Description

The basic causes of urinary frequency can be divided into 3 groups:

1. Polyuria when too much urine is being produced
2. Instability of the detrusor mechanism
3. 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

The prevalence increases with age and is more common in women. In the elderly it is very common in both sexes.

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)¹
• Also question about systemic symptoms, e.g. weight loss, fever etc.

• 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

• Full blood count, renal function, liver function, glucose, calcium
• PSA in men

Imaging

• This will depend on the clinical suspicion
• Bladder, renal and ureteric ultrasound
• CT scan or 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 leucocytes and blood.²

Management

Depends on the underlying cause and may range from a course of antibiotics to removal of bladder neoplasm.

Overactive bladder

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.

Treatment involves the anticholinergic drugs oxybutynin and tolterodine. However these drugs have troublesome anticholinergic side-effects. Newer agents currently being investigated include antispasmodics and selective anticholinergic agents.³