Differential Diagnosis for Increased Urinary Frequency in a 71-Year-Old Female with a Negative Urine Culture

Single Most Likely Diagnosis

• Urinary Tract Dysfunction due to Aging or Menopause: This is likely due to the natural decline in bladder elasticity and strength, as well as hormonal changes that can affect bladder control and sensation, leading to increased frequency.

Other Likely Diagnoses

• Overactive Bladder (OAB): Characterized by a sudden, intense urge to urinate, often with increased frequency and nocturia, which can be due to a variety of factors including neurological disorders, bladder outlet obstruction, or idiopathic causes.
• Benign Prostatic Hyperplasia (BPH) in Males is Common, but in Females, it could be related to: Urethral stricture, bladder neck obstruction, or other less common obstructive causes, though these are less likely in females.
• Diabetes Mellitus: Can cause polyuria (increased urine production) leading to increased frequency, especially if blood sugar levels are not well-controlled.
• Medication Side Effects: Certain medications, such as diuretics, can increase urine production and lead to increased frequency.

Do Not Miss Diagnoses

• Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which can lead to increased frequency and urgency. It's crucial to diagnose due to its significant impact on quality of life.
• Bladder Cancer: Though less common, it's a critical diagnosis not to miss, as it can present with increased frequency, urgency, and hematuria (blood in the urine).
• Neurological Disorders (e.g., Multiple Sclerosis, Stroke): Can affect bladder control, leading to increased frequency, urgency, and incontinence.
• Pelvic Organ Prolapse: Can cause obstructive symptoms and increased frequency due to the mechanical effects on the bladder and urethra.

Rare Diagnoses

• Bladder Fistula: An abnormal connection between the bladder and another organ (e.g., bowel or vagina), which can lead to continuous urine leakage and increased frequency.
• Eosinophilic Cystitis: A rare condition characterized by an eosinophilic infiltration of the bladder wall, leading to symptoms similar to interstitial cystitis.
• Sarcoidosis Involving the Bladder: A rare manifestation of sarcoidosis that can cause bladder symptoms including frequency and urgency.

Each of these diagnoses has a different set of implications for treatment and management, emphasizing the importance of a thorough diagnostic workup to determine the underlying cause of increased urinary frequency in this patient.