Andrew Siegel MD 1/15/2022
Last week’s entry showed you how to do a 24-hour bladder diary, a simple at-home test useful to help assess common urological complaints–urinary urgency and frequency. Today’s entry reviews and interprets four patients’ actual bladder diaries. All of the patients had frequent urination as their chief complaint. Before reading through the cases that follow, recall that the average person urinates 6 or so times a day with a typical voided volume of about 8-12 ounces.
* Please understand that these diaries were not interpreted in isolation, but as part of the total clinical picture (history, physical, lab and imaging tests, etc.) that enabled making the proper diagnosis. Bladder diaries must be put in context this way in order to interpret them properly.
Case #1
The diary above shows 14 urinations (too many) over the course of 24 hours. The total volume of urine is 172 ounces ( almost 1.5 gallons!) with an average voided volume of > 12 ounces. This indicates that all voided volumes are of appropriate volume, and the problem is simply that this patient is consuming too much liquid volume.
Diagnosis: over-aggressive hydration (simply too much fluid intake)
Solution: decrease fluid intake
Note well: You would be shocked about how many patients come to see me with this situation! Stay hydrated, but no need to overdo it. One of the clues that points to this diagnosis is when I walk into the exam room to greet the patient and they are holding a large bottle of water. Please visit: How much water do you really need to drink?
Case #2
The diary above shows 15 urinations (too many) over the course of 24 hours. The total volume of urine is 67 ounces (normal total) with an average voided volume of little more than 4 ounces (indicating an abnormal small capacity bladder). Notably, the patient experienced a full sense of urgency prompting each void and simply has a decreased functional bladder capacity.
Diagnosis: overactive bladder
Solution: behavioral techniques, urgency suppression techniques, bladder relaxant medication
Case #3
The diary above shows 24 urinations (too many) over the course of 24 hours. The total volume of urine is 348 ounces (2.5 gallons!) with an average voided volume of 14.5 ounces (higher end of normal). All voided volumes are full and therefore appropriate, and some are massive, with a tremendous volume of urine made during sleep hours. This patient needed to drink constantly to satisfy the thirst that occurred from the constant voiding.
Diagnosis: kidney dysfunction (renal concentration defect) causing large volume production of dilute urine (one of the important functions of the kidney is to concentrate urine to maintain blood volume and when this goes awry, massive urine outputs may result).
Solution: referral to nephrologist (medical doctor specializing in kidney diseases) for further evaluation and management
Case #4
This diary above shows 16 urinations (too many) over the course of 24 hours. The total volume of urine is 70 ounces (normal) with an average voided volume of 4.5 ounces (decreased bladder capacity). The pattern demonstrates consistent low volume voids during the day, but full and appropriate voided volumes at night.
Diagnoses: overactive bladder and nocturnal polyuria (two diagnoses)
Solution: First, behavioral techniques, urgency suppression techniques, bladder relaxant medication to manage the overactive bladder. Second, sleep studies to rule out obstructive sleep apnea (OSA), which is one of the most common causes of nocturnal polyuria. if OSA confirmed, patient is excellent candidate for continuous positive airway pressure (CPAP) or other management techniques for the OSA that typically dramatically improve the nocturnal polyuria. If the diagnosis of OSA is ruled out, patient is excellent candidate for an anti-diuretic medication taken prior to sleep.
Bottom Line: There are many varied and different underlying causes of urinary frequency. In order to effectively pinpoint the underlying diagnosis, the bladder diary is a vital and invaluable initial test that must be interpreted in the context of the entire clinical picture.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. He is the co-founder of PelvicRx and Private Gym. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
Tags: bladder diary, nocturnal polyuria, obstructive sleep apnea, over-hydration, overactive bladder, renal concentration defect, voiding diary
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