Urinary frequency

Bar chart to show difference in rates of urination between those with and without frequency of urine.

Definition

Frequency of urine means needing to wee a large number of times. This is distinct from polyuria - passing large volumes of urine. You might go to the toilet once but be standing there for three hours weeing - that's polyuria, not frequency of urine. You might go to the toilet a 100 times in a day but in total pass about 25ml (a shot glass worth) of urine.

Urgency is the desire to go to the toilet. Urge incontinence is wetting oneself with the desperate desire to go. Generally, it's sudden onset. Nocturia is going to the toilet at night a lot.

Epidemiology

Differential Diagnosis

Basically, there are some that are urinary tract related and some that are not.

• Urinary tract - UTI (most common, especially in women), prostate (cancer, prostatitis, BPH), bladder obstruction (cancer or anatomical problem)
• Non-urinary tract - type I diabetes, heart failure, neuro stuff (spinal injury, MS), diuretics (the drugs themselves, plus caffeine and alcohol).

Clinical and Associated Features

Urinary tract

• UTI - dysuria, fever (possibly rigors), abdo pain, haematuria, frequency of urine
• Prostate
  • Cancer - dysuria, hesitancy/retention, haematuria, haematospermia (blood in sperm), pain (back, perineal, testicular), constipation. Secondary signs: bone - pain, fracture, hypercalcaemia, lower limb neurological deficit; jaundice; seizures; oedema. General features: weight loss, anorexia, fever.
  • Prostatitis - perineal pain, frequency, urgency, haematuria, pain on defaecation. Can progress to chronic prostatitis if treated poorly.
  • Benign prostatic hyperplasia - see prostatitis plus flattened surface on DRE.
• Bladder obstruction - hesistancy, poor stream, dribbling, nocturia, urgency, urge incontinence (urinary retention, uraemia, renal failure if it gets really bad). Palpable mass on abdominal exam and DRE.

Non-urinary tract

• Type 1 diabetes - polyuria (lots of wee, thus causing frequency), polydipsia (excessive thirst), weight loss, coma, DKA
• Heart failure - Bilateral oedema in the lower leg. In right heart failure, there will also be a raised JVP. In congestive heart failure, you will get all sorts of crazy: pulmonary oedema (bilateral crackles in the lung bases), orthopnoea, paroxysmal nocturnal dyspnoea, pulse abnormalities (tachycardia, pulsus alternans, reduced volume), hepatomegaly, ascites
• Neuro
  • Spinal injury - you get a spinal injury
  • MS - basically, a series of temporary neurological deficits, becoming longer and more frequent (eventually permanent). Urinary problems is one of these deficits but optic neuritis is common plus any other neurological deficit. Must be 'disseminated in time and place' i.e. different locations for the lesions, not related in time.
• Diuretics - well, that makes sense really.
• Alcohol and caffeine - worth considering in a presentation of lots of weeing.