| Frequent
Daytime Urination-
Pollakiuria Pollakiuria , also called extraordinary daytime urinary frequency, is a benign condition defined as frequent small voids in a previously toilet trained child with no polyuria or evidence of infection. The condition is self-limited with an average duration of 7-12 months.
Signs and Symptoms: · Distinct change in normal voiding pattern to one with increased frequency. Main complaint of parents is frequent urination that interrupts school or daily activities · Average frequency is every 15-20 minutes, but can occur as often as every five minutes. · Peak age is 5-6yo with a range of 3-14yo · Small amount of urine with each void · Urine color, stream, and odor are normal · Nocturia may be present (25% of patients) but urination is not as frequent as daytime symptoms · No incontinence, although a small percentage may develop secondary nocturnal enuresis · No changes in bowel habits · No dysuria, abdominal, or flank plain · Usually associated with a psychological stressor
Differential Diagnosis: · Neurogenic bladder o May present with weak and dribbling stream, loss of bladder control o Often associated with spinal cord injury · Enterobius vermicularis infestation o May cause urinary frequency o Present with anal puririts, especially at night o Positive scotch tape test · Polyuric conditions (Diabetes mellitus/insipidus) o Abnormal urinalysis · Urinary tract infection o Dysuria o Abnormal urinalysis · Drugs (antihistamines, diuretics, theophylline, cisapride, psychotropic drugs.)
Evaluation and Diagnosis: Parents are usually concerned that their child has diabetes mellitus or a urinary tract infection Careful history and physical · Evidence of change in normal voiding pattern · Any history of UTIs · Small voids · Absence of polydypsia · No abdominal or flank pain · No dysuria · Normal neurological exam, especially of lower extremities Urinalysis · Normal urine specific gravity (low in DI) · Negative urine glucose · No hematuria, proteinuria or WBCs · Spot urine calcium to creatinine ratio to evaluate to hypercalciuria (>0.2 is abnormal) o 24 hr urine calcium (normal <4mg/kg/day) Ultrasonography and voiding cystourethrography have not show any abnormalities in patients with solitary symptom of urinary frequency and is thus not indicated.
Causes: No definitive cause of pollakiuria but some triggers include: · Non bacterial cystitis · Chemical urethritis · Abnormal urine composition o Hypercalciuria has been indentified in children with pollakiuria · Heightened bladder sensitivity in cold weather months · Significant social or emotional stressors o Frequency may occur only in the stressful environment and improvement in symptoms following counseling or resolution of the stressful situation has been reported. o Most frequently described psychogenic triggers are school problems, academic difficulties or bullying, perceived threat to self or a loved one. Parental divorce. Death of a family member, relocated to a new school, birth of a sibling
Treatment: · Reassure the parents, it will likely resolve over days or weeks · Anticholinergics (oxybutynin and propantheline) are useful for treating incontinence but are not very effective for urinary frequency · Identification of an emotional trigger and allow child to talk to parent about what worries them may relieve symptoms
References:
|