Excessive Urination Volume or Polyuria: Causes, Symptoms and Treatment

All of us have gone through instances when we feel like our bladder is going to burst from holding in so much of urine. And when we finally are able to get to a washroom, the feeling of relief that washes over as one finally gets to pee is truly indescribable. In such instances, we always feel like we are peeing like never before. While this may happen once or twice, every now and then, experiencing excessive urination frequently is not something to take lightly. Excessive urination, also known as polyuria, is a condition marked by the production of abnormally large amounts of urine on a daily basis. This condition can be caused by a variety of factors, including medical conditions such as diabetes, kidney disease, and urinary tract infections. Certain medications, such as diuretics, can also cause excessive urination. Keep reading to find out more about what is excessive urination volume or polyuria.

Excessive urination volume, also known as polyuria, happens when you produce an abnormally large amount of urine on a daily basis. The exact volume of urine to be characterized as excessive production varies from person to person and also depends on factors such as age, sex, and a person’s overall health. In general, producing more than 2.5 to 3 liters of urine per day in adults is considered to be excessive and may be a sign of polyuria. It is important to note that the exact definition of excessive urination volume may vary depending on the individual’s circumstances. For example, athletes or people who engage in a lot of physical activity may naturally produce more urine due to increased fluid intake and sweat production.

On the other hand, older adults or those with kidney disease may produce less urine than average due to decreased kidney function. At the same time, a ‘normal’ urine volume also depends on many factors, including your gender and age. Nevertheless, a urine volume of less than two liters per day is typically considered to be normal urine volume.^(1,2,3)

As mentioned above, excreting excessive volumes of urine can happen to all of us at some point in our lives, but it should not last for more than a few days at a stretch. It is common for most people to notice polyuria at night when they go to sleep, and in such cases, the condition is referred to as nocturnal polyuria or nocturia.^(4,5,6)

It is important to note that polyuria is not a standalone medical condition, but it is typically a symptom of an underlying health condition. Some of the common causes of polyuria can include diabetes, kidney disease, and certain types of medications. Pregnancy, consumption of excess caffeine, an electrolyte imbalance, and alcohol consumption can also be the cause of polyuria.⁽⁷⁾

When you literally translate the term polyuria, it means to ‘urinate too much’. While urinating too much is of course the defining symptom, and in some cases, it could very well be the only symptom you experience, there are some other symptoms of polyuria as well. In general, an adult individual gives out up to 2.5 liters of urine on a daily basis. If the amount of urine being given out is over three liters, though, it is considered to be abnormally excessive.

The symptoms of polyuria depend on the underlying medical condition. Some of the common accompanying symptoms of polyuria may include:

• Producing more than 2.5 to 3 liters of urine per day in adults.
• Frequent urination during the day and night.
• Feeling an urgent need to urinate.
• Experiencing difficulty controlling urine flow.
• Experiencing fatigue, weakness, and dizziness.
• Excessive thirst and dry mouth.
• Unintentional weight loss.
• Dehydration.
• Changes in urine color or odor.
• Pain or discomfort during urination.

When the cause of excessive urination is diabetes mellitus or diabetes insipidus, you are likely to also experience the symptom of excessive thirst, also known as polydipsia. While nocturia, or frequent urination at night is also often associated with polyuria, but it does not always have to be.^(8,9)

Excessive urine output that continues to persist for several days may be a sign of an underlying health problem. Some of the medical causes behind excessive urination volume or polyuria may include the following:

• Bladder infection, especially in women and children
• Diabetes
• Urinary incontinence or urine leakage
• Kidney failure
• Kidney stones
• Interstitial nephritis
• Sickle cell anemia
• Psychogenic polydipsia, which is a mental disorder that causes excessive thirst
• Enlarged prostate, which is also known as benign prostate hyperplasia and is mostly observed in men over the age of 50
• Certain types of cancer

Some people also find themselves peeing excessively after undergoing a CT scan or any other type of diagnostic test in a hospital that requires a dye to be injected into the body.

Excessive urination volume is quite common the day after such a test. However, if the problem of polyuria continues even after 24 hours, you should let your doctor know.

Excessive urine volume can also be caused due to some other factors, including lifestyle habits. This includes drinking large amounts of beverages, a condition referred to as polydipsia. While this is not a serious health concern, but drinking too much of caffeine and alcohol, which may also lead to polyuria, can cause certain types of health issues.

