How Are Dysuria, Frequency, and Urgency Defined?

Dysuria refers to painful or uncomfortable urination.

Frequency refers to a pattern of voiding at brief intervals, triggered by the sensation of bladder fullness. Although the voiding frequency can be quite variable in children, most children older than 7 years void between 3 and 8 times per day. This variability means that the term urinary frequency should be applied only after taking into consideration the baseline urinary habits of your particular patient.

Urgency refers to an exaggerated sense of needing to urinate.

What Causes These Symptoms?

Common causes of these three symptoms include conditions that lead to irritation of the bladder or urethral mucosa:

Uncommon causes must be considered if none of the previous can be identified:

How Do I Evaluate a Child with These Symptoms?

Obtain a complete history and perform a careful physical examination. Evaluate for signs and symptoms of UTI (Chapter 65). Ask about perineal hygiene and the use of bubble baths or the presence of a urethral/vaginal discharge. Consider a self-inserted vaginal foreign body in a young girl. Get details on the amount and type of fluids consumed by the child during a typical day. Obtain a sexual history, especially use of condoms, by adolescents. Ask about emotional stressors, such as the death of a family member, recent changes in school, and parental divorce. Investigate for possible sexual abuse and examine the external genitalia. Query the patient for a history of flank or abdominal pain and the family for a history of kidney stones in family members. Inspect the spine of the child for tufts of hair and sacral dimples. Perform a complete neurodevelopmental history and examination, especially of the lower extremities, rectal tone, and anal wink.