Utilising frequency volume charts PDF Free Download
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52 NT 7 January 2003 Vol 99 No 1 www.nursingtimes.net
SUPPLEMENT CONTINENCE SKILLS
Anthony Hinchliffe and
colleagues explain how
frequency volume charts can
be used as part of an
assessment to help patients
overcome urinary tract
symptoms
KEY WORDS
Urinary frequency
Nocturia
Anthony Hinchliffe, FRCS,
consultant urologist, Sharon
Tonkin, RGN, Cath Williams, RGN,
Lyn Kirkwood, RGN, clinic nurse
specialists, Weston Area Health
NHS Trust, Weston-super-Mare
The charts illustrated have a seven-day grid with 24
boxes on each of the seven lines to record separately
each voided urinary volume during any one hour. The
exact times are not requested, and there is room to
record several voids in each box if necessary. A line
across a box records bedtime and rising for the day,
and incontinent episodes are noted with a ‘W’.
Current medication is listed at the bottom of the chart.
Recording over one week takes into account the effect
of variations in peoples’ daily life and activities through
the week and weekend.
Fig 1 is a frequency volume chart completed by a
young man. This shows an unremarkable pattern of
urinary production and voiding, with his largest void on
rising in the morning – that is, his usual maximal
functional bladder capacity.
Fig 2a and 2b These charts are from a 75-year-old
man with normal flow rates and no post-void residual
urine.
Fig 2a shows that his 24-hour urine output is large,
and over one third of this is produced during the night
hours, although he is not drinking at this time – an
example of nocturnal polyuria. His maximal functional
capacity is during the night hours, and during the day
he is voiding much smaller individual volumes, probably
indicating detrusor instability.
On one occasion he had an incontinent episode
before voiding only 200ml of urine. On questioning, he
revealed that he was drinking up to 3.5 litres of tea
Frequency and nocturia are common lower urinary
tract symptoms associated with a variety of organic
pathologies as well as with life style and
psychological factors.
A frequency volume chart is a patient’s recorded
account of times and volumes of urine voided over
several days and nights. The purpose is to obtain an
objective record of one aspect of lower urinary tract
symptoms to augment the history and other patient-
recorded information, such as the international prostate
symptom score (IPSS).
Fluid intake is more difficult to measure accurately.
The patient and the continence adviser can clarify
details of type and quantity of fluid intake as well as
other factors as they study the frequency volume chart
together.
The frequency volume chart alone can give immediate
insight into several problems underlying lower urinary
tract symptoms, but is always used in combination with
measures of urinary voiding flow rates and ultrasound-
estimated post-void residual bladder volume, sometimes
progressing to functional urodynamic measures if
necessary.
Design of frequency volume charts Frequency
volume charts have been developed in different ways
over the past 30 years so that there is no standard
validated format. The design should accommodate ease
of use for the patient and adviser.
Utilising frequency volume charts
am pm am
Day 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8
1 350 370 290 150 120/ 600
2 100 125 275 300 325/ 600
3 100 350 300 280 320/ 600
4 100 285 280 250/ 400
5 325 200 125 350 250 350/ 500
6 200 380 420 480/ 520
FIG 1
am pm am
Day 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8
1 150 100 100 200 100 150 100 150 150/ 400 500 500 400
2 100 100 200 100 200w / 400 500 500 400
3 150 150 200 150 100 200 / 500 500 500
4 100 150 150 100 200 150 / 400 500 500 150
5 150 200 200w 150 150 150 150 / 500 500 500 200
6 100 100 100 100 50 50 / 100 500 500 500
FIG 2A
53NT 7 January 2003 Vol 99 No 1 www.nursingtimes.net
SKILLS CONTINENCE SUPPLEMENT
REFERENCES
Abrams, P., Klemark, B. (1996)
Frequency volume charts: an
indispensable part of lower urinary
tract assessment. Scandinavian
Journal of Urology and Nephrology
(supplement) 179: 47.
Gudjrel, S. et al (1998) A
prospective audit of the use of
frequency volume charts in the
prostatic assessment clinic. British
Journal of Urology;. 81: Suppl 4,
53.
Reynard, J. et al (1998) Anoral
therapy for nocturnal polyuria: a
double blind randomised trial of
frusemide against placebo. British
Journal of Urology;. 81: 215–218.
studied naturetic peptides influencing circadian rhythm
of urine secretion – are fully understood. Therapeutic
attempts to restore normality in urinary voiding have met
with variable results (Reynard et al, 1998).
Interpretation The above are a few examples of how
frequency volume charts can help to uncover problems
of fluid balance. Abrams and Klevmark (1996)
recognised six patterns, ranging from the normal to
nocturnal polyuria.
Although high fluid intake may be the result of choice
or habit, it may indicate significant underlying causes,
such as diabetes mellitus or insipidus. Reduced fixed
volumes during the day and night may indicate a small
fixed bladder capacity due to a serious underlying
condition, such as interstitial cystitis or bladder
carcinoma in situ.
Reduced variable volumes during the day and night
often indicate detrusor instability, while normal early
morning volumes with reduced and variable day
volumes may indicate psychosomatic causes or be
associated with genuine stress incontinence, when the
patient voids urine more frequently to avoid stress leaks
with a larger bladder volume.
Conclusion Frequency volume charts are a very
useful way of augmenting the symptom history and of
engaging the patient in trying to overcome lower urinary
tract symptoms. ■
during the day, which may also have contributed to the
detrusor instability.
His second chart (Fig 2b), completed after he had
modified his fluid intake, shows that his problem of
frequency has largely resolved, although he still voided
small volumes in the day, which improved after a period
of bladder training.
Fig 3 is the chart of a 74-year-old man who complained
of a weak voiding stream, urgency and nocturia. His flow
rate showed evidence consistent with mild bladder outlet
obstruction, and his frequency volume chart showed a
marked nocturnal polyuria, although his last drink was
taken at 8pm in the evening. He was prescribed an
alpha blocker, alfusozin, which works by relaxing the
muscles of the bladder neck and prostatic urethra,
resulting in a normal (25ml per second) maximal urinary
flow rate.
However, a second chart showed that nocturia
persisted, confirming that this was not secondary to
bladder outlet obstruction. In the days before objective
measurements were routinely used and
pharmacotherapy was not available he might have been
advised to undergo prostatectomy and would have had
a disappointing result.
Nocturnal polyuria is common in elderly people,
causing troublesome nocturia. Although the main
hormonal mechanisms controlling sodium and water
excretion and consequently affecting urinary volume are
well known, not all factors – including the more recently
am pm am
Day 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8
1 100 100 100 150 / 150 400 100
2 200 100 150 50 /50 400
3 50 100 50 50 100 / 100 300 100
4 100 100 50 50 / 50 200 50
5 100 50 100 / 50 300 50
6 100 50 50 50 / 300 50
FIG 2Bb
am pm am
Day 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8
1 150 80 125 200 180 75/ 230 340 200 225
110
2 100 250 130 80 160 50/ 180 310 270
3 300 40 100 100 125/ 360 240
4 290 100 75 80 90 150 70 50/ 150 130 300 260 300 300
5 270 70 75 50 30 150 / 460 300 320 470 300
6 160 70 130 140 / 350 400 400 320 250
FIG 3
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