Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.
Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
What causes urinary frequency?
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.
How common is urinary frequency?
The true prevalence of urinary symptoms is difficult to study as embarrassment may contribute to under-reporting, but studies suggest it increases with age, as causative risk factors become more likely- eg, benign prostatic hypertrophy in men and genito-urinary syndrome of the menopause in women.
In a 2015 UK-based postal survey 7% of the women had symptoms of overactive bladder and 20% had mixed urinary incontinence. A 2018 study of adults aged over 40 years in South Korea showed nocturia (36%) and frequency (30%) were the most often reported symptoms. In the elderly it is very common in both sexes.[3, 4]
- 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 - eg, associated with neurological conditions such as multiple sclerosis or Parkinson's disease.
- Bladder tumours.
- Urinary tract stones or foreign bodies.
Urinary frequency - associated symptoms
- Other urinary symptoms:
- 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.
- A 2018 study of 1,052 women presenting to an emergency department with UTI-type symptoms with possible STI, found sterile pyuria in 74% with negative urine cultures.
Urinary frequency treatment
This depends on the underlying cause and may range from medications such as a course of antibiotics to surgery.
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. European guidelines recommend keeping a symptom diary for 3-7 days. This both assesses the scale of the presenting problem and acts as a marker for response to treatment.
Current management options include bladder training, anticholinergic drugs, intravesical botulinum toxin injections, intermittent self-catheterisation and sacral or posterior tibial nerve stimulation. Current research is focusing on novel therapeutic agents and some modifications of existing drugs.
See also the separate Overactive Bladder article.
Further reading and references
Lower urinary tract symptoms in men: assessment and management; NICE Guidelines (June 2015)
Incontinence - urinary, in women; NICE CKS, October 2019 (UK access only)
Burgio KL, James AS, LaCoursiere DY, et al; Views of Normal Bladder Function Among Women Experiencing Lower Urinary Tract Symptoms. Urology. 2021 Apr150:103-109. doi: 10.1016/j.urology.2020.08.021. Epub 2020 Aug 22.
Cooper J, Annappa M, Quigley A, et al; Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey. Prim Health Care Res Dev. 2015 Jul16(4):377-82. doi: 10.1017/S1463423614000371. Epub 2014 Oct 2.
Yoo TK, Lee KS, Sumarsono B, et al; The prevalence of lower urinary tract symptoms in population aged 40 years or over, in South Korea. Investig Clin Urol. 2018 May59(3):166-176. doi: 10.4111/icu.2018.59.3.166. Epub 2018 Apr 23.
Guidelines on Non-neurogenic Female LUTS; European Association of Urology (updated March 2022)
Guidelines on the Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO); European Association of Urology (2022)
Shipman SB, Risinger CR, Evans CM, et al; High Prevalence of Sterile Pyuria in the Setting of Sexually Transmitted Infection in Women Presenting to an Emergency Department. West J Emerg Med. 2018 Mar19(2):282-286. doi: 10.5811/westjem.2017.12.35605. Epub 2018 Feb 26.
Loloi J, Clearwater W, Schulz A, et al; Medical Treatment of Overactive Bladder. Urol Clin North Am. 2022 May49(2):249-261. doi: 10.1016/j.ucl.2021.12.005.