Urinary frequency is a symptom that refers to the need to urinate very often as a result of pelvic floor dysfunction.

What is defined as “frequent” can vary from person to person due to age, medications, fluid intake, and many other factors—but on average, a person normally urinates every 2 to 3 hours during the day, and 0 to 1 times per night. Many people use the restroom to urinate 7 to 8 times total per day.

There are many aspects that can make a person experience urinary frequency. Age, medications, pelvic floor dysfunction, surgery, pregnancy and delivery (vaginal or c-section), dietary changes, bathroom habits, vigorous exercise, or even an injury to the back or hips.

Age can often play a significant role in this frequency. One of the many jobs of the pelvic floor is bladder control. In addition to allowing the release of urine when needed, it also gives you the ability to hold urine for a period of time.

Naturally as you age, your body will change—especially if you are not addressing these age-related changes. Your pelvic floor muscles can become tight, tender, inflexible, weak, and poorly coordinated. Similarly, other nearby muscles such as the abdomen, hips, thighs, and back will also change.

These muscles are all interconnected with the pelvic floor, and may experience the same age-related changes, resulting in an increased urinary frequency.

Therefore, for individuals above the age of 60, their urinary frequency will often increase to 1 to 2 times per night and even higher as they reach above the age of 80.

Unfortunately, this also increases the likelihood of urinary incontinence and the possibility of falls for people of this age due to decreased mobility, walking speed, balance impairments, and other comorbidities.

As mentioned earlier, medications and other aspects can also affect an individual’s “normal” frequency. Urinating less or more than 7 to 8 times per day can still be normal depending on the individual.

Your level of fluid intake, daily activity, age, and pre-existing conditions can all affect the number of times you urinate. There is no magic number for all people, so you can consider a few questions:

• Is your time significantly interrupted by restroom breaks?
• Do you use the restroom to urinate more times than the average amounts discussed above?
• Do you experience other symptoms, such as urinary urgency, urinary hesitancy, or being unable to empty your bladder completely?

It is important to recognize that alongside many other causes, those who need to urinate more often than average or who experience additional symptoms are likely experiencing pelvic floor dysfunction.

Symptoms of pelvic floor dysfunction like urinary frequency can be a very big issue, and not just for older individuals at a higher fall risk—it also significantly affects the quality of life for individuals of all ages.

The constant need to visit a restroom, anxiety of needing a restroom nearby at all times, and the possibility of experiencing leakage can significantly impact a person’s confidence and comfort.

As mentioned before, urinary frequency isn’t always felt as a lone symptom. It can actually fall under an umbrella of many urinary-related symptoms, which can vary from person to person depending on the underlying cause. Let’s explore some common examples:

• Urinary urgency: A sudden, strong need to urinate that can be uncomfortable and make it difficult to delay urination.
• Urinary incontinence: Unintentional leakage from the bladder due to being unable to hold urine or reach a restroom in time. Can vary in terms of amount.
• Pain with urination (Dysuria): Pain or a burning sensation that occurs during urination.
• Pain in other areas: Pain can also be felt in the abdomen or pelvis, especially in the case where the individual has pelvic floor dysfunction or other conditions. Some individuals may also experience pain with intercourse.
• Nocturia: Frequent urination at night.
• Hematuria: Blood in the urine, which can indicate infection or other conditions.
• Incomplete emptying: The feeling of not having emptied the bladder completely after urinating.

These are just some examples of symptoms that someone may have alongside urinary frequency. Experiencing additional symptoms is common, especially in the case of overactive bladder or interstitial cystitis. Next, let’s talk about some possible causes of these symptoms!

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As mentioned before, there are many causes for urinary frequency. One of the main contributors is pelvic floor dysfunction, which can stem from many things—such as improper posture, certain habits or behaviors, injury, and other conditions that create tension in the pelvic floor.

Pelvic floor dysfunction can be experienced in a variety of ways that vary from person to person. This is because the pelvic floor is a group of muscles in the pelvis that is interconnected with many areas of the body, and that also holds many different jobs.

These muscles help support your pelvic organs, allow for balance and stability of the whole body, and allow for functions such as urination and bowel movements. However, when these muscles are not in good health—such as being too tight, too weak, or uncoordinated—this can create problems with the bladder.

For example, when the pelvic floor muscles are overly tight, this tension can create pressure on the bladder, creating a feeling that you need to urinate more often. This can also create an issue with incomplete emptying, as the muscles cannot relax enough to empty the bladder properly.

Or, if the pelvic floor muscles are too weak, they may be unable to support the bladder enough to hold urine for very long. This can result in frequent restroom trips and incontinence.

The pelvic floor muscles can also be uncoordinated, and unable to communicate effectively with the bladder. Typically, the bladder alerts the brain when it is full, allowing for an urge to be felt and the bladder to be emptied as necessary.

However, when there is a disconnection between the pelvic floor muscles and the bladder, this urge may be felt even when the bladder is not full—resulting in frequent restroom trips that may not produce much urine. Additionally, it may create uncontrollable urges that can result in leakage.

Pelvic floor dysfunction can be created by a variety of factors. The pelvic floor is very interconnected with other parts of the body, and therefore is affected in ways you may not even realize. One contributor can simply be harmful habits that individuals unknowingly make. Here are some examples:

• Making restroom trips more frequently than necessary, which results in the brain receiving a signal from the bladder when it is not actually full.
• Diet choices, such as caffeine or alcohol, which can irritate the bladder.
• Posture and misalignment such as with the pelvis or lower back can affect the pelvic floor and the bladder’s ability to coordinate, contract, and relax.
• Stress or anxiety, which can increase tension in the pelvic floor.
• Other conditions, such as chronic pelvic pain or other conditions that may increase tension of the pelvic floor.

Our pelvic floor physical therapists at Hive are very familiar with urinary-related symptoms of pelvic floor dysfunction. To help alleviate your symptoms, they’ll first do a thorough evaluation by talking through your symptoms with you and identifying areas of weakness or tightness in your pelvic floor (with your consent).

The goal will be to improve your pelvic floor health, better your coordination and control of these muscles, reduce urination frequency, and improve your quality of life overall.

To achieve these goals, your Hive pelvic floor therapist will likely do some or all of the following:

• Provide education and guidance to help you better understand your pelvic floor, how it feels and works, and your current level of dysfunction.
• Improve control by strengthening the pelvic floor muscles with exercises.
• Release tension and teach relaxation, so that the bladder can be completely emptied during a restroom trip.
• Coordination training—helping you gain control over your bladder and urgency with practice and intentional efforts. Hive outlines these practices in a free guide that you can find here!

Additionally, your physical therapist will outline and guide you through important behavioral modifications that will be necessary not only to relieve your symptoms, but to also prevent them from occurring again in the future:

• Proper posture on the toilet, appropriate length of time for urination, and reducing cell phone use in the restroom. Posture during standing positions can be applied here as well.
• Dietary changes may be suggested to see if these are contributors to your urgency and frequency. This can include eliminating certain dietary items, or balancing the amount of fluid a person takes in per day. Both underconsumption and overconsumption can contribute to urinary frequency!

At Hive Therapy and Wellness, our physical therapists may use a variety of different treatment methods to help support patients experiencing frequent urination.

To achieve a healthy, coordinated pelvic floor, you can expect your Hive physical therapist to utilize any of the following treatments in your comprehensive care plan:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback