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Frequent Urination (Pollakiuria) In Children: Causes, Diagnosis, And Treatment

Frequent Urination In Children

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Pollakiuria is usually considered a sensory urgency, wherein a child feels like going to the bathroom frequently without any physical need to do so. The child may pass only a small amount of urine each time (1).

This condition is benign and self-limited, lasting anywhere from a few weeks to a few months (2).

Read this MomJunction post to learn about the causes and symptoms of pollakiuria, and how you can help your child in managing this condition.

How Often Should A Child Urinate During The Day?

There are no hard and fast rules on the number of times a child can urinate in a day. However, it would be safe to say that a visit to the washroom every two hours is normal.

Sometimes, the child may visit the washroom more often if they have taken more fluids, if the weather is cold, or just for fun (younger children).

What Causes Frequent Daytime Urination in Children?

The cause of frequent daytime urination is not exactly known. There is rarely any physical cause associated with this condition (3). Experts believe that it may be related to psychological or psychogenic factors. In certain cases, stress or problems related to school, home, or family may be the triggering factors in children (2).

The triggering or precipitating factors may include the following (2, 3, 4, 5, 6).

  1. Psychological factors such as school-related stress; the death of a family member or friend; relocation to a new home or school; the birth of a sibling; abuse or bullying; or parents’ divorce
  2. Dietary factors such as excessive intake of milk or caffeine
  3. Constipation
  4. Inflammation of the bladder (non-bacterial cystitis)
  5. Inflammation of the urethra (chemical urethritis)
  6. Overactive bladder or increased sensitivity of the bladder (can also occur during winters or cold days)
  7. Excessive secretion of calcium in urine (hypercalciuria)
  8. Tic disorders such as Tourette Syndrome

Often, no obvious triggering factor can be identified in children with this condition.

[ Read: Urinary Tract Infection In Children ]

Symptoms Of Frequent Urination Or Pollakiuria In Children

The signs and symptoms of pollakiuria may include the following ( 4, 7)

  • The child may urinate (void) as frequently as every five to ten minutes. The frequency can be three to four times a hour or up to 30–40 times a day. It may also recur in a few months or years.
  • The child may experience no abdominal, flank, or dysuria pain while urinating.
  • There is no urinary incontinence (leaking of urine) or loss of bladder control in the child.
  • A small amount of urine is passed in each void.
  • There are no changes in bowel movements.
  • The child may urinate at night (nocturia may be present in 25% of the cases), but the frequency will be quite less compared to the daytime.
    Nocturia is defined as a condition wherein one needs to wake up at night to urinate.
  • There is no sign of polyuria (passing large volumes of urine) or an infection. The color, odor, and stream of the urine are normal.
  • There is no excessive increase in the intake of liquids or fluids.

[ Read: Abdominal Pain In Kids ]

Diagnosis

Pollakiuria is a benign condition. Therefore, healthcare practitioners may not opt for invasive examinations if the urinalysis report and physical examination results are normal.

Doctors usually examine the medical history and perform a physical examination (1). In addition, doctors distinguish frequent daytime urination (pollakiuria) from polyuria (excessive production or passage of urine) due to metabolic disorders such as diabetes insipidus and diabetes mellitus (2).

Doctors may suggest the following laboratory or clinical evaluations (1, 4).

  • Medical history: This evaluation may help identify the history of urinary tract infections (UTIs), diabetes mellitus, or other infections in your child. Any changes in your child’s urinating pattern or behavior can also be detected.
  • Physical examination: The presence of abdominal or flank pain may be checked. Normal neurological examination to check lower extremities (legs and feet) can also be performed.
  • Urinalysis: Protein and glucose levels, urine osmolality, and specific gravity may be checked through urinalysis. A sediment examination may also be performed. The presence of proteinuria (presence of excess protein in urine), hematuria (presence of blood in urine), or white blood cells (WBCs) may be checked. In addition, the presence of hypercalciuria (excessive calcium in the urine) may be evaluated. A urine culture may be suggested too.
  • Imaging/ultrasound: Ultrasonography of the bladder and kidneys may also be performed to detect any abnormalities in some instances.

[ Read: Peptic Ulcer In Children ]

Treatment For Frequent Urination Or Pollakiuria In Children

Once the doctor has performed the initial examination of your child and identified the triggering factor(s) for pollakiuria, the required therapy or management options can be discussed. Usually, children may not need medication for this condition.

Management of frequent daytime urination may involve the following ( 6, 7).

  • Reassuring and supporting both the child and the parents: It is important to understand that this condition is benign and self-limiting (occurs for a specific duration). Reassurance and emotional support can help parents understand that this condition does not indicate any medical complication or underlying diseases and that the child is healthy.

Besides, if emotional or stress-related triggers are identified as the probable causes, children should be encouraged to talk to their parents or undergo counseling.

Do not get annoyed at your child over the frequency of urination. Be mindful of their feelings or emotional distress. You can also assure your child that waiting a bit longer to use the washroom will not cause any mishappening.

  • Dietary changes: It has been observed that the presence of excessive calcium in the urine and consumption of acidic and oxalate-rich beverages have an association with pollakiuria. Therefore, doctors may suggest avoiding acidic or oxalate-rich beverages, caffeine, and milk. Also, increasing the intake of healthier fluids and water may be recommended.
  • Medications: Anticholinergic agents are commonly used to treat overactive bladder in children. However, their effectiveness in urinary frequency is debatable.

[ Read: Constipation In Children ]

Home Care Tips For Management

If you notice any unusual increase in the frequency of urination in your child, make sure to visit a healthcare practitioner for the correct diagnosis.

In general, your child may not require drug management for this condition. You can help your child manage and cope with this condition, with these tips (3).

  • Make sure your child’s teachers or caregivers do not penalize your child for this condition.
  • When you are at home, help them understand that it is not necessary or urgent to use the washroom every time there is an urge.
  • Try to figure out the possible causes or triggers (emotional or stress-related) and address them by talking to your child frequently and openly.
  • You can also encourage them to play, read, watch favorite shows, or do a fun activity to distract them from the urge to go to the washroom.

[ Read: Personal Hygiene For Kids ]

Complications Of Frequent Urination In Children

There aren’t any complications associated with this condition. However, if your child experiences symptoms such as pain, difficulty in urinating, loss of bladder control (leaking or bedwetting), or a sudden increase in thirst, then make sure to visit your doctor.

Frequent daytime urination or pollakiuria in children may resolve in a few weeks or months. However, it may also recur in months or years. In most of the cases, children may not require any medications. If the triggers are emotional or stress-related, try to make your child comfortable and talk about any issues, problems, or fears with them.

References:

1. Urinary Frequency: Children’s Hospital of Philadelphia
2. Herman A. Cohen, et al.; Extraordinary daytime urinary frequency in children; The Journal of Family Practice;(1993).
3. Extraordinary Urinary Frequency: C.S. Mott Children’s Hospital, Michigan Medicine
4. Frequent Daytime Urination- Pollakiuria: Pediatrics Clerkship, The University of Chicago
5. Huei-Shyong Wang, Hsieh-Lin Chang, and Siao-Wen Chang; Pollakiuria in Children With Tic Disorders; Chang Gung Medical Journal (2005).
6. Manuela Bergmann, et al.; Childhood extraordinary daytime urinary frequency—a case series and a systematic literature review: Pediatric nephrology (2009).
7. Pollakiuria: St. Louis Children’s Hospital

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