Certain types of medications can also be the cause of excessive urine volume. Diuretics are the most common class of drugs that causes polyuria. If you notice changes in your urine volume output especially if you have recently started a new medication or changed the dosage, then you should let your doctor know. Caffeine and alcohol also act as diuretics and they can also cause polyuria. Certain medications prescribed for edema (swelling) and high blood pressure are also diuretics and may cause excessive urination volume, including:

• Loop diuretics like furosemide and bumetanide⁽¹⁰⁾
• Potassium-sparing diuretics like triamterene and eplerenone⁽¹¹⁾
• Thiazide diuretics like hydrochlorothiazide and chlorothiazide⁽¹²⁾
• It is common to experience polyuria as a side effect of these types of medications.

Let us take a closer look at the most common causes of polyuria, including diabetes.

1. Diabetes Mellitus: Polyuria, or excessive urination, is a common symptom of diabetes mellitus, particularly of type 1 diabetes. Diabetes mellitus is a condition in which the body is unable to produce or properly use insulin, a hormone that is responsible for regulating blood sugar levels in the body. When blood sugar levels are high, the kidneys try to remove the excess glucose by filtering it out of the blood and into the urine, which leads to increased urine production and frequent urination. In people with type 1 diabetes, the symptoms of polyuria usually develop quickly and can be severe, often leading to dehydration and electrolyte imbalances. On the other hand, people with type 2 diabetes may experience milder symptoms of polyuria and may not even realize that they have the condition until other complications start to develop.^(13,14,15)
2. Diabetes Insipidus: Diabetes insipidus is a completely different condition than diabetes mellitus or type 1 and type 2 diabetes. What is surprising to note is that diabetes insipidus has nothing to do with the levels of blood glucose in the body. In diabetes insipidus, the body is unable to properly regulate the fluid balance due to a deficiency of the hormone vasopressin, which is also known as antidiuretic hormone (ADH).^(16,17) This can lead to excessive urination, or polyuria, as the kidneys are unable to retain water and produce large amounts of dilute urine. Diabetes insipidus is linked to polyuria due to its association with arginine vasopressin (AVP), which is an antidiuretic hormone in the body. As mentioned, diabetes insipidus is caused by a deficiency of AVP secretion mostly because of a neurological condition. The symptoms of polyuria in diabetes insipidus are similar to those of other causes of polyuria, such as diabetes mellitus. However, the urine produced in diabetes insipidus is usually clear and odorless, as opposed to the sweet-smelling urine produced in diabetes mellitus due to high blood sugar levels.⁽¹⁸⁾
3. Lithium as a Medication: Lithium is often used as a medication to regulate some types of mood disorders. It is most commonly used in the treatment of bipolar disorder, which is a mental health disorder that is marked by extreme mood swings. Lithium gets almost completely excreted from the body through urine, but it can have a huge impact on the kidneys in people who take it regularly.⁽¹⁹⁾ It is known that lithium can cause polyuria as well as polydipsia because of the development of lithium-induced nephrogenic diabetes insipidus. Polyuria because of lithium use occurs because lithium can impair the kidneys’ ability to concentrate urine, resulting in the production of large volumes of dilute urine. Polyuria is a common side effect of lithium, with up to 60% of people taking the medication experiencing this symptom. Other symptoms that may accompany polyuria due to lithium intake include increased thirst, dehydration, and electrolyte imbalances.^(20,21,22) The good news is that if lithium is discontinued as early as the polyuria is noticed, the symptoms can be reversed in time and without any long-term damage. However, if the symptom of polyuria develops and lithium use is not discontinued, it can cause irreversible damage to the kidneys and it can even lead to permanent polyuria.
4. Excessive Intake of Alcohol and/or Caffeine: Both caffeine and alcohol have diuretic effects on the body. Drinking too much of either beverage in excess can trigger polyuria, and that too to the extreme point of developing dehydration. Alcohol increases urine production by inhibiting the release of vasopressin, which is the hormone that controls fluid balance and urine concentration in the body. This can not only lead to dehydration but also cause electrolyte imbalances in the body, especially when alcohol is consumed in large amounts. Caffeine, on the other hand, is also a diuretic and can increase urine production by stimulating the kidneys to produce more urine. This effect can be especially pronounced in people who are not regular coffee drinkers. In both cases, excessive intake of alcohol or caffeine can lead to polyuria and also cause other symptoms like excessive thirst, dehydration, and electrolyte imbalances. While the diuretic effects of caffeine can decrease over a period of time in people who have it regularly, but the effect of alcohol will not be reduced even if a person has it regularly.^(23,24)
5. Pregnancy: Pregnancy can be another cause of polyuria, especially in the first trimester. During pregnancy, the body undergoes many changes, including an increase in blood volume and hormonal changes that can affect the kidneys and bladder. As a result of this, pregnant women often need to urinate more frequently, particularly in the first and third trimesters. In the first trimester, increased urination can be caused by the hormonal changes that occur as the body prepares for pregnancy. As the uterus grows in the second and third trimesters, it can put pressure on the bladder, making it more difficult to hold urine and increasing the need to urinate. In addition, as the pregnancy progresses, the body also produces more urine to remove waste products from both the mother and the growing fetus. This can contribute to polyuria as well. Polyuria can also be caused due to an increase in the hormones progesterone and human chorionic gonadotropin (HCG). While polyuria in pregnancy tends to resolve by itself after the end of the first trimester, but it is necessary to consult your doctor if it persists in the second trimester as well. This is because experiencing polyuria in the second trimester could be a sign of gestational diabetes as well. So it is always a good idea to talk to your doctor if you are worried about the excessive urination during pregnancy.^(25,26,27)

Remember that polyuria is not a standalone medical condition, but a symptom in itself. Due to this, there is no actual diagnosis of polyuria. Instead, doctors will try and diagnose the underlying cause of polyuria once the symptom appears. The diagnostic process varies in each case as the underlying cause is different. In each case, doctors will start by determining when polyuria began and whether the symptom began suddenly or developed gradually over a period of time.⁽²⁸⁾

If someone experiences an increased amount of urine (polyuria) after a significant neurological event, such as a stroke or traumatic brain injury, it could indicate the presence of central diabetes insipidus. Polyuria and excessive thirst (polydipsia) are symptoms shared by both diabetes mellitus and diabetes insipidus. Both conditions are significant and require further medical evaluation.⁽²⁹⁾

To diagnose the specific type of diabetes, a physician may order a hemoglobin A1C blood test to measure the average blood glucose levels over the previous six months. Additionally, a urine glucose test may be performed to determine if the body is excreting sugar in the urine, which would be a sign of diabetes mellitus.^(30,31)

Many people often remain in a state of confusion about whether to seek treatment for excessive urination or not. However, if you feel that you might be having an underlying health condition that is causing this excessive urination volume, you should not delay seeking medical help. There are some symptoms that should alert you to see the doctor immediately, including:⁽³²⁾

• Back pain
• Weakness in the legs
• Fever
• Mental disorders
• Weight loss without any apparent reason
• Night sweats
• Sudden onset of polyuria, especially in children⁽³³⁾

Symptoms like these could be an indication of diabetes, kidney infections, spinal cord disorders, or even cancer. This is why you should seek medical assistance at the earliest after noticing any of these symptoms. Early treatment can help you address the underlying cause of polyuria and maintain your overall well-being as well.

If, on the other hand, you feel that the increase in urination volume is due to a large intake of fluids or some medication, keep monitoring your urine output for a few days. If you find that the excess volume tends to persist after this monitoring period, it is best to consult a doctor.

The first step of treating polyuria is to address the underlying medical condition causing the excessive urination volume. For example, if you have lithium-induced nephrogenic diabetes insipidus, the treatment will revolve around discontinuing the lithium at the earliest.⁽³⁴⁾ If, on the other hand, polyuria is being caused by diabetes mellitus, then the urination volume will go back down to normal levels once the person’s blood sugar levels are controlled and within healthy limits.

In cases where polyuria cannot be treated even by treating the underlying health condition, doctors usually come up with a treatment plan which includes many medications that are taken from several different classes.

Other treatments may include prescribing a certain type of diuretic, which will increase the urine output first to improve the manner in which urine gets processed within the kidneys.

Meanwhile, you can also relieve the symptoms associated with polyuria by changing certain behaviors that could be causing excessive urine output. Some tips to do this include:

• Restrict the intake of fluids before bedtime
• Watch how much fluid you are consuming
• Restrict your intake of alcoholic and caffeinated beverages
• Research the side effects of medications properly before taking them

Changes in diet and medication are usually sufficient to relieve the side effect of polyuria unless the underlying cause is something serious.

Remember that it is very important to be completely honest and open with your doctor about problems like excessive urination volume. There is no doubt that discussing topics such as your urination habits with your doctor can be uncomfortable, but it is essential for reaching a proper diagnosis and treatment. In most cases, polyuria has a positive outlook, especially if you do not have any other underlying medical conditions. Simple lifestyle changes are often enough to resolve the symptoms. However, there can be some underlying conditions that cause polyuria and require extensive or long-term treatment. If your polyuria is caused by diabetes or cancer, your doctor will discuss the necessary treatments to manage these medical issues and also help control the polyuria symptoms.

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