Daytime urinary frequency and urgency syndrome or pollakiuria refers to the sudden onset of extraordinary urinary urgency and frequency in a previously toilet trained child(1-3). As the name indicates the symptoms are confined to the daytime, and bladder emptying may occur as often as every 5 to 10 minutes. Nocturia is unusual and the affected children are not incontinent. The affected children are physically normal and urological investigations do not reveal any abnormality. The disorder though of unknown etiology is benign in that spontaneous remission occurs in almost all of them over a period of few days to months. Recurrences are rare(1-3).

The excellent outcome, however, should not distract the treating physician from the distress, embarrassment and anxiety caused to the child and family by the symptoms. The precise pathophysiological mechanisms underlying the condition are unknown and therapy remains unclear and empirical.

A patient with symptoms of daytime urinary frequency of one year duration is being described here. Treatment with liberal fluid intake and bladder stretch and sphincter control exercises(4) resulted in significant improve-ment in a very short time.

A 10-year-old boy presented with one-year history of passing urine at short interval ranging from 5 to 15 minutes. The child would pass only a small amount of urine at each voiding. The symptoms were particularly disturbing just before bedtime, when the child would visit toilet every 2-3 minutes. The parents also reported that they had many times observed the child not visiting the toilet for more than an hour when watching his favorite sport on the TV. Similarly, the child was able to postpone urination for about 2 hours during the school hours. There was no history of incontinence, dysuria, nocturia or enuresis. The symptoms apparently had begun suddently, without any obvious triggering event and parents could remember no stressful event preceding the onset of symptoms. Physical examination did not reveal any abnormality. Examination of spine and the genitalia was normal. The results of urinalysis and urine culture were normal.

Bladder stretch and sphincter control exercises(4) were advised. The child was instructed to postpone micturition as long as possible whenever he felt the urge to pass urine. He was also asked to take more fluid during the day to enable him get additional training opportunities. For sphincter control, he was instructed to interrupt the stream of urine intermittently when voiding. He was also encouraged for his ability to control micturition during school time and during watching TV. Benign nature of the disorder was explained to the family. A month later the child showed marked improvement in his symptoms, and could now easily delay urination for 2-3 hours.

Treatment of the daytime frequency and urgency syndrome remains unclear and empirical. Anticholinergic agents and anti-biotics are ineffective(1,2). Since the disorder is benign and self-limited, no treatment other than reassurance is usually recommended(1-3). This approach is harmless and allays parental anxiety, but does not ameliorate the distressing symptoms of visiting the toilet every few minutes. Therefore, any form of therapy which safely cuts down the urinary frequency to a tolerable level is expected to bring considerable relief to the affected child and his family.

The definitive treatment of this syndrome is hampered by the lack of clear understanding of the etiology and pathophysiology underlying the disorder. It is believed that the primary symptom is urgency and urinary frequency is secondary. Whatever the cause, it appears that the hypersensitivity of the sensory pathways detecting bladder filling causes even small amounts of urinary volume to evoke conscious sensation of bladder fullness. The ability to inhibit urination is preserved as is evident from the fact that these children are never incontinent, and from their ability to postpone urination under circumstances of school time discipline and during the time when the child is engaged in some intense mental activity like watching TV. Bladder stretching exercises in association with increased intake of fluids are expected to increase the functional bladder capacity and control over micturition reflex(4).

In the present case described here, it can be argued that improvement of symptoms following therapy might represent the natural remission over a period of time, or the result of anxiety-allaying effect of counseling and reassurance(1,2,5). However, the relatively dramatic improvement in the long-standing symptoms and the efficacy of this regimen in nocturnal enuresis, another condition associated with reduced functional capacity, supports the beneficial effect of such therapy. More patients should be evaluated to examine the benefits of the above treatment. Previously, only one study has reported the beneficial effect of liberal water intake(6).

Jatinder S. Goraya,
Department of Pediatrics,
Government Medical College Hospital,
Sector 32-B, Chandigarh 160 047, India.
E-mail: [email protected]

1. Koff SA, Byard MA. The daytime urinary feuqency syndrome of childhood. J Urol 1998; 140: 1280-1281.

2. Walker J, Rickwood AMK. Daytime urinary frequency in children. BMJ 1988; 297: 455.

3. Zoubek J, Bloom DA, Sedman AB. Extraordinary urinary frequency. Pediatrics 1990; 85: 1112-1114.

4. Howe AC, Walker CE. Behavioral management of toilet training, enuresis and encopresis. Pediatr Clin North Am 1992; 39: 413-432.

5. Glazier DB, Ankem MK, Ferlise V, Gazi M, Barone JG. Utility of biofeedback for the syndrome of urinary frequency and urgency syndrome of childhood. Urology 2001; 57: 57: 791-794.

6. Robson WLM, Leung AKC. Daytime urinary frequency. Pediatrics 1990; 86: 1004.