Increased Frequency of Micturition

In a normal person the act of micturition occurs 5 or 6 times during 24 hours. There will be increased frequency if the fluid intake is more than usual(physiological) or if the amount of urine formation is increased as in diabetes and chronic interstitial nephritis. If the total amount of urine remains normal, causes of increased frequency are:-

1. Renal - any form of pyelitis, stone, tuberculosis and movable kidney

2. Ureteric - Stone ( the lower the position of the stone the more is the frequency)

3. Vesical - any form of cystitis and stone; inflammatory condition of the pelvis, eg salpingitis, appendicitis, secondary infiltration from carcinoma of the uterus or rectum; mechanical obstruction to normal distension by a tumour, eg- ovarian cyst, fibroid or retroverted uterus

4. Prostatic - Postatitis, senile enlargement and malignant prostate

5. Urethral - Posterior urethritis(Gonococcal), stone, pin hole meatus, phimosis and Balanitis.

Investigation- History is taken as discussed above. Enquire whether frequency is more marked during the day or night, or there is no such distinction. Diurnal Frequency is peculiar to vesical calculus and is due to irritation of the trigone in the erect position; nocturnal frequency when complained of by an elderly man, is due to senile enlargement of the prostate; whereas in cystitis, frequency is equally marked by day and night. It must be remembered that frequency in a young adult with sterile acid urine containing pus should be regarded as being due to renal tuberculosis until this can be excluded.

The other common cause in a young adult is gonococaal posterior urethritis in which the history is often helpful. In the middle-aged person one should think of diabetes in which the triad is polyuria( excessive discharge of urine)), polydipsia (extreme thirst) and polyphagia (excessive eating). In the old, senile enlargement of the prostate is the commonest cause.