Symptom Finder - Frequency and Urgency of Urination
FREQUENCY AND URGENCY OF URINATION
Frequency of urination may be due to polyuria (increased output of urine), obstruction to the output of urine (requiring frequent voiding to get the urine out) because the net capacity of the bladder is reduced, or irritative lesions in or near the urinary tract.
Polyuria: Increased output of urine, but, in summary, it may be caused by pituitary diabetes insipidus, nephritis, diabetes mellitus, hyperthyroidism, hyperparathyroidism, or
nephrogenic diabetes insipidus.
Obstruction of the bladder: This may be mechanical, as occurs in bladder neck obstruction due to prostatic hypertrophy, prostatitis, median bar hypertrophy, urethral stricture, and bladder calculi; or it may be due to a neurogenic bladder, as occurs in poliomyelitis, parasympatholytic drugs, tabes dorsalis, multiple sclerosis, other spinal cord lesions, and diabetic neuropathy.
Irritative lesions of the urinary tract: Infection, calculus, or neoplasm of the bladder, kidney, ureters, or urethra may do this. Chronic or acute prostatitis is sometimes the culprit. Inflammation anywhere in the pelvis (vaginitis, hemorrhoids, diverticulitis, appendicitis, or salpingitis) may also cause this.
Approach to the Diagnosis
This is no problem. Examine a drop of unspun urine under the microscope. You may be surprised to find multiple WBCs to confirm your suspicion of a UTI. More than one or two motile bacteria per high-power field is diagnostic of UTI. If this is negative, be sure to do a rectal and vaginal examination. Then culture the urine, catheterize for residual urine, and do an IVP, CT urography, and voiding cystogram. Ultrasonography is another way to confirm residual urine. A cystoscopy may be necessary. If these are negative for abnormal findings, it is a good idea to collect a 24-hour specimen; if the amount of urine exceeds 5 L, check the response to pitressin. Special cultures for Chlamydia should be done if all else fails. The workup of polyuria can proceed further, if necessary.
Other Useful Tests
1. Prostatic massage and examination of exudate (prostatitis)
2. Fishberg concentration test (chronic nephritis)
3. CT scan of the brain (pituitary tumor)
4. Serum antidiuretic hormone (ADH) (diabetes insipidus
5. Hickey–Hare test (diabetes insipidus)
6. Cystometric studies (neurogenic bladder)
7. Circulation time (CHF)
8. PSA (prostatic carcinoma, BPH)
Frequency of urination may be due to polyuria (increased output of urine), obstruction to the output of urine (requiring frequent voiding to get the urine out) because the net capacity of the bladder is reduced, or irritative lesions in or near the urinary tract.
Polyuria: Increased output of urine, but, in summary, it may be caused by pituitary diabetes insipidus, nephritis, diabetes mellitus, hyperthyroidism, hyperparathyroidism, or
nephrogenic diabetes insipidus.
Obstruction of the bladder: This may be mechanical, as occurs in bladder neck obstruction due to prostatic hypertrophy, prostatitis, median bar hypertrophy, urethral stricture, and bladder calculi; or it may be due to a neurogenic bladder, as occurs in poliomyelitis, parasympatholytic drugs, tabes dorsalis, multiple sclerosis, other spinal cord lesions, and diabetic neuropathy.
Irritative lesions of the urinary tract: Infection, calculus, or neoplasm of the bladder, kidney, ureters, or urethra may do this. Chronic or acute prostatitis is sometimes the culprit. Inflammation anywhere in the pelvis (vaginitis, hemorrhoids, diverticulitis, appendicitis, or salpingitis) may also cause this.
Approach to the Diagnosis
This is no problem. Examine a drop of unspun urine under the microscope. You may be surprised to find multiple WBCs to confirm your suspicion of a UTI. More than one or two motile bacteria per high-power field is diagnostic of UTI. If this is negative, be sure to do a rectal and vaginal examination. Then culture the urine, catheterize for residual urine, and do an IVP, CT urography, and voiding cystogram. Ultrasonography is another way to confirm residual urine. A cystoscopy may be necessary. If these are negative for abnormal findings, it is a good idea to collect a 24-hour specimen; if the amount of urine exceeds 5 L, check the response to pitressin. Special cultures for Chlamydia should be done if all else fails. The workup of polyuria can proceed further, if necessary.
Other Useful Tests
1. Prostatic massage and examination of exudate (prostatitis)
2. Fishberg concentration test (chronic nephritis)
3. CT scan of the brain (pituitary tumor)
4. Serum antidiuretic hormone (ADH) (diabetes insipidus
5. Hickey–Hare test (diabetes insipidus)
6. Cystometric studies (neurogenic bladder)
7. Circulation time (CHF)
8. PSA (prostatic carcinoma, BPH)
