Polyuria: Excessive Urination Volume

Polyuria is the medical term for excessive urination; poly is from the root word “many” and uria means related to urine.

The average person has a urine output of about 800-2,000 milliliters (ml) per day. In the case of polyuria, it is defined as a urine output of greater than 3,000 ml, or 3 liters, per day.

Polyuria is different from having the urge to urinate frequently (urinary frequency) because urine volume is often normal or less-than-normal in the case of urinary frequency.

People with polyuria often have to urinate frequently throughout the day and night. This is similar to urinary frequency, but the overall volume is higher than normal.

Who can get Polyuria?

Several factors play into the cause of polyuria. The kidneys play a significant role in urine production, as well as antidiuretic hormone, or ADH.

Antidiuretic hormone encourages the kidneys to absorb more water, so when ADH levels are low, urine output can increase. ADH helps prevent dehydration because it helps our bodies hold on to more fluid instead of excreting it.

Diabetes insipidus is a condition where the body lacks adequate levels of ADH. If the body doesn’t make enough ADH because of a problem with hormone production in the brain, it’s considered central diabetes insipidus.

If diabetes insipidus occurs because the kidneys fail to respond to the ADH that the brain does make, it’s called nephrogenic (kidney) diabetes insipidus. Diabetes insipidus is quite rare, and nephrogenic diabetes insipidus is even rarer.

Polyuria can also occur in diabetes mellitus. When blood sugar levels are high, sugar also becomes present in the urine.

When urine osmolality is high (osmolality refers to the amount of dissolved particles in a substance; in this case, sugar dissolved in urine), the body tries to balance out the high amount of sugar by excreting more fluid to dilute the sugar. The result is polyuria due to increased urine volume.

Polyuria is often associated with polydipsia in diabetes. Polydipsia means abnormally increased thirst and water intake, which occurs from the fluid loss and dehydration that polyuria can cause.

Psychogenic polyuria is different from classic polydipsia. It is usually observed in people with mental illness or developmental disabilities.

Some forms of chronic kidney disease can also cause polyuria since the kidneys play such a large role in urine production and volume output.

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How common is Polyuria?

Polyuria is as common as some of the leading causes previously mentioned. Diabetes mellitus, especially type 2, is becoming more common. It’s estimated that about 9.4% of the United States population is affected by diabetes, both type 1 and type 2. Diabetes can also occur during pregnancy, which is referred to as gestational diabetes.

The prevalence of chronic kidney disease in the general population is around 14%. Not everyone who has chronic kidney disease will experience polyuria.

Diabetes insipidus is more rare, with an incidence of about 3 in 100,000 in the general population.

How is Polyuria diagnosed?

Polyuria is diagnosed with a physical exam, including medical history and a timeline of symptoms. Healthcare providers may order a urine collection test over 8, 12, or 24 hours to measure urine output. Urine output should be higher than 3 liters in 24 hours to diagnose polyuria.

A water deprivation test may also be used to diagnose polyuria. This test helps identify the cause of polyuria by determining if the body is making (and effectively responding to) adequate levels of ADH. This can rule out or diagnose conditions like diabetes insipidus.

Signs and symptoms of Polyuria

  • Frequent urination– The most common symptom of polyuria is frequent urination. People with polyuria often have to wake up several times during the night to urinate, which is referred to as nocturia.

  • Urine volume– Polyuria is distinguishable from an overactive bladder by looking at the urine volume. With overactive bladder, people may have to urinate frequently even if there is minimal urine volume. With polyuria, the body is making large volumes of urine, sometimes up to 15 liters per day!

  • Increased thirst– Polyuria is often associated with polydipsia (increased thirst). Polyuria can cause dehydration from fluid loss.

If polyuria is ignored, health complications may occur. This is especially true for someone with undiagnosed diabetes mellitus. Getting prompt evaluation and diagnosis of diabetes helps reduce complications.

Polyuria can be very inconvenient and impact a person’s quality of life, such as when traveling. Having to urinate frequently is inconvenient, and can also cause sleep disruption in the case of nocturia.

Factors contributing to Polyuria

Elevated blood glucose levels cause an imbalance of dissolved particles in the urine or increased urine osmolality. When there is a lot of sugar in the urine, the body attempts to dilute the sugar by pulling fluid from the body.

The result is increased urine volume due to less water being absorbed by the kidney and more being excreted through the bladder.

