Case

A 4 year old boy is brought in to your office by his mother who is very distressed because her son is urinating very frequently. According to his mother, he urinates every 5-10 minutes. How would you evaluate this patient?

Pollakiuria is defined as frequent daytime urination that may occur as often as every 5 minutes, although usually the child urinates 3-4 times/hour. This is a common pediatric complaint and the parents are usually concerned that their child has diabetes mellitus or a UTI. The majority of children are between 4-6 years of age. Pollakiuria is more common than urinary tract infections in children. Symptoms may last for years, but the average length is 7-12 months. 

Frequent characteristics:

1. There is no dysuria and the volumes of urine are small (no polyuria)
2. There is no incontinence, dribbling, and the urinary stream is normal
3. Although there may be nocturia, it is not to the extent of the daytime frequency.
4. There are no changes in bowel habits
5. There may be "stress" factors identified

1. Diabetes mellitus
2. Diabetes insipidus
3. Urinary tract infection

1. Careful history
1. Frequency, volume, bowel history, burning
2. History of UTIs
3. Fluid intake and diet (caffeine)
4. Night pattern
2. Physical examination
3. Urine analysis- no hematuria, wbcs. nor proteinuria. Absence of glucose and normal spg.
4. Urine Culture- sterile
5. If the history is consistent with pollakiuria and the physical examination and urine are normal, there is no need to do a radiographic evaluation. 

If the evaluation points toward the diagnosis of pollakiuria, the child should be observed and the family must be reassured. If there are obvious stress factors, they should be dealt with. Often, paying less attention to the frequent urination may enhance its disappearance. If symptoms and signs change, further evaluation may be warranted. There is no role for antispasmodics.

Reference

1. Zoubek,J. Extraordinary Urinary Frequency. Pediatrics June 1990
2. Waternberg, Nathan. Daytime Urinary Frequency in Children. Clinical Peds. Jan 1994
3. Casale A. Daytime Wetting Contemporary Pediatrics February 2000