Urinary frequency is the need to urinate many times during the day, at night (nocturia), or both but in normal or less-than-normal volumes. Frequency may be accompanied by a sensation of an urgent need to void (urinary urgency). Urinary frequency is distinguished from polyuria Polyuria Polyuria is urine output of > 3 L/day; it must be distinguished from urinary frequency, which is the need to urinate many times during the day or night but in normal or less-than-normal volumes... read more , which is increased urine output of > 3 L/day.
Pathophysiology of Urinary Frequency
Urinary frequency usually results from disorders of the lower genitourinary tract. Inflammation of the bladder, urethra, or both causes a sensation of the need to urinate. However, this sensation is not relieved by emptying the bladder, so once the bladder is emptied, patients continue trying to void but pass only small volumes of urine.
Etiology of Urinary Frequency
There are many causes of urinary frequency (see table Some Causes of Urinary Frequency Some Causes of Urinary Frequency 
), but the most common include
Evaluation of Urinary Frequency
History
History of present illness should first ask about the amounts of fluid consumed and voided to distinguish between urinary frequency and polyuria Polyuria Polyuria is urine output of > 3 L/day; it must be distinguished from urinary frequency, which is the need to urinate many times during the day or night but in normal or less-than-normal volumes... read more . If urinary frequency is present, patients are asked about acuity of onset, presence or absence of irritative symptoms (eg, irritation, urgency, dysuria Dysuria Dysuria is painful or uncomfortable urination, typically a sharp, burning sensation. Some disorders cause a painful ache over the bladder or perineum. Dysuria is an extremely common symptom... read more ), obstructive symptoms (eg, hesitancy, poor flow, sensation of incomplete voiding, nocturia), and recent sexual contacts.
Review of systems should cover symptoms suggestive of a cause, including fever, flank or groin pain, and hematuria (infection); missed menses, breast swelling, and morning sickness (pregnancy); and arthritis and conjunctivitis (reactive arthritis Reactive Arthritis Reactive arthritis is an acute spondyloarthropathy that often seems precipitated by an infection, usually genitourinary or gastrointestinal. Common manifestations include asymmetric arthritis... read more 
).
Past medical history should ask about known causes, including prostate disease and previous pelvic radiation therapy or surgeries. Drugs and diet are reviewed for the use of agents that increase urine output (eg, diuretics, alcohol, caffeinated beverages).
Physical examination
Examination focuses on the genitourinary system.
Any urethral discharge or any lesions consistent with sexually transmitted infections Overview of Sexually Transmitted Infections Sexually transmitted infection (STI) refers to infection with a pathogen that is transmitted through blood, semen, vaginal fluids, or other body fluids during oral, anal, or genital sex with... read more are noted. Rectal examination in men should note the size and consistency of the prostate and rectal tone; pelvic examination in women should note the presence of any cystocele Anterior and Posterior Vaginal Wall Prolapse Anterior and posterior vaginal wall prolapse involve protrusion of an organ into the vaginal canal. Anterior vaginal wall prolapse is commonly referred to as cystocele or urethrocele (when the... read more . Patients should be instructed to cough while the urethra is observed for signs of urinary leakage.
The costovertebral angle should be palpated for tenderness, and the abdominal examination should note the presence of any masses or suprapubic tenderness.
Neurologic examination should test for lower-extremity weakness and loss of sensation.
Red flags
The following findings are of particular concern:
Lower-extremity weakness or signs of spinal cord damage (eg, loss of sensation at a segmental level, loss of anal sphincter tone and anal wink reflex)
Fever and back pain
Interpretation of findings
Dysuria Dysuria Dysuria is painful or uncomfortable urination, typically a sharp, burning sensation. Some disorders cause a painful ache over the bladder or perineum. Dysuria is an extremely common symptom... read more suggests frequency is due to urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more (UTI) or calculi Urinary Calculi Urinary calculi are solid particles in the urinary system. They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection. Diagnosis is based on... read more . Prior pelvic surgery suggests incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine; some experts consider it present only when a patient thinks it is a problem. The disorder is greatly underrecognized and underreported. Many... read more . Weak urine stream, nocturia, or both suggests benign prostatic hyperplasia Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary... read more (BPH). Urinary frequency in an otherwise healthy young patient may be due to excessive intake of alcohol or caffeinated beverages. Gross hematuria suggests UTI and calculi in younger patients and genitourinary cancer in older patients.
Testing
All patients require urinalysis and culture, which are easily done and can detect infection and hematuria Isolated Hematuria Hematuria is red blood cells (RBCs) in urine, specifically > 3 RBCs per high-power field on urine sediment examination. Urine may be red, bloody, or cola-colored (gross hematuria with oxidation... read more .
Cytoscopy, cystometry, and urethrography can be done to diagnose cystitis, bladder outlet obstruction, and cystocele Anterior and Posterior Vaginal Wall Prolapse Anterior and posterior vaginal wall prolapse involve protrusion of an organ into the vaginal canal. Anterior vaginal wall prolapse is commonly referred to as cystocele or urethrocele (when the... read more . Prostate-specific antigen Prostate-specific antigen (PSA) levels Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary... read more level determination, ultrasonography, and prostate biopsy Prostate biopsy Biopsy of the urinary tract requires a trained specialist (nephrologist, urologist, or interventional radiologist). Indications for diagnostic biopsy include unexplained nephritic or nephrotic... read more may be required, especially in older men, to differentiate BPH Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary... read more from prostate cancer Prostate Cancer Prostate cancer is usually adenocarcinoma. Symptoms are typically absent until tumor growth causes hematuria and/or obstruction with pain. Diagnosis is suggested by digital rectal examination... read more .
Treatment of Urinary Frequency
Treatment varies by cause.
Geriatrics Essentials: Urinary Frequency
Urinary frequency in older men is often caused by bladder neck obstruction secondary to prostate enlargement Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary... read more or cancer Prostate Cancer Prostate cancer is usually adenocarcinoma. Symptoms are typically absent until tumor growth causes hematuria and/or obstruction with pain. Diagnosis is suggested by digital rectal examination... read more . These patients usually require an ultrasonographic bladder scan to determine postvoid residual urine volume. Urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more or use of diuretics may be a cause in both sexes.
Key Points
UTI is the most common cause in children and women.
Prostate disease is a common cause in men aged > 50 years.
Excessive intake of caffeine can cause urinary frequency in healthy people.
