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Nocturia: Definition, Causes, Treatment, Epidemiology, and More

Nocturia

Do you wake up multiple times during the night to urinate? You may be suffering from Nocturia. 

Nocturia is a medical condition that causes excessive urination during the night. Linked to many problems, Nocturia can disrupt sleep patterns, cause excessive daytime sleepiness, and increase the risk of falls.

Being that this condition is equally common in both men and women, there are several treatment options that can reduce symptoms and make life easier.

What is Nocturia?

It is a medical condition that causes a person to wake up two or more times at night to pass urine. 

Waking up in the middle of the night to urinate is relatively common amongst all ages, but a problem arises when the need to urinate is persistent. 

Usually, the person has difficulty falling back asleep after their first trip to the bathroom. Their sleeplessness and exhaustion only increase as they visit the bathroom more frequently. Note that there are slight differences between Nocturia and other similar ailments such as bedwetting (nocturnal enuresis) and Polyuria. 

The former refers to the involuntary passing of urine due to a full bladder. The latter is the condition where the body urinates a far larger quantity than is considered normal.

So the common bedwetting condition in teens and kids should not be confused with Nocturia. Teens can develop Nocturia, but it's quite rare.

Healthy Bladder Function

People with a healthy bladder can sleep without urinating for 6-8 hours. If you find yourself urinating more than once a night, it may be a sign of Nocturia.

When you start to experience Nocturia, your nerves become overstimulated. They begin signaling to the bladder that it's time to go, which increases your urge to urinate at night.

A healthy bladder may give this signal, but you can still control the need to urinate and can wait to go to the bathroom later.

What Causes Nocturia?

Nocturia

There are three leading causes of Nocturia amongst age groups, which are:

  •         Polyuria
  •         Nocturnal Polyuria 
  •         Nocturnal Urinary Frequency 

Polyuria

One of the most common causes of Nocturia, Polyuria is a condition that causes one to secrete larger than average amounts of urine. 

This is when an individual urinates more than approximately 100 fluid ounces in 24 hours, often transpiring during both day and night time.

The condition usually occurs due to:

  •         Excessive fluid intake 
  •         Medication side-effects 
  •         Diabetes 
  •         Poor kidney functioning 
  •         High consumption of diuretics like coffee, alcohol, and other substances

    Old age is a decisive risk factor for Polyuria. Weakening bladder control and muscles along with a change in the circadian rhythm can make this condition worse.

    Nocturnal Polyuria 

    This particular condition occurs when people experience the symptoms of Polyuria only at night. During daylight hours, their urine volume is either normal or reduced. 

    The primary cause behind this is that while sleeping, gravity doesn't act on our legs or upper body. Hence, the fluid re-enters our veins and passes out. 

    Other medical causes of Nocturnal Polyuria are:

    •         High sodium diets 
    •         Drinking excessive amounts of fluid before sleeping
    •         Sleeping disorders like sleep apnea 
    •         Medication side-effects 

    Age

    Nocturia age

    Women can experience Nocturia as early as age 30. However, most men and women who experience Nocturia do so in their 50s and 60s.

    Pregnancy

    Nocturia can be extremely common during pregnancy, especially during the first trimester. It often reduces as the pregnancy wears on, but sometimes the condition extends to after childbirth, as well.

    Nocturnal urinary frequency

    This condition is when someone passes small amounts of urine in constant intervals. One's entire bladder is never fully emptied at one time. 

    Some of the causes are:

    •         Bladder infection
    •         Bladder inflammation
    •         Sleep apnea
    •         UTI's 

    Gender Differences in Nocturia 

    Nocturia is very common amongst both men and women. Older men are at the highest risk of developing the condition. Urinary tract problems are exceptionally high amongst men suffering from Nocturia.

    On the other hand, Nocturnal Polyuria was the most common cause of Nocturia for women age 60 and older. Many women have an increased risk of falling and tripping due to the cognitive disturbances caused by Nocturia. Other side-effects include the risk of limb fracture, bedwetting, and excessive daytime sleepiness. 

    Is Frequent Nighttime Urination Always Something Serious?

    Nighttime urination does not always have such serious consequences and health risks.

    Sometimes the cause is as simple as:

    •         Fluid intake right before sleeping
    •         Excessive fluid intake of alcohol or coffee
    •         Reduced bladder capacity with age

    If these are the causes, a simple lifestyle change is enough to prevent the incontinence condition. Consulting with a doctor for a proper and accurate diagnosis can be of great use here.

