Over the last few years, I have been noticing an uptick in a common, but concerning, parental concern.
The triage notes from our nurse usually state "frequent urination." The parents' concerns are comparable. "My 4-year-old son has been peeing every five to 10 minutes." Or, "I'm worried that my 4-year-old daughter has a urinary tract infection." Sometimes it's, "I think my 6-year-old son has diabetes like me."
Stories of disruptions in school from frequent bathroom breaks, or problems with long car rides because of their child needing to pee, are frequent themes from worried parents.
Medical students and residents who are still in the early parts of their training echo these concerns.
"I think he/she might have a urinary tract infection," a first-year pediatric resident said after completing a lengthy history and physical exam. "I'm worried about diabetes in this 4-year-old," a third-year medical student stated with confidence, as he described the sudden onset of frequent urination in the patient he just examined.
After delving a little more deeply into the history of each one of these children, what are almost always missing are the other telltale signs of a UTI, such as pain with urination. Nor do we hear about constipation, which can push on the bladder, causing more need to pee. Or a child drinking more than usual, starting to wet the bed, or experiencing weight loss, all signs of type 1 diabetes.
After hearing the parents, residents, and medical students stories, and after performing my own history and physical exam, I perform a urinalysis in my office, confident that it will be normal. I'm also confident that the child who can't hold his urine in for more than a few minutes has a disorder that is medically benign, but potentially more difficult than those that respond to medication.
The diagnosis in almost all these children, is pollakiuria, from the Greek pollakis, meaning often. The other name for this medically benign condition is a mouthful: extraordinary daytime urinary frequency syndrome. The hallmark is usually an abrupt change in normal voiding pattern with children urinating sometimes every five to 10 minutes. The peak age is 5- to 6-years-old, but can occur from ages 3 to 14. There usually is a small amount of urine with each void with no pain with urination, incontinence, or change in urine appearance.
The differential diagnosis varies from worrisome possibilities such as a UTI, to diabetes or even a spinal cord injury or infection. When there are no symptoms besides frequent urination, and both the physical exam and urinalysis are normal, I probe a little deeper and usually discover the most common cause of pollakiuria: stress.
So what is stressing these children? Once I explain the diagnosis, and convey that their child doesn't have an infection or diabetes, I gently ask about any recent stressors in their family. A few years ago, that question uncovered domestic violence in the home of a child with pollakiuria. Another child had been bullied in school prior to the start of their symptoms. Other stressors include the recent death of a loved one, a parental separation, and several poverty-related stressors such as food insecurity or eviction from a stable, familiar housing situation.
As a recent op-ed in the Inquirer pointed out, 126,521 children in Philadelphia live in poverty. In many cases, these children experience poorer health outcomes.
With Philadelphia being the most impoverished large American city, the effects of deprivation on its children — including pollakiuria — will continue unless there are strategic interventions to address poverty.