Increased Daytime Frequency

Editor: Daniele Minardi

Last Updated June 2018

Current definitions

Increased daytime frequency is complaint that micturition occurs more frequently during waking hours than previously deemed normal by the patient (1).

History

Increased daytime frequency is the complaint by the patient who considers that he/she voids too often by day. This term is equivalent to pollakisuria used in many countries. (Abrams)

Other definitions include frequent urination during the day, as going constantly and having to go too much.(2), less than 2 hours (3).

Controversies

Symptoms need to be defined as ‘subjectively relevant’ when the patient regarded the symptom as at least ‘quite a problem’, 'some bother’ and ‘much/major bother’ (4).

One of the challenges to this term and to the use of nocturia is that they are patient complaints and we recognize that an individual may not have the perspective to realize what is the normal frequency of micturition during the day, unless they have had a recent change in these symptoms. Individuals tend to define normative experiences based on their own environments and if a person has a friend or family member who has urinated 16 times/ day for many years they might not think to complain about increased daytime frequency. Certainly this can be later defined as a sign by the clinician, but shouldn’t this be qualified as a symptom by the professional collecting this history?

Studies on bladder sensations, obtained during cystometry or from voiding diaries, are proving difficult to transfer to everyday experiences; there is therefore a need to explore what does influence when and where to void; many voids are driven by behavioral factors not by sensations of desire or need to void. Afferent bladder outflow originates from discrete systems (pain, stretch receptors, urothelial-dependent mechanisms and a motor/sensory system). Sensations of bladder filling and need to void are contained within this ‘ afferent noise ’ (5-8).

References

1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21:5–26

2. 11. 19. Coyne, C. C. Sexton, Z. Kopp, C. R. Chapple, S. A. Kaplan, L. P. Aiyer, T. Symonds. Assessing patients’ descriptions of lower urinary tract symptoms (LUTS) and perspectives on treatment outcomes: results of qualitative research. Int J Clin Pract, 64 (9): 1260–1278, 2010
3. 11. 19. Coyne, A. I. Barsdorf, C. Thompson, A. Ireland, I. Milsom, C. Chapple, Z.S. Kopp, T. Bavendam. Moving Towards a Comprehensive Assessment of Lower Urinary Tract Symptoms (LUTS) Neurourology and Urodynamics 31:448–454, 2012
4. 10. Haltbakk, B. R. Hanestad, S. Hunskaar: Relevance and variability of the severity of incontinence, and increased daytime and night-time voiding frequency, associated with quality of life in men with lower urinary tract symptoms. BJU Int 9 6: 83–87; 2005

5. Gillespie JI, van Koeveringe GA, de Wachter SG, de Vente J. On the origins of the sensory output from the bladder: the concept of afferent noise . BJU Int 103: 1324 – 1333, 2009

6. de Groat WC , Yoshimura N . Afferent nerve regulation of bladder function in health and disease . Handb Exp Pharmacol 194: 91–138, 2009

7. Fowler CJ, Griffiths D, de Groat WC . The neural control of micturition . Nat Rev Neurosci 9: 453–466, 2008

8. Birder LA, de Groat. Mechanisms of disease: involvement of the urothelium in bladder dysfunction. Nat Clin Pract Urol 4: 46–54, 2007