Frequent urination refers to an increased frequency of urination compared to normal; leaking urine refers to involuntary urination, i.e., urinary incontinence, such as when lifting heavy objects or sneezing, leading to leaking urine. Frequent urination and leaking urine can occur independently or simultaneously, both affecting quality of life. As age increases, the likelihood of frequent urination and leaking urine also gradually rises. According to statistics, about 60-70% of people over 40 experience nocturia once, and about 80% of those over 60; the incidence of leaking urine is 22% in elderly men and 35% in elderly women, with rates as high as 60% in long-term care facilities(1). It is evident that the older one gets, the more prone they are to frequent urination and leaking urine, hence early maintenance is crucial.
In modern medicine, frequent urination and leaking urine are collectively referred to as overactive bladder syndrome, which is closely related not only to aging but also to conditions such as heart failure, liver cirrhosis, chronic obstructive pulmonary disease, the three highs (hypertension, hyperlipidemia, hyperglycemia), and sleep apnea syndrome. This article primarily discusses frequent urination and leaking urine caused solely by aging. For frequent urination caused by urinary tract infections, please refer to the section on urethritis.
Urination is an important part of the body's fluid metabolism. It takes about 10-15 minutes for water to be transported from the stomach to the intestines, and after absorption by the intestines, it is transported via blood to the kidneys to form urine, a process that takes at least 40 minutes. Traditional Chinese Medicine (TCM) has long discovered in Neijing that the body's water originates from the spleen system's absorption of food and drink. After entering the body, the regulation of water is mainly completed by the lung and kidney systems. The lung system expels about one-third of the body's total water through the lungs and skin, while the kidney system's regulation of water covers the kidneys themselves and the endocrine system. Therefore, frequent urination in TCM is often related to imbalances in the kidney, spleen, and lung systems, symptoms arising from the deficiency and aging of the body's zang-fu organs.
Kidney deficiency is a common pattern for frequent urination, the kidney in TCM is a broad concept that encompasses the modern medical reproductive, urinary, and endocrine systems. Kidney deficiency leading to frequent urination can be further divided into several subcategories:- decreased kidney function, leading to poor regulation of body fluids and excessive urine production;
- aging of the bladder wall muscles, reduced elasticity, inability to withstand high urine pressure, and inability to hold much urine;
- uterine prolapse pressing on the bladder, feeling the need to urinate even when the bladder is not full;
- prostate enlargement pressing on the bladder, leading to frequent urination with a thin stream and difficulty urinating;
- aging, brain degeneration, insufficient secretion of antidiuretic hormone by the pituitary gland also leading to particularly frequent urination at night(2), severely affecting both day and night, which is also part of kidney deficiency.
If kidney deficiency is of the kidney yin deficiency pattern, frequent urination with small amounts of yellow urine, often accompanied by dry mouth and throat, dryness-heat sensation, hard stools, tinnitus, or dysphoria, insomnia, and other "heat signs," it is necessary to nourish kidney water and kidney yin; if it is kidney qi deficiency, frequent urination with clear and copious urine, often accompanied by a pale complexion, dizziness, weak waist and knees, and easy fatigue, it is necessary to tonify kidney qi; the further progression of kidney qi deficiency is kidney yang deficiency, where patients also experience cold intolerance, cold hands and feet, edema, or impotence, and must tonify kidney yang.
In the aspect of the spleen, TCM has discovered that spleen qi is primarily ascending and upward. For example, the essence and water obtained after the digestion and absorption of food by the stomach and intestines are transported upward to the heart and lungs, and then distributed throughout the body. If spleen qi deficiency is insufficient, digestive power is poor. In severe cases of spleen and stomach qi and blood deficiency, the phenomenon of sinking of middle qi can be observed. The ligaments of the organs in the abdominal and pelvic cavities of the patient will become loose and weak, causing the stomach, intestines, or uterus to prolapse, pressing down on the bladder, which can also lead to frequent urination. The treatment in TCM, which is currently beyond the imagination of modern medicine, is called "tonifying middle and replenishing qi" or "boosting middle qi." In addition to improving the digestive and absorptive functions of the spleen and stomach, it can also restore the tension of the ligaments of the abdominal organs and improve visceral prolapse. The further progression of spleen qi deficiency is spleen yang deficiency, where patients also exhibit symptoms such as a preference for warmth and aversion to cold, cold hands and feet, watery stools or stools containing undigested food, or excessive watery leucorrhea. In such cases, it is necessary to tonify spleen yang.In TCM, there is another type of frequent urination related to the spleen—"splenic constipation," which is caused by the overactive function of the large intestine in absorbing water, leading to hard stools and frequent urination. The treatment often uses Hemp Seed Pill to moisten the intestines and soften the stools. Once the stools are no longer dry and hard, frequent urination can be alleviated.
