There's a common debate about the ideal frequency of bowel movements, but what about urination? Experts confirm that there is indeed a recommended range for how often you should use the restroom for this purpose, and significant deviations from this norm may indicate a need to evaluate your lifestyle and health. According to Dr. Jamin Brahmbhatt, a urologist at Orlando Health and a contributor, most healthy individuals urinate approximately six to eight times throughout the day. "Generally, it's reasonable to need to urinate every three to four hours," he elaborates. "At night, it's ideal to wake up only once or not at all. Frequent awakenings could signal an underlying issue.

Dr. Brahmbhatt notes that some individuals might urinate up to 10 times a day, particularly if they're consuming copious amounts of water or beverages that promote more frequent urination, such as alcohol, tea, and coffee, which are known to have diuretic effects and can irritate the bladder. Dr. David Shusterman, a board-certified urologist at NY Urology in New York City, suggests that if these beverages are causing discomfort, one could try reducing their intake or diluting them with water to lessen their impact

"It's important to recognize that everyone's body is unique, and there isn't a one-size-fits-all number," Dr. Brahmbhatt says. "If you're in a hot environment and sweating profusely, you might urinate less. The key is to understand what's normal for your body. If you find yourself urgently needing to use the restroom much more or much less frequently than usual, it could be worth investigating, especially if it's affecting your daily life."

Excessive urination, not attributed to high fluid intake, can stem from various causes, including overactive bladder syndrome, diabetes, urinary tract infections, or medications. Diuretic medications, often prescribed for blood pressure or heart conditions, are a common cause. Dr. Jason Kim, a clinical associate professor of urology at the Renaissance School of Medicine at Stony Brook University on Long Island, New York, explains that urination is controlled by a complex neurological system involving signals between the bladder, urethra, and brain. Therefore, excessive urination can also result from stroke, spinal cord injuries, and certain neurological conditions such as Parkinson's disease, multiple sclerosis, and central nervous system tumors.

Pregnancy is another factor that can influence urination frequency, as it often requires increased water intake and metabolism. Stress or anxiety can also lead to more frequent urination, as the fight-or-flight response or adrenaline release can cause the bladder to contract or increase urine production. An overactive bladder can also be a result of hormonal issues, such as genitourinary syndrome of menopause, which is caused by decreased estrogen levels. "Interestingly, there are thought to be estrogen receptors in the bladder," Dr. Kim adds, who is also the director of the university's Women's Pelvic Health and Continence Center. "In many cases, we incorporate vaginal estrogen cream or suppositories into a patient's treatment plan, which has been shown to help with overactive bladder symptoms."

If your urination pattern is concerning or if you're regularly waking up at night to urinate, it's advisable to consult a urologist who can help determine the cause and potentially initiate bladder training exercises. In cases where pelvic floor dysfunction is suspected, a referral to a pelvic floor therapist may be recommended. There are several minimally invasive treatments available, including medications, bladder Botox injections, and various types of nerve stimulation. Botox injections work by weakening the bladder's nerves, reducing the frequency of contractions and thus decreasing the need to urinate. Dr. Kim and Dr. Shusterman agree that procedural interventions are generally more effective than medications.

On the other hand, urinating only every six to eight hours or fewer than four times a day could indicate dehydration or issues with bladder or kidney function, according to Dr. Brahmbhatt and Dr. Shusterman. High levels of calcium can lead to bladder stones, which can block the exit of urine. The National Academy of Medicine recommends a daily fluid intake of 2.7 liters (91 ounces) for women and 3.7 liters (125 ounces) for men, including all fluids and water-rich foods like fruits, vegetables, and soups. With an average water intake ratio of fluids to foods being around 80:20, this translates to approximately 9 cups for women and 12.5 cups for men daily.

Infrequent urination can increase the risk of harboring bacteria in the urethra and developing urinary tract infections (UTIs), as regular urination is the body's primary defense against UTIs. Holding urine can also harm health by increasing the risk of kidney infections or weakened bladder muscles from constant straining. If you're not urinating enough despite maintaining proper lifestyle habits, it's important to see a urologist or a subspecialist in voiding dysfunction, which refers to issues with bodily functions that excrete waste. Doctors will assess whether the cause is obstructive or nonobstructive. "Urinary retention from obstruction occurs when, for example, the urethra is blocked, preventing urine from exiting," Dr. Kim explains. "Nonobstruction is more related to a holding behavior, common in aging men as the prostate grows in size and often becomes a cause."

For aging women, retention may be due to a tightening urethra, Dr. Shusterman says. Reduced urinary function can also result from the aforementioned neurological diseases or injuries. Unfortunately, there are fewer treatments for an underactive bladder, except for self-administered intermittent catheterization, long-term catheterization, and sacral neuromodulation, a type of bladder pacemaker. These procedures can be life-changing, Dr. Kim adds, so if you need assistance, it's crucial not to delay seeking help.