Urinary frequency
Urinary frequency refers to an increased urge to void without an increase in the total volume of urine produced. Usually resulting from decreased bladder capacity, urinary frequency is a cardinal sign of urinary tract infection (UTI). However, it can also stem from another urologic disorder, neurologic dysfunction, or pressure on the bladder from a nearby tumor or from organ enlargement (as occurs in pregnancy).
History and physical examination
Ask the patient how many times a day he voids and how this compares to his previous pattern of voiding. Also ask about the onset and duration of the increased frequency and about any associated urinary signs or symptoms, such as dysuria, urgency, incontinence, hematuria, discharge, or lower abdominal pain during urination.
Also ask about neurologic symptoms, such as muscle weakness, numbness, and tingling. Explore the patient’s medical history for UTIs or other urologic problems, recent urologic procedures, and neurologic disorders. Ask a male patient about a history of prostatic enlargement. Ask a female patient of childbearing age whether she is or could be pregnant.
Obtain a clean-catch midstream urine specimen for urinalysis and culture and sensitivity tests. Then palpate the patient’s suprapubic area, abdomen, and flanks, noting any tenderness. Examine the urethral meatus for redness, discharge, or swelling. The physician may palpate the prostate gland of a male patient.
If the patient’s history or symptoms suggest a neurologic disorder, perform a neurologic examination.
Medical causes
Anxiety neurosis
Morbid anxiety produces urinary frequency and other types of genitourinary dysfunction, such as dysuria, impotence, and frigidity. Other findings may include headache, diaphoresis, hyperventilation, palpitations, muscle spasm, generalized motor weakness, dizziness, polyphagia, and constipation or other GI complaints.
Benign prostatic hyperplasia
Prostatic enlargement causes urinary frequency along with nocturia and possibly incontinence and hematuria. Initial effects are those of prostatism: reduced caliber and force of the urine stream, urinary hesitancy and tenesmus, inability to stop the urine stream, a feeling of incomplete voiding, and occasionally urine retention. Assessment reveals bladder distention.
Bladder calculus
Bladder irritation from a calculus may lead to urinary frequency and urgency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. If the calculus lodges in the bladder neck, the patient may have overflow incontinence and referred pain to the lower back or heel.
Bladder cancer
Urinary frequency, urgency, dribbling, and nocturia may develop from bladder irritation. The first sign of bladder cancer commonly is intermittent gross, painless hematuria (often with clots). Patients with invasive lesions commonly have suprapubic or pelvic pain from bladder spasms.
Multiple sclerosis (MS)
Urinary frequency, urgency, and incontinence are common urologic findings in patients with MS, but these effects widely vary and tend to wax and wane. Visual problems (such as diplopia and blurred vision) and sensory impairment (such as paresthesia) are usually the earliest symptoms. Other findings may include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer
In advanced prostate cancer, urinary frequency may occur along with hesitancy, dribbling, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped prostate.
Prostatitis
Acute prostatitis commonly produces urinary frequency and urgency, dysuria, nocturia, and a purulent urethral discharge. Other findings include fever, chills, low back pain, myalgia, arthralgia, and perineal fullness. The prostate may be tense, boggy, tender, and warm. Prostate massage to obtain prostatic fluid is contraindicated. Signs and symptoms of chronic prostatitis are usually the same as those of the acute form, but to a lesser degree. The patient may also experience pain on ejaculation.
Rectal tumor
The pressure that this tumor exerts on the bladder may cause urinary frequency. Early findings include altered bowel elimination habits, commonly starting with an urgent need to defecate on arising or obstipation alternating with diarrhea; blood or mucus in the stool; and a sense of incomplete evacuation.
Reiter’s syndrome
In this self-limiting syndrome, urinary frequency and other symptoms of acute urethritis occur 1 to 2 weeks after sexual contact. Other symptoms of Reiter’s syndrome include asymmetrical arthritis of the knees, ankles, and metatarsophalangeal joints; unilateral or bilateral conjunctivitis; and small painless ulcers on the mouth, tongue, glans penis, palms, and soles.
Reproductive tract tumor
A tumor in the female reproductive tract may compress the bladder, causing urinary frequency. Other findings vary but may include abdominal distention, menstrual disturbances, vaginal bleeding, weight loss, pelvic pain, and fatigue.
Spinal cord lesion
Incomplete cord transection results in urinary frequency, continuous overflow, dribbling, urgency when voluntary control of sphincter function weakens, urinary hesitancy, and bladder distention. Other effects occur below the level of the lesion and include weakness, paralysis, sensory disturbances, hyperreflexia, and impotence.
Urethral stricture
Bladder decompensation produces urinary frequency, urgency, and nocturia. Early signs include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence, urinoma, and urosepsis may develop.
UTI
Affecting the urethra, the bladder, or the kidneys, this common cause of urinary frequency may also produce urgency, dysuria, hematuria, cloudy urine and, in males, a urethral discharge. The patient may report a fever and bladder spasms or a feeling of warmth during urination. Women may experience suprapubic or pelvic pain. In young adult males, a UTI is usually related to sexual contact.
Other causes
Diuretics
These substances, which include caffeine, reduce the body’s total volume of water and salt by increasing urine excretion. Excessive intake of coffee, tea, and other caffeinated beverages leads to urinary frequency.
Treatments
Radiation therapy may cause bladder inflammation, leading to urinary frequency.
Special considerations
Prepare the patient for diagnostic tests, such as urinalysis, culture and sensitivity tests, imaging tests, ultrasonography, cystoscopy, cystometry, postvoid residual tests, and a complete neurologic workup. If the patient’s mobility is impaired, keep a bedpan or commode near his bed. Carefully and accurately document the patient’s daily intake and output.
Pediatric pointers
UTIs are a common cause of urinary frequency in children, especially girls. Congenital anomalies that can cause UTIs include a duplicated ureter, congenital bladder diverticulum, and an ectopic ureteral orifice.
Geriatric pointers
Men older than age 50 are prone to frequent UTIs that aren’t related to sexual contact. Decreased estrogen levels in postmenopausal women cause urinary frequency, urgency, and nocturia.
Patient counseling
Instruct sexually active male patients in safe sex practices. Advise girls to clean the genital area from front to back to reduce contamination by Escherichia coli. Encourage women to increase intake of fluids, especially water; to void frequently throughout the day; and to clean themselves in the same manner as girls.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Reduced urine
» Next page: Urinary hesitancy (Professional Guide to Signs & Symptoms (Fifth Edition))
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