Urinary problem in elderly is common however it is probably under reported. Many studies done in other countries reveal the percentage of elderly suffering from urinary problem is from 7 to 42 % among the elderly population. Another study reported that urinary problem occurs among 10 % of women age less than 30 years and increases to 23.5 % among those age 60 years and above. The study also reported 55.7 % elderly living in institution had urinary problem. A local study done in a rural community in Selangor showed that 1 in every 10 elderly had urinary problem. This figure is less compared to studies done in western countries probably due to the perception that urinary problem is part of aging and our elderly seems to tolerate with the problem.

Normal aging causes reduction of bladder capacity to half of its original volume. This leads to the need for frequent emptying of the bladder.

What is urinary frequency?

Urinary frequency refers to how many times a person void per day. It differs between individuals according to their bladder habit, drinking habit and personality traits. Most people void 3 to 7 times during daytime and once at night. The total normal urine volume pass out is about 1 to 2 litres a day.

The International Continence Society definition:

• increase daytime urinary frequency: a person complaint that he or she voids too often in the daytime
• increase nighttime urinary frequency (nocturia): a person has to wake up more than once to void at night

What are the symptoms of abnormal urinary frequency?

The elderly may either complaint of passing urine more frequent than usual and/or may wake up at night to pass urine more than once.

Increased urinary frequency may be associated with other urinary symptoms such as pain or burning sensation on voiding, passing out blood or stone, feeling of unable to control the bladder and sensation of incomplete void despite having passed urine recently.

It is important to understand the various symptoms that are associated with urinary frequency to differentiate between normal urinary habits and those due to disease process.

What are the causes of urinary frequency?

A person suffers from urinary frequency when there is irritation to bladder, increased urine volume and/or reduced bladder capacity.

The following are non-pathological causes of increasing urinary frequency:

• Drinking a lot of water throughout the day.
• Cold weather.
• Drinking substance which increases urine production such as coffee, tea and alcohol.
• Anxiety

On the other hand, the following are pathological causes of increasing urinary frequency:

• Medication
  Certain blood pressure medications cause urinary frequency. It is advisable to take them in the morning and/or early evening rather than night time to avoid nocturia.

• Urinary tract infections
  This is usually caused by bacteria that spillover from the anus and contaminates the urethra and bladder. Other associated symptoms are dysuria (burning pain on passing urine) and blood in the urine.

• Diabetes mellitus
  Uncontrolled blood sugar may cause urinary frequency, excessive amount of urine and thirst.

• Diabetes insipidus
  A condition cause by a reduce level of antidiuretic hormone. This results in excessive production of diluted urine by the kidney which leads to increase urinary frequency

• Prostate disease
  Enlarged prostatic gland in men causes obstruction of the bladder neck. This results in more frequent void to empty the bladder.

• Chronic kidney disease
  More diluted urine may be formed by the damaged kidney due to its inability to conserve water back into the body system efficiently.

• Urinary stones
  Stones may cause irritation and obstruction to the bladder and outflow tract.

• Overactive bladder syndrome
  This occurs when the bladder wall is overactive and contracts frequently regardless of bladder fullness. The results are frequent void and unintentional urine leakage (urine incontinence)

• Neurogenic bladder
  This occurs when there are damages to the nerves that control bladder function. This leads to reduction in the bladder capacity or increase in the residual urine volume.

• Cystocele
  This occurs in women when the bladder wall prolapsed into the vaginal wall, obstructing the urine outflow leading to urinary problems.

• Vaginal atrophy
  The vaginal wall becomes thin and inflamed due to lack of female hormone during menopause. It affects the bladder as both structures are located close to each other.

What complication may arise from urinary frequency if underlying problem not treated?

Urinary frequency may cause medical, social and economic consequences. It may cause skin irritation and breakdown. The elderly may avoid social interaction as going to toilet frequently is troublesome and embarrassing. These problems will eventually lead to social isolation and depression.

What is the management for urinary frequency?

The management of urinary frequency will depends on the underlying disorder. Your doctor will ask further history, perform full clinical examination and do relevant investigation to ascertain the diagnosis.

Relevant investigations may include urine examination and blood tests such as full blood count, renal function and blood sugar. Blood check for prostate specific antigen (PSA) may be done in men. Imaging modalities such as x-ray and ultrasound of the urinary tract system may be undertaken if the need arise.

Urinary frequency due to urinary tract infection will require a course of antibiotic to eliminate the causation bacteria. Urinary alkaliniser may be given to alleviate symptom.

Topical oestrogen cream applied on the vaginal mucosa has shown to prevent urinary tract infection in post menopausal women by increasing the colonisation of good bacteria. However, the need of oestrogen cream should be assessed and advised by health professionals.

Management of overactive bladder includes bladder training and anti cholinergic drug.
Regular pelvic floor exercise to strengthen the pelvic floor muscle is recommended in the management of mild cystocoele.

References

1. The epidemiology of urinary incontinence within the community Australia, www.bladderbowel.gov.au/…/EpidemiologyofUrinaryIncontinenceReport. retrieved on 2014 – 06-18
2. MS Sherina. The Prevalence of urinary incontinence among the elderly in a rural community in Selangor.  The Malaysian Journal of Medical Sciences 2010 Apr-Jun; 17(2): 18–23.
3. The standardization of terminology of lower urinary tract function www.ics.org/Publications/ICI_3/v2.pdf/abram.pdf  retrieved on 2014 – 06-18
4. H Kenneth Walker, MD, W Dallas Hall, MD, and J Willis Hurst, MD.Clinical Methods 3rd Edition, The History, Physical and Laboratory Examination. Emory University School of Medicine, Atlanta, Georgia. Boston, Butterworths 1990.