Nocturia-Frequent urination at Night

Nocturia is the frequent need to get up to urinate at night. This is not an uncommon problem, but can lead to sleep deprivation and other risks associated with rushing to the toilet such as trips and falls.

Most people without nocturia can sleep for 6-8hrs without urinating. Patients with severe nocturia may get up five or six times during the night to go to the bathroom. It differs from enuresis or bedwetting, in which the person does not arouse from sleep, but the bladder empties anyway. Nocturia is a common cause of sleep loss, especially among older adults.

Nocturia is often a symptom of other medical conditions including neurological infection, a tumour of the bladder or prostrate, a condition called "bladder prolapse" or disorders affecting sphincter control.
It is also common in people with heart failure, liver failure, poorly controlled diabetes mellitus or diabetes insipidus. Diabetes, pregnancy and diuretic medications are also associated with nocturia.
Until recently, nocturia was thought to be caused by a full bladder. Nocturia becomes more common as we age. As we get older our bodies produce less of anti-diuretic hormone (ADH) that enables us to retain fluid.
With decreased concentration of this hormone, we produce more urine at night. Another reason for nocturia among the elderly is that the bladder tends to lose holding capacity as we age.

Symptoms of Nocturia

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• ·         Frequent urination, urinary urgency (need to urinate without much result) or reduced urine. It may be as a result of drinking too many fluids, especially caffeine, before going to bed.
• ·         You have a great deal of urine (more than 1.5 litres) a day (polyuria)
• ·         You always have a great amount of urine while you sleep (nocturnal polyuria)
• ·         You have more urine at night than your bladder is able to contain (low nocturnal bladder capacity).
• ·         Going to the bathroom frequently whenever you are awake

Causes of Nocturia

• ·         Prostate problems: An enlarged prostate can press against the urethra (the tube that carries urine out of the body) and block the flow of urine. This causes the bladder wall to become irritable. The bladder begins to contract even when it contains small amounts of urine, causing frequent urination.
• ·         Interstitial cystitis:  This condition of unknown cause is characterised by pain in the bladder and pelvic region. Often symptoms include an urgent and/or frequent need to urinate.
• ·         Diuretic use: These medications are used to treat high blood pressure or fluid build-up work in the kidney and flush excess fluid from the body.
• ·         Stroke/other neurological diseases: Damage to nerves that supply the bladder can lead to problems with bladder function, including frequent and sudden urges to urinate
• Other causes of nocturia include:
• ·         Untreated diabetes insipidus
• ·         Untreated gestational diabetes (occurs during pregnancy)
• ·         Congestive heart failure
• ·         Drinking too much fluid before going to bed like coffee, caffeinated beverages, or alcohol
• ·         Sleeping disorders such as obstructive sleep apnea
• ·         Use of drugs like diuretics (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
• ·         Edema of lower extremities (swelling of the legs)
• ·         Bladder obstruction
• ·         Bladder infection or recurrent urinary tract infection
• ·         Bladder distortion
• ·         Bladder inflammation (swelling)
• ·         Bladder over activity
• ·         Interstitial cystitis (pain in the bladder)

Often, frequent urination is not a symptom of a problem, but it is the problem. In people with overactive bladder syndrome, involuntary bladder contractions lead to frequent and often urgent urination even if the bladder is not full.

Treatment

• ·         If you are experiencing nocturia consult your doctor as soon as possible and follow his/her recommended therapy. It may be helpful to keep a diary of times and amounts of urine voided to bring with you to the doctor. Also bring a record of your sleep habit as well as daytime fatigue you may be experiencing
• ·         Your doctor may prescribe medications diagnostic testing such as urinalysis, cystometry (a measurement of pressure within the bladder), and neurological tests.
• ·         Drink your normal amount of liquid but do so in the day. Cut down on any drinks in the last two hours before you go to bed especially alcohol, caffeine as these stimulates urine production.
• ·         Keep a diary of how much you drink, what you drink and when. This may be helpful in identifying situations which make the nocturia worse.

• ·         Restrict fluids in the evening (especially coffee, caffeinated beverages, and alcohol).
• ·         Take afternoon naps.
• ·         Elevate the legs (helps prevent fluid accumulation).
• ·         Wear compression stockings (helps prevent fluid accumulation).

Medications

• ·         Anticholinergic medications: reduce symptoms of overactive bladder.
• ·         Bumetanide (Bumex®), Furosemide (Lasix®): diuretics that assist in regulating urine production.
• ·         Desmopressin (DDAVP®): helps the kidneys produce less urineicines, hypnosis or acupuncture can be beneficial.

Overactive bladder treatments

• ·         Bladder retraining: This involves increasing the intervals between using the bathroom for 12 weeks. This helps retain your bladder to hold urine longer and less frequently.
• ·         Diet modification: Eat high fibre foods, because constipation may worsen the symptoms of overactive bladder syndrome. Avoid carbonated drinks, alcohol, caffeine and spicy foods.
• ·         Monitoring fluid intake: Drink enough water to avoid constipation and urine concentration. Avoid drinking just before bedtime to avoid nocturia.
• ·         Kegel exercises: These help to strengthen the muscles around the bladder and urethra to improve bladder control and reduce urinary frequency and urgency.
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References

National Association for Continence. Nocturia. Accessed 2/23/2016.

Marinkovic SP, Gillen LM, Stanton SL. BMJ 2004;328:1063. Managing nocturia. Accessed 2/23/2016.

National Sleep Foundation. Frequent urination at night. Accessed 2/23/2016.

Written by Ruth

Edited by Nakelium