood in the urine or semen, a weakened urine stream, pain during urination, urine spraying, abdominal pain, and more frequent UTIs.

Urinary Tract Infections

One of the most common causes of frequent urination is a UTI, which can easily be cleared by a course of antibiotics. Other symptoms of a UTI may include burning during urination, feeling like you need to urinate when your bladder is empty, fever, chills, and bloody urine. Certain sexually transmitted infections (STIs) can mimic the symptoms of UTI. One possible sign of an STI is unusual discharge from the penis. In contrast, UTIs are more likely to cause a frequent, urgent need to urinate, even if little comes out. If you’re experiencing symptoms and think an STI might be the cause, don’t wait—reach out to a healthcare provider and get tested.

Finding the main cause of frequent urination is the first step in choosing the right treatment plan. If frequent urination is impacting your quality of life and you’re noticing other symptoms like cloudy urine, blood in your urine, or difficulty passing urine, it’s crucial that you see your healthcare provider.

To diagnose your condition, your provider may perform a physical exam, ask about your medical history, and run the following types of tests:

• Urinalysis

• Urine culture

• Cystoscopy (bladder examination with a tube)

• Nervous system tests

• Ultrasound or CT scan of the abdomen or pelvic area

Treatment options depend on the cause of frequent urination. For instance, if the underlying cause is a UTI, your provider may prescribe antibiotics or pain medicine to help you feel better.

If the cause is an overactive bladder, they may prescribe an anticholinergic for bladder control, such as darifenacin, oxybutynin, or tolterodine. They may also suggest natural methods to strengthen your pelvic floor muscles (which support your bladder muscles), like Kegel exercises.

If the cause is BPH, your provider may prescribe medicine like alpha blockers or 5-alpha reductase inhibitors. For more advanced cases of BPH, they may recommend surgery or laser therapy.

Other health conditions, like diabetes, will require more intensive treatment plans.

If your frequent urination is more likely due to lifestyle habits like drinking too much caffeine during the day or consuming too much liquid close to bedtime, making a few tweaks to your personal routine may help reduce your nighttime bathroom visits.

Lifestyle changes to make to reduce nighttime urination include:

• Avoid fluid intake at least two hours before going to sleep

• Cut back on food and drinks that act as diuretics (like caffeine, alcohol, spicy foods, and artificial sweeteners)

• Track your symptoms to find potential triggers for frequent urination

• Eat high-fiber foods to avoid constipation (which can put pressure on the bladder)

• Perform pelvic floor exercises

Urinating more than usual has many potential causes, and not all of them alarming. But, it’s always a good idea to see your physician to be on the safe side. Remember:

• Frequent urination in men is a common part of aging, but it also isn’t something to ignore. While needing to urinate more often can become more common with age, it can also signal an underlying health issue.

• There are a number of potential causes. Common triggers include alcohol and caffeine intake, but more serious health issues like an enlarged prostate, bladder conditions, or diabetes need to be considered as well.

• Treatment depends on the underlying cause, but lifestyle changes and medicine can help. Managing fluid intake and limiting caffeine may help, while medical treatments may include antibiotics, prostate medications, or surgeries, depending on the diagnosis.

If frequent urination is affecting your rest, your confidence, or your ability to enjoy everyday activities, don’t wait it out. Talk to a healthcare provider to determine what’s going on and take the first step toward relief—and more restful nights ahead.