Urinary frequency

Urinary frequency refers to increased incidence of the urge to void without an increase in the total volume of urine produced. Usually resulting from decreased bladder capacity, frequency is a cardinal sign of urinary tract infection. 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 with pregnancy).

History and physical examination

Ask the patient how many times a day he voids. How does this compare to his previous pattern of voiding? Ask about the onset and duration of the abnormal frequency and about any associated urinary signs or symptoms, such as dysuria, urgency, incontinence, hematuria, discharge, or lower abdominal pain with urination.

Ask also about neurologic symptoms, such as muscle weakness, numbness, or tingling. Explore his medical history for urinary tract infection, other urologic problems or recent urologic procedures, and neurologic disorders. With a male patient, ask about a history of prostatic enlargement. If the patient is a female of childbearing age, ask whether she is or could be pregnant.

Obtain a clean-catch midstream sample for urinalysis and culture and sensitivity tests. Then palpate the patient’s suprapubic area, abdomen, and flanks, noting any tenderness. Examine his urethral meatus for redness, discharge, or swelling. In a male patient, the physician may palpate the prostate gland.

If the patient’s medical history reveals symptoms or a history of neurologic disorders, perform a neurologic examination.

Medical causes

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 may lead to urinary frequency and urgency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. The patient may have overflow incontinence if the calculus lodges in the bladder neck. Greatest discomfort usually occurs at the end of micturition if the stone lodges in the bladder neck. This may also cause overflow incontinence and referred pain to the lower back or heel.

Prostate cancer

In advanced stages of 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, along with urgency, dysuria, nocturia, and 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 exerted by a rectal tumor on the bladder may cause urinary frequency. Early findings include changed bowel 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 Reiter’s syndrome, urinary frequency occurs with symptoms of acute urethritis 1 to 2 weeks after sexual contact. Other symptoms of this self-limiting syndrome include asymmetrical arthritis of 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, along with urgency and nocturia. Early signs include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence may occur. Urinoma and urosepsis may develop.

Urinary tract infection

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, urethral discharge. The patient may report bladder spasms or a feeling of warmth during urination and a fever. Women may experience suprapubic or pelvic pain. In young adult males, urinary tract infection 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 amounts.

Pediatric pointers

Urinary tract infection is a common cause of urinary frequency in children, especially girls. Congenital anomalies that can cause urinary tract infection include a duplicated ureter, congenital bladder diverticulum, and an ectopic ureteral orifice.

Geriatric pointers

Men older than age 50 are prone to frequent non–sex-related urinary tract infections. In postmenopausal women, decreased estrogen levels cause urinary frequency, urgency, and nocturia.

Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

Other Book Chapters Related to Urinary symptoms

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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Urinary symptoms

• Back to symptom: Urinary symptoms: Introduction (review 1071 causes)
• Next Book Extract About Urinary symptoms: Urinary hesitancy (Handbook of Signs & Symptoms (Third Edition))
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More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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