Nephrology

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.

See also: diurnal enuresis and nocturnal enuresis

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
  • May present with weak and dribbling stream, loss of bladder control
  • Often associated with spinal cord injury
  • Enterobius vermicularis infestation
  • May cause urinary frequency
  • Present with anal puririts, especially at night
  • Positive scotch tape test
  • Polyuric conditions (Diabetes mellitus/insipidus)
  • Abnormal urinalysis
  • Urinary tract infection
  • Dysuria
  • 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)
  • 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
  • Hypercalciuria has been indentified in children with pollakiuria
  • Heightened bladder sensitivity in cold weather months
  • Significant social or emotional stressors
  • Frequency may occur only in the stressful environment and improvement in symptoms following counseling or resolution of the stressful situation has been reported.
  • 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:

  1. Farber,JM.  A Strategy to Treat Pollakiurua.  Contemporary Pediatrics March 2013 http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics...
  2. Bass, L. Pollakiuria, Extraordinary Daytime Urinary Frequency: Experience in Pediatric Practice. Pediatrics. 1991 May;87(5):735-737
  3. Bergman M, Corigliano T, et.al. Childhood extraoridinary daytime urinary frequence—a case series and systematic literature review. Pediatric Nephrology.  2009 (24): 789-995
  4. Glazer DB, Ankem MK, Ferlise V, Gazi M, Barone JD. Utitily of biofeedback for the daytime syndrome of urinary frequency and urgency of childhood. Urology. 2001 April 57(4):791-3
  5. Hellerstein S, Lineharger J. Voiding Dysfunction in Pediatric Patients. Clincial Pediatrics. 2003 (42):43-49
  6. Robson WM, Leung A. Extraordinary Urinary Frequency Syndrome. Urology. 1999 Sept;43(3):43-49
  7. Index of Suspicion. Pediatrics in Review.  2003 June;24(6)207-212.