Key distinguishing features of the most common diagnoses
|Age Related||Excess Fluid Intake||Swollen Ankles||Cystitis||LUTS|
|Daytime Ankle Oedema||Possible||No||Yes||No||No|
|Poor Urinary Flow||No||No||No||No||Yes|
Likely:Urinalysis, MSU, urinary frequency volume chart.
Possible:Blood sugar/HbA1c, PSA.
Small Print:Cystoscopy, urodynamic studies, ultrasound, water deprivation test.
- Urinalysis: Protein, nitrites, leucocytes and possible haematuria in infection; glucose in diabetes; specific gravity very low in diabetes insipidus.
- MSU: To confirm infection and identify pathogen.
- Urinary frequency volume chart: To help distinguish nocturnal polyuria (increased urine production at night) from reduced bladder storage capacity.
- Blood sugar/HbA1c: To confirm diabetes mellitus.
- PSA: Pros and cons of this test may be discussed if assessment raises the possibility of prostate cancer.
- Specialist tests include: Cystoscopy and ultrasound (for lower urinary tract obstruction), urodynamic studies (for unstable bladder) and water deprivation test (for diabetes insipidus).
- In the elderly, the cause is often multifactorial.
- The effects: Such as disturbed sleep, a disrupted household, exhaustion and occasional incontinence – may be more important to the patient than the specific diagnosis.
- Swollen ankles: Of any aetiology – are frequently overlooked as an underlying cause
- Nocturia may just be a manifestation (albeit the most distressing) of polyuria or urinary frequency. Focus your approach on the underlying problem.
- Exclude diabetes – but remember that it is not the only cause of polyuria, nocturia and thirst.
- A habitual ‘nightcap’ may be the cause of nocturia – and may be a pointer to an underlying alcohol problem, especially in solitary elderly males.