What is Nocturia?
Nocturia, also known as nocturnal polyuria, is a medical term used to describe an excessive urination that is experienced at night. The body produces less urine that is more concentrated at night in a healthy individual. As a result, healthy people do not have to wake up from sleep to urinate at night.
Nocturia is a common symptom and sleep follows each micturition episode. According to epidemiological evidence and expert clinical opinion, Nocturia is likely to be diagnosed when an individual wakes up more than two times to urinate at night. Statistics show that patients are more likely to seek medical assistance when they encounter three or more episodes of Nocturia.
Nocturia is a cause of bother and stress to most patients. Nocturia mostly affects older men diagnosed with benign prostatic hyperplasia. It is considered as one of the symptoms of the lower urinary tract that is linked to poor life ratings. Most patients report Nocturia as one of the most common causes of sleep disturbance. The problem affects both sleep onset and maintenance.
Nocturia has been reported as a risk factor for other disorders such as depression, absenteeism from work, and poor mental as well as physical health. Nocturia may also cause heart disorders such as congestive heart failure. In the older population, Nocturia may lead to high rates of accidental falls leading to bone fractures.
The diagnostic approach for Nocturia is challenging because it is associated with several clinical syndromes and disorders. A healthy person should be able to sleep six to eight hours at night without having to wake up to pass urine. People diagnosed with Nocturia wake up more than two times to go to the bathroom.
As already mentioned, diagnosing the cause of Nocturia is challenging because it is linked to various diseases. The doctor will ask the patient several questions to try to get an idea of the cause.
The patient should maintain a diary for a few days noting down what they eat and drink and how frequently they visit the bathroom. The doctor will ask when the patient started experiencing Nocturia. The patient will be required to tell the number of times they get up at night to go the bathroom. They will also be required to state whether there are any medications they are taking, as well as other symptoms besides the increased urination at night.
The patient may also undergo some testing such as a blood sugar test to check whether they might have diabetes. A blood urea test, as well as a urine culture, will also be performed. Imaging tests such as ultrasounds, as well as fluid deprivation tests, may be conducted.
Possible Causes of Nocturia
Nocturia is related to several causes. The causes can be put into four categories and they include polyuria, nocturnal polyuria, mixed Nocturia, and bladder storage problems.
Polyuria occurs when the total 24-hour urine volume exceeds 40ml/kg. Polyuria is caused by high fluid intake and untreated diabetes, both Type 1 and Type 2. Diabetes insipidus and gestational diabetes are also risk factors for polyuria. Gestational diabetes is the one that develops during pregnancy.
Urine output decreases at night in a healthy individual. The decline in urine output is thought to be related to the increase in secretion of the anti-diuretic hormone. The increase in synthesis of the hormone reduces urine output by increasing the resorption of water from the renal tubules.
As a result, small volumes of concentrated urine are produced. The urine output in individuals diagnosed with nocturnal polyuria is greater than 20 percent of the normal daily output in young adults and 33 percent of the normal daily output of older adults. Nocturnal polyuria can result from excess fluid intake including alcohol.
The intake of diuretics may also lead to nocturnal polyuria. However, the effects of diuresis depend on the time of the day taken. Disruption of the normal secretion of the anti-diuretic hormone is also a common cause among the elderly. Low blood volume, as well as congestive heart failure, can lead to fluid retention that is associated with nocturnal polyuria.
High intake of salt may also result in fluid retention causing nocturnal polyuria. Respiratory conditions such as hypoxia in the lungs may lead to pulmonary vasoconstrictions, as well as increased peptide concentration which is responsible for the removal of peptide from the body. This may cause increased secretion of water at night while the patient is asleep.
Bladder storage problems
In both healthy men and women, the mean (average) urine volume voided at night is one-third larger than that produced during the day irrespective of the number of micturition episodes. The bladder storage problems may be as a result of neurological defects.
Any neurological condition that affects the central nervous system or the peripheral nerves will have effects on the performance of the bladder. The neurological problem may lead to increased voiding frequency as seen in individuals with multiple sclerosis (MS).
Increased urinary frequency has been reported as an early sign of cervical cord compression. The neurological condition may lead to urine retention which results in either true Nocturia or an overflow incontinence that may present as Nocturia.
When fluid retention occurs in patients who are unlikely to have bladder obstruction, neurological problems should be considered. Urgent neurological conditions to be diagnosed include cauna equida syndrome and cord compression.
Patients diagnosed with Nocturia may present with more than one etiology. The etiology may include both nocturnal polyuria and reduced voided volumes. A study that was performed on individuals with Nocturia found that seven percent was due to Nocturia polyuria and 57 percent due to reduced voided volumes.
Other Causes of Nocturia
Nocturia can also result from several medical conditions that do not have anything to do with the age of the affected individual. The medical conditions involved include:
- Constipation: this may cause distension of the bowel leading to increased pressure on the bowel.
- Pregnancy: during growth of the fetus, the pressure on the bladder increases reducing its ability to hold urine for an extended duration.
- Kidney or Bladder Condition: conditions such as kidney stones or bladder infection may cause Nocturia. An overactive bladder and bladder infection is also a leading cause of Nocturia.
- Drugs: Nocturia may occur as a side effect of drug use. It is advisable to check with the pharmacist or doctor to confirm whether any of the prescribed medications may result in Nocturia.
- A heart condition may result in reduced blood circulation. Poor blood circulation is associated with fluid retention which may lead to Nocturia.
Top Treatments of Nocturia
Creating a diary is one of the strategies involved in the management of Nocturia. The patient is expected to record the circumstances that surround the nighttime bathroom trips.
The information contained in the diary helps the healthcare provider determine the major cause of the disorder as well as the most appropriate form of treatment. At the appointment, the patient undergoes a physical examination, as well as urinalysis and urine culture.
Individuals who believe that they have Nocturia are advised to visit a general practitioner. Once the general practitioner has confirmed the diagnosis, the patient will then be referred to a specialist.
Management of Nocturia
- Mattress covers: several products such as vinyl and absorbing mattress can be used to cover the mattress for easy cleanup.
- Absorbent briefs: these are modified underwear designed to absorb liquid to prevent leakage of urine. There are both reusable and disposable products available.
- Skincare products: skincare products can be used to protect the skin from irritation and soreness that may occur when an individual experiences nocturnal enuresis. There are various soaps, lotions, and cleansing cloths that are available for different skin types.
- Deprivation of fluid intake: limiting of fluid intake in the evening results in reduced amount of urine produced at night.
- Afternoon naps: this reduces retention of fluid buildup by promoting fluid absorption into the bloodstream. When one gets up from a nap, it is advisable to visit the bathroom and get rid of the accumulated urine.
There are different types of medications that can be used to treat Nocturia. The medications can be used alone or in combination with the behavioral modifications discussed above. Anticholinergic medications are effective in the treatment of enuresis with detrusor over activity. The side effects of anticholinergic drugs include dry mouth and blurred vision. The drugs include:
- Oxybutynin: the medication works by relaxing the detrusor muscle of the urinary bladder.
- Trospium Chloride: the drug is used to treat an unstable bladder by inhibiting cholinergic receptors that are located in the wall of the bladder. Once the receptors are blocked, the bladder relaxes reducing its over activity.
- Darifenacin: the drug relieves bladder spasms. It also treats an overactive bladder.
- Solifenacin: this is an anti-cholinergic drug that was recently introduced. It is a selective anti-muscarinic agent with few side effects.
Nocturia affects sleep cycle. As a result, one may experience dizziness, drowsiness, and depression if it is left untreated. It is advisable to talk to your doctor or pharmacist to discuss the lifestyle changes that are suitable for your case.