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Updated 11 February 2013

Urinary frequency

Urinary frequency is the need to pass urine more often than normal, although the total amount of urine passed may not be increased.

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 Definition

Urinary frequency is the need to pass urine more often than normal, although the total amount of urine passed may not be increased. Frequency during the night is called nocturia. Urgency, which is a sudden urgent need to empty the bladder, often accompanies frequency.

 Polyuria is the passing of increased amounts of urine: more than 3l/day.

 Causes and associated conditions

Mechanical irritation or inflammation of the bladder stimulates bladder emptying of even small amounts of urine.

Frequency and urgency together are usually caused by a bladder infection. Nocturia is common in middle-aged men with enlarged prostate glands, and those who drink too much fluid near to bedtime.

Common causes of urinary frequency are:

  1. Pregnancy – the uterus physically presses on the bladder;
  2. Diabetes – polyuria and increased risk of bladder infections;
  3. Cystitis – bladder infection;
  4. Interstitial cystitis – frequency without demonstrable urine infection;
  5. Diuretic use – usually with accompanying polyuria;
  6. Stroke and other neurological conditions affecting the bladder;
  7. Bladder cancer; and
  8. Chronic prostatitis. 

Diagnosis


The patient’s history will provide clues to the diagnosis, which can be confirmed by: 

  1. Urinalysis to detect infection or blood in the urine;
  2. Urine culture and sensitivity to identify infecting organisms and their antibiotic sensitivity;
  3. Ultrasound to visualise the genito-urinary structures;
  4. Cytstoscopy to inspect the inside of the bladder;
  5. Cystometry to measure bladder pressures; and
  6. Neurological tests where indicated (for instance, for urgency). 

Treatmemt


This will be dictated by the underlying cause. 

  • Nocturia may be helped by limiting fluid intake in the evenings.
    Prostate problems are treated accordingly.

  • For proven infections, urinary alkalinisers alter the pH (acidity) of the urine, to reduce bladder and urethral irritation, thus relieving symptoms. Antibiotics are prescribed according to the reported sensitivity of the organism. In patients at high risk for recurrent infections, for instance diabetics, extended treatment may be needed, with careful monitoring during and after treatment.

  • Interstitial cystits is managed by a regime of pain management, lifestyle changes (specifically, avoiding known precipitating factors), and use of gabapentin in some resistant cases. 

(Dr AG Hall)

 
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