Polyuria is often one of the major symptoms of diabetes, along with polydipsia. Glycosuria, or the presence of glucose (sugar) in the urine, usually occurs when polydipsia is related to diabetes because blood sugar levels are abnormally high.

Glycosuria is tested using a urine sample and is often done at prenatal appointments to test for blood sugar and kidney problems.

Issues with antidiuretic hormone also play a role in polyuria not caused by diabetes mellitus. Chronic kidney disease can also affect urine output through both excessive and lack of urination.

What behaviors can contribute to Polyuria?

Drinking excessive amounts of fluids could lead to polyuria. In this case, there isn’t an imbalance of antidiuretic hormone, nor are there physical problems causing polyuria.

People with poorly-controlled diabetes can also experience polyuria. Taking steps to manage diabetes is crucial for overall health, as well as improving the quality of life by reducing polyuria.

Some people can tell their blood sugar is running higher, even without checking their blood glucose levels, based on changes in urination frequency.

People who overuse or abuse certain substances such as alcohol, caffeine, and diuretic medications could also experience polyuria. Diuretics, or water pills, work by increasing the excretion of water and salt from the body in the form of urine.

Diuretics are often used to treat health conditions such as congestive heart disease and high blood pressure. However, they should be used under the close supervision of a medical professional. Diuretics may be abused in the case of eating disorders because they cause fluid-related weight loss.

What other urinary tract disorders can cause polyuria?

Other health and urinary conditions that can cause frequent urination but not increased urine volume include :

Again, these usually don’t cause increased urine volume, which is why a correct medical diagnosis is important for proper treatment.

Natural treatments for Polyuria

If underlying medical conditions are ruled out, there are some things to consider trying at home to treat polyuria or frequent urination naturally.

If you’re drinking excessive amounts of fluids, try cutting back and drinking just to avoid the thirst.

Cut back on alcohol and caffeine. Many people consume a lot of coffee, which contains caffeine. Caffeine has a diuretic effect, which means it increases the output of fluid in the form of urine.

If polyuria is related to anxiety, practicing natural relaxation techniques such as deep breathing and seeking treatment for anxiety may be beneficial.

For pregnancy-related frequent urination, space intake of fluids evenly throughout the day and avoid consuming large amounts of fluids before bedtime.

For men, having regular medical exams to evaluate prostate health can help with early detection of prostate enlargement and/or prostate cancer. An enlarged prostate can block urine output and lead to frequent urination and urinary tract infections.

How effective are natural treatments for polyuria?

Depending on the cause of frequent urination, natural treatments may be enough to control symptoms. If someone reduces their fluid intake from 150 ounces to 64 ounces per day, they are likely to experience a drastic decrease in symptoms.

Cutting back on caffeine can help reduce frequent urination. It’s estimated that 90% of Americans consume caffeine in some form, so this is a good place to start.

Natural treatments for polyuria should be used if an underlying medical condition is ruled out. If there is a more serious health issue, such as undiagnosed diabetes mellitus, natural treatments will do nothing to solve the problem.

The longer a medical condition goes undiagnosed, the chances of complications arising increases. If there isn’t a medical condition explaining frequent urination, then natural treatments can be a reasonable pursuit.

Conclusion

Polyuria is the term for increased urinary output. Polyuria is different from frequent urination because urine output is higher than normal in polyuria; frequent urination often results in normal urine output.

Polyuria can be caused by different health conditions, including diabetes mellitus and diabetes insipidus. Polyuria may be caused by lifestyle factors, such as drinking excessive amounts of fluids. Getting a proper medical evaluation is important for the proper treatment of polyuria.

Sources

  1. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
  2. https://pedsinreview.aappublications.org/content/21/4/122
  3. https://www.nbt.nhs.uk/sites/default/files/Water%20Deprivation%20Test%20in%20Adults.pdf
  4. https://www.uptodate.com/contents/evaluation-of-patients-with-polyuria
  5. Christ-Crain M. EJE AWARD 2019: New diagnostic approaches for patients with polyuria polydipsia syndrome. Eur J Endocrinol. 2019;181(1):R11–R21. doi:10.1530/EJE-19-0163
  6. Oelke M, De Wachter S, Drake MJ, et al. A practical approach to the management of nocturia. Int J Clin Pract. 2017;71(11):e13027. doi:10.1111/ijcp.13027
Alternative Text

Diana Gariglio-Clelland (RD)

Diana Gariglio-Clelland obtained her B.S. in Nutrition from the University of Idaho and is a Registered Dietitian with experience in the hospital, community and primary care health settings.

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