In terms of the lungs, TCM believes that the lungs are closely connected to the skin. Normally, one-third of the body's water is excreted through the lungs and skin. When the lungs and skin are exposed to cold, the alveoli, bronchi, and sweat glands contract, inhibiting the evaporation of water, which also increases urination. This is why urination tends to be more frequent and voluminous in winter. For those who are cold on the body surface, taking a hot shower, drinking a bowl of ginger sugar soup, or using releasing exterior with pungent-warm agents can dispel wind-cold and restore normal fluid metabolism pathways.Acupoint massage and moxibustion
| Frequent urination pattern | Acupoint selection |
|---|---|
| Kidney qi deficiency | Taixi (KI3), Shenshu (BL23), Guanyuan (RN4) |
| Kidney yin deficiency | Taixi (KI3), Fuliu (KI7), Sanyinjiao (SP6) |
| Spleen-stomach weakness | Hegu (LI4), Zusanli (ST36), Guanyuan (RN4), Baihui (DU20) |
Each treatment session: Press each acupoint for 3-5 seconds, release for 3-5 seconds, repeat for 3-5 minutes, then move to the next acupoint. Perform one session in the morning, noon, and evening.
Acupoint massage method: Use a tuina stick of moderate hardness or your fingers to massage the relevant acupoints in sequence. Press until a slight soreness is felt, but avoid excessive force. If pain is felt upon light touch, it indicates that the acupoint has been injured, and it should not be pressed further.
Patients with yang deficiency can use moxibustion on the acupoints. Moxibust one acupoint at a time, switching to the next acupoint when a burning sensation is felt. For mild cold deficiency, moxibust for 10 minutes per session; for severe cold deficiency, moxibust for 15-20 minutes per session. If dry mouth and tongue occur, it indicates over-moxibustion and heatiness, and moxibustion should be paused.
Patients with yin deficiency should not use moxibustion.
Food therapy and medicinal cuisine
| Frequent urination due to kidney qi deficiency | |
|---|---|
| Ingredients | 2 pig kidneys, 30g English Walnut Seed, 15g Eucommia Bark |
| Method | Slice the pork kidney, crush the Eucommia Bark, add walnuts and an appropriate amount of water, stew until cooked, remove the Eucommia Bark residue, and consume in 2 to 3 servings. |
| kidney yin deficiency frequent urination | |
|---|---|
| Ingredients | 30g pig spinal cord, 50g Chinese Yam, 20g Barbary Wolfberry Fruit |
| Method | Add an appropriate amount of water, stew until cooked, and consume in 2-3 servings. |
| spleen-stomach weakness frequent urination | |
|---|---|
| Ingredients | 500g pig stomach, 100g rice, 30g each of Astragalus Root, Gordon Euryale Seed, Lotus Seed, Chinese Yam |
| Method | First, boil the pig stomach in water until half-cooked, then remove and slice into strips. Mix with other ingredients and cook with the broth from the pig stomach to make porridge. Consume in 2-3 servings. |
Exercise and Health Care
Strengthen the pelvic floor muscles through repeated Kegel exercises to improve frequent urination and leaking urine. How to perform Kegel exercises? When you stop urinating midstream or hold in gas, you are engaging the pelvic floor muscles.Method: Coordinate with abdominal breathing, relax for 5-10 seconds while inhaling, and contract for 5-10 seconds while exhaling. Repeat this exercise for 10 minutes per session, 2-3 sessions daily, for several weeks. This may have a certain effect on some patients.
Other Recommendations
- Avoid beverages containing caffeine (including tea leaves, coffee beans, cola), spicy and dry-heat foods, cold melons and fruits, and alcohol.
- Avoid drinking too much water before bedtime.
bubble_chart Footnote
- Based on the 1998 survey results of the Asian Urinary Incontinence Advisory Committee across 11 Asian countries.
- The function of antidiuretic hormone is to reduce urine production and retain body fluids, with a significant diurnal rhythm, secreting less during the day hence more urine, and more at night hence less urine for better sleep.