    How To Consult With A Doctor About Nocturia

    Nocturia treatment

    Here are some questions to ask your doctor for a better understanding of Nocturia:

    •         Why do I have an overactive bladder at night?
    •         Do you have any special instructions for the treatment?
    •         What are the different treatment options?
    •         Do I need medication? Why or why not?
    •         How soon will I see improvements?

    How To Treat Nocturia

    Specific changes and drugs may facilitate the reduction of the debilitating symptoms of Nocturia. Some of them are: 

    Medication

    If Nocturia is caused by medicinal usage, adjusting the timing and dosage might be able to alleviate symptoms. 

    Based on symptoms, age, and co-morbidities, the doctor may be able to prescribe an effective medication. Some of the popular ones are:

    •         Desmopressin: Helps the body produce less urine
    •         Anticholinergic medicines: Causes relaxation and relief for the bladder i.e. Oxybutynin (Ditropan), Tolterodine (Detrol)
    •         Diuretic medicines: Regulates urine production and blood pressure i.e. Furosemide (Lasix) 

    Pregnancy

    Nocturia can often be caused by pregnancy, especially during the first trimester. 

    Some ways to reduce pregnancy-related Nocturia are: 

    •         Perform Kegel exercises to strengthen pelvic muscles
    •         Reduce caffeinated beverages

    Natural Remedies For Nocturia 

    The best natural remedies for treatment can be lifestyle changes and management techniques.

    Lifestyle Changes

    Lifestyle Changes include:

    •         Restricting most fluid intake before sleeping
    •         Reduce consumption of diuretics 
    •         Keep legs elevated as it prevents fluid accumulation 
    •         Wear compression stockings to redistribute fluid build-up 

    Sleep hygiene is a concept designed to improve the quality of sleep. It focuses on improving sleep environments. Some practices under Sleep Hygiene are:

    •         Consistent sleeping and waking schedule 
    •         Relaxation techniques like yoga before sleeping 
    •         Daily exercise during daylight hours 
    •         Using comfortable pillows, sheets, and quilts
    •         Limiting technology use before sleeping 

    Management Techniques 

    Managing Nocturia can be difficult. Some tips and products may be of help, such as: 

    The TENA Overnight Pull-up Underwear is a useful product for older people who have trouble managing excessive urine production. Other brands include the Prevail Pull Up Underwear for Women, the Tranquillity Unisex Tabbed Brief and the Prevail Pads for women.

    Physical Therapy For Nocturia 

    Nocturia

    Specific exercises can help strengthen your bladder muscles, preventing a weak bladder and thereby frequent urination at night.

    Physical therapists may provide a program with Kegel exercises – pelvic contractions that strengthen muscles that control urine flow.

    Some recommend around three sets of 30 pelvic contractions (10 sitting, 10 standing, and 10 reclining) daily, which may result in better urine control within 3 to 6 weeks. Obviously, results may vary, and scheduling an appointment with a physical therapist to examine your specific condition is your best bet here.

    Nocturia: A Summary

    Nocturia is a medical condition that causes one to wake up two or more times at night to pass urine. It is relatively common in older men and women, with more cases in men.

    It causes debilitating changes in life, including but not limited to poor sleep, increased risk of accidents, urinal infections, exhaustion, and more.  

    There are three leading causes of Nocturia - Polyuria (large amounts of urine production), Nocturnal Polyuria (large amounts of urine production at night), and Nocturnal Urinary Frequency (widespread but small amounts of urine production). 

    Some of the popular subclasses of medication for Nocturia are Diuretic medication and Anticholinergic medicines. Some lifestyle changes include managing fluid intake, reducing diuretic consumption, and wearing compression stockings.

    Some management techniques make life easier by practicing sleep hygiene and wearing all-nighter pads or underwear, which are especially useful for the senior population. 

    FAQs

    Will I need surgery for Nocturia?

    In cases where the bladder is not responding to non-surgical treatment, doctors may recommend surgery. Be sure to ask them the questions listed below.

    •         What improvements will I see after surgery?
    •         How long does it take to recover?
    •         What are the risks involved?

    Can diuretics cause Nocturia?

    Yes, diuretics may promote the production of urine. If you absolutely have to take diuretics, take the pills at least 6 hours before sleeping.

    Note that this article is for informational purposes only, and is not professional medical advice. For an expert medical opinion, always consult with your primary care physician.