PrintThis PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.
Description
The basic causes of urinary frequency can be divided into three groups:
- Polyuria when too much urine is being produced.
- Instability of the detrusor mechanism.
- Inability of the bladder to stretch.
However, urinary frequency strictly speaking occurs when there is an increased need to urinate more often without a concomitant increase in the volume of urine.
Epidemiology[1]
The prevalence increases with age and is more common in women. In the elderly it is very common in both sexes. Risk factors include hypertension, obesity and smoking.[2]
Causes
- Cystitis - eg, bacterial cystitis, interstitial cystitis; chemical cystitis - eg, cyclophosphamide.
- Urethritis.
- Vaginitis or vulvar vestibulitis.
- Urinary tract infection.
- Detrusor instability.
- Diabetes mellitus.
- Pregnancy.
- Prostate-related - eg, prostatitis, benign prostatic hypertrophy, prostate cancer.
- Medications - eg, diuretics, doxazosin.
- Radiotherapy.
- Schistosomiasis.
- Bladder dysfunction.
- Bladder tumours.
- Urinary tract stones or foreign bodies.
Presentation
Symptoms
- Other urinary symptoms:
- Dysuria.
- Urgency.
- Haematuria.
- Nocturia.
- Hesitancy.
- Dribbling.
- Abdominal pain.
- Urinary incontinence (may suggest detrusor instability or may relate to inability to get to the toilet on time; also common in pregnancy).[3]
- Also question about systemic symptoms - eg, weight loss, fever, etc.
Signs
- May be normal.
- Look for a distended bladder.
- In women vaginal examination may be appropriate.
- In men digital rectal examination should be performed.
Investigations
Definite
- Mid-stream urine for dipstick, microscopy, culture and sensitivities and pregnancy testing as appropriate.
Blood tests
- FBC, renal function, liver function, glucose, calcium.
- Prostate-specific antigen (PSA) in men.
Imaging
- This will depend on the clinical suspicion.
- Bladder, renal and ureteric ultrasound.
- CT scan or intravenous urography (IVU) looking for ureteric stones.
- Bladder flow studies and cytometry.
- Cystoscopy.
Other
A screen for sexually transmitted diseases may be appropriate:
- Urinary tract symptoms may also be associated with sexually transmitted infections.
- One study found that the prevalence of sexually transmitted infections in sexually active adolescent females to be as high as 33%. This was associated with positive urine samples for leukocytes and blood.[4]
Management
This depends on the underlying cause and may range from a course of antibiotics to removal of a bladder neoplasm.
Overactive bladder
This is a clinical syndrome with one or more of the following:
- Urgency
- Frequency
- Nocturia
- Incontinence
Patients have an immediate need to empty the bladder, which comes on suddenly.
Current management options include bladder training, anticholinergic drugs, intravesical botulinum toxin injections, intermittent self-catheterisation and sacral or posterior tibial nerve stimulation.[5][6]
See separate article Detrusor Instability and Irritable Bladder for more details.
Further reading & references
- Guidelines on the Management of Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO); European Association of Urology (2012)
- The management of lower urinary tract symptoms in men, NICE Clinical Guideline (May 2010)
- Lukacz ES, Whitcomb EL, Lawrence JM, et al; Urinary frequency in community-dwelling women: what is normal? Am J Obstet Gynecol. 2009 May;200(5):552.e1-7. doi: 10.1016/j.ajog.2008.11.006. Epub 2009 Feb 27.
- Link CL, Steers WD, Kusek JW, et al; The association of adiposity and overactive bladder appears to differ by gender: results from the Boston Area Community Health survey. J Urol. 2011 Mar;185(3):955-63. doi: 10.1016/j.juro.2010.10.048. Epub 2011 Jan 19.
- Hsieh CH, Chang WC, Hsu MI, et al; Risk factors of urinary frequency among women aged 60 and older in Taiwan. Taiwan J Obstet Gynecol. 2010 Sep;49(3):260-5. doi: 10.1016/S1028-4559(10)60058-7.
- Wesnes SL, Rortveit G, Bo K, et al; Urinary incontinence during pregnancy. Obstet Gynecol. 2007 Apr;109(4):922
- Huppert JS, Biro F, Lan D, et al; Urinary symptoms in adolescent females: STI or UTI? J Adolesc Health. 2007 May;40(5):418
- Madhuvrata P, Cody JD, Ellis G, et al; Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012 Jan 18;1:CD005429. doi: 10.1002/14651858.CD005429.pub2.
- Martinson M, Macdiarmid S, Black E; Cost of neuromodulation therapies for overactive bladder: percutaneous tibial nerve stimulation versus sacral nerve stimulation. J Urol. 2013 Jan;189(1):210-6. doi: 10.1016/j.juro.2012.08.085. Epub 2012 Nov 20.
| Original Author: Dr Gurvinder Rull | Current Version: Dr Laurence Knott | Peer Reviewer: Dr Helen Huins |
| Last Checked: 11/01/2013 | Document ID: 499 Version: 4 | © EMIS |
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