Pediatric emergency medicine trisk 1534 1534
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Uninhibited bladder contractions (“unstable bladder” syndrome) occur
involuntarily in children who have failed to gain complete voluntary control over
the voiding reflex, related to delayed nervous system maturation. If the urethral
sphincter is relatively weak, urinary frequency associated with urgency and
enuresis may result. Females may exhibit the so-called “curtsy” sign as the child
squats and attempts to prevent leakage by compressing the perineum with the heel
of one foot. If performed, a screening ultrasound examination would reveal
normal (minimal) residual urine volumes. With maturity, spontaneous resolution
of uninhibited contractions occurs in most cases. In children with significant
developmental delay or behavioral disorders, the infantile pattern of spontaneous
bladder contraction may persist.
Abdominal
Masses in the pelvis (including abdominal tumors, appendicitis, and ovarian
torsion) that press on the bladder can cause frequency. Generally, these diagnoses
cause abdominal pain and/or other symptoms, and physical examination will
elicit tenderness. Constipation is a common cause of urinary frequency in schoolaged children. It results in large fecal masses that cause mass effect with extrinsic
bladder pressure, as well as stimulating bladder contraction or inhibiting the full
bladder capacity. Such frequency may then be small volume excretions. There is
noted association with constipation and UTI. Pregnancy should always be
considered as a cause of frequent urination in the adolescent female.
Metabolic and Endocrinopathies
Diabetes mellitus (DM) causing osmotic diuresis from increased glucosuria is an
emergent condition causing frequency. Typically, new-onset diabetes presents
with polydipsia, polyphagia, and polyuria; uncontrolled DM with or without
diabetic ketoacidosis can present similarly. Be alert for other concerning findings
including altered mental status and respiratory changes. Hypercalciuria has been
reported as a significant noninfectious cause of the “frequency–dysuria
syndrome” in pediatric patients. Onset of symptoms generally ranges from 2 to 14
years of age. Occasionally, hypercalciuria can present in early infancy, where
irritability is a hallmark symptom. Symptoms often spontaneously resolve within
2 months. There may be a positive family history of calcium urolithiasis. Dysuria
may or may not be present. Hematuria (generally microscopic) and/or crystalluria
are often seen. However, the urinalysis may be normal. If the diagnosis is
suspected and symptoms persist, studies of urinary calcium excretion and
urologic consultation should be considered. The salt-losing form of congenital
