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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.
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.
- Cystitis - eg, bacterial cystitis, interstitial cystitis; chemical cystitis - eg, cyclophosphamide.
- Vaginitis or vulvar vestibulitis.
- Urinary tract infection (UTI).
- Detrusor instability.
- Diabetes mellitus.
- Prostate-related - eg, prostatitis, benign prostatic hypertrophy, prostate cancer.
- Medications - eg, diuretics, doxazosin.
- Bladder dysfunction.
- Bladder tumours.
- Urinary tract stones or foreign bodies.
- Other urinary symptoms:
- Abdominal pain.
- Urinary incontinence (may suggest detrusor instability or may relate to inability to get to the toilet on time; also common in pregnancy).
- Also question about systemic symptoms - eg, 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.
- Midstream urine for dipstick, microscopy, culture and sensitivities and pregnancy testing as appropriate.
- FBC, renal function, liver function, glucose, calcium.
- Prostate specific antigen (PSA) in men.
- 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.
A screen for sexually transmitted infections (STIs) may be appropriate:
- Urinary tract symptoms may also be associated with STIs.
- One study of 264 women presenting to an emergency department with UTI-type symptoms reported 100 (57%) as having been treated without performing a urine culture. Of these, sixty (23%) had one or more positive STI tests.
This depends on the underlying cause and may range from a course of antibiotics to removal of a bladder neoplasm.
This is a clinical syndrome with one or more of the following:
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]Current research is focusing on modifications of existing drugs and a re-evaluation of old treatments.
See also separate Overactive Bladder article.
Further reading and references
Treatment of Non-neurogenic Male LUTS; European Association of Urology (2016)
Lower urinary tract symptoms in men: assessment and management; NICE Guidelines (June 2015)
Lukacz ES, Whitcomb EL, Lawrence JM, et al; Urinary frequency in community-dwelling women: what is normal? Am J Obstet Gynecol. 2009 May200(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 Mar185(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 Sep49(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 Apr109(4):922
Tomas ME, Getman D, Donskey CJ, et al; Overdiagnosis of Urinary Tract Infection and Underdiagnosis of Sexually Transmitted Infection in Adult Women Presenting to an Emergency Department. J Clin Microbiol. 2015 Aug53(8):2686-92. doi: 10.1128/JCM.00670-15. Epub 2015 Jun 10.
Madhuvrata P, Cody JD, Ellis G, et al; Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012 Jan 181: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 Jan189(1):210-6. doi: 10.1016/j.juro.2012.08.085. Epub 2012 Nov 20.
Andersson KE; Drug therapy of overactive bladder--what is coming next? Korean J Urol. 2015 Oct56(10):673-9. doi: 10.4111/kju.2015.56.10.673. Epub 2015 Oct 2.
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