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Frequency

Alison C. Agner MD
Basics
Description
>8 voids in 24 hours and >1 void per night
More practical definition is greater number of voids than the woman is used
to.
Age-Related Factors
More common in older adults due to increased prevalence of pelvic organ prolapse.
Risk Factors
History of UTI
History of pelvic organ prolapse

History of urinary incontinence or surgery for incontinence

History of disorder that causes neurogenic bladder:


o

Spinal cord injury

Stroke

Multiple sclerosis

Pathophysiology
4 common categories:
Infection
Inflammation

Neoplasm

Neuromuscular

Associated Conditions
Dysuria
Urinary incontinence

Urinary tract infection (see topic)

Diagnosis
Signs and Symptoms
History
Assess urinary habits carefully with urinary diary:
o Ask about fluid intake and caffeine intake

Assess for associated dysuria and urgency

Assess for incontinence


o

Stress versus urge

Review of Systems

General:
o Fever, chills

GI:
o

GU:
o

Dysuria, urgency, hematuria

Neurologic:
o

Diarrhea, nausea, emesis

Weakness or numbness

Gynecologic:
o

Abnormal vaginal discharge

Physical Exam
General:
o Fever

Pelvic exam:
o

Evaluate for bladder and urethral tenderness

Postvoid residual

Tests
Labs

UA and urine culture:


o To evaluate for infection

Postvoid residual volume:


o

To evaluate overflow incontinence

Random or fasting blood glucose if other symptoms of diabetes are present

Plasma sodium to evaluate for diabetes insipidus if other symptoms of


diabetes are present

Plasma sodium if concern exists for diabetes insipidus:


o

Expect normal or elevated sodium

Imaging
Not routinely needed
MRI if concern for urethral diverticulum

Referral for urodynamics only if patient has complex incontinence symptoms

Differential Diagnosis

UTI
Stress or urge urinary incontinence

Overactive bladder

Urinary retention with overflow incontinence

Interstitial cystitis

Diabetes mellitus

Diabetes insipidus

Infection
Most common cause:
Escherichia coli is most common pathogen in otherwise healthy female
Staph saprophyticus is nitrite negative
P.45
Metabolic/Endocrine
Diabetes may present with polyuria and polydipsia:
Type I DM, Type II DM
Diabetes insipidus
Tumor/Malignancy
Urothelial tumors are uncommon:
o Warning signs include gross hematuria

Pelvic masses or neoplasms may also cause frequency.

Drugs
Diuretics may cause frequency, especially soon after initiation of therapy:
Hydrochlorothiazide, furosemide
Other/Miscellaneous
Inflammation:
o Painful bladder syndrome (interstitial cystitis)

Pelvic organ prolapse

Lifestyle choices:
o

High fluid intake or fluid intake prior to bed

Pregnancy Considerations
Urinary frequency is a common symptom in early pregnancy.
Management
General Measures
Start by having patient keep a voiding diary for at least 1 week, which may be
completed prior to visit.

Medication (Drugs)
Antibiotics for UTI:
o TMP-SMX is first-line therapy

3 days for uncomplicated UTI

7 days for complicated UTI

Ciprofloxacin is second line

Nitrofurantoin is used in pregnancy.

Anticholinergics for urge urinary incontinence

Surgery
Useful for stress urinary incontinence
Suprapubic catheter may be considered for neurogenic bladder with overflow
incontinence.
Followup
Disposition
Issues for Referral
Consider urology referral if:
Infection is not present
Lifestyle changes do not improve symptoms

Other red-flag symptoms are present:


o

Painless hematuria, pain on exam, etc.

Prognosis
UTIs are usually easily treated with oral antibiotics.
Patient Monitoring
Antibiotic prophylaxis is indicated if patient has recurrent UTIs.
TMP-SMX PO daily
Miscellaneous
Synonym(s)
Polyuria
Abbreviations
TMP-SMXTrimethoprim/Sulfamethoxazole UTIUrinary tract infection
Codes
ICD9-CM
253.5 Diabetes insipidus
595.0 Cystitis
788.42 Polyuria
Patient Teaching
For recurrent UTI, advise voiding prior to and immediately after intercourse.
Counseling on lifestyle changes:
Limiting fluid intake, especially 3 hours prior to bed time
Limiting caffeine and citrus
ACOG Patient Education PamphletUrinary Tract Infection

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