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A. Nocturia is waking up one or more times during the night because of the need to urinate.
This means that if you wake up during the night because you are thirsty, hear noises, worry, or feel pain etc and you decide to visit the toilet in the meantime, you do not have nocturia.
You also do not suffer from nocturia if you go to the toilet first thing in the morning.
Waking up once in a while to urinate is common and is generally not very bothersome. However, if you regularly wake up two or more times a night, it can affect your quality of life and general health. The more times you wake up each night, the more it impacts your wellbeing.
Nocturia disrupts your sleep and may cause you to be more tired than usual during the day. This can make it difficult to concentrate at work and carry out your daily activities. Your lower energy levels could also affect your social life.
A. Nocturia affects both men and women, and becomes more common as you grow older. In adults under 30, more women than men suffer from nocturia while over the age of 50, it affects men more often. Over the age of 60, the chances of suffering from nocturia rapidly increase for men and women alike.
A. In some people the kidneys produce too much urine. If the kidneys only overproduce at night, this is called nocturnal polyuria.
There are several conditions which can cause overproduction of urine, such as diabetes type I or II or primary polydipsia, the sensation that your mouth is dry which leads you to drink too much.
Some people have a smaller bladder which is filled to capacity more quickly and cannot store the urine all night.
If you have a bladder or prostate condition, such as benign prostatic enlargement (BPE), you may not be able to empty your bladder completely before going to bed. As a result, the bladder fills more quickly and may not store the urine all night.
Other possible causes of nocturia are:
Understanding what causes your nocturia will help your doctor to offer the best possible treatment option for your individual situation.
A. The diagnosis of nocturia is relatively simple, but understanding the underlying causes is much more complex. This is because nocturia may be a symptom of other medical conditions, including lower urinary tract disorder (LUTD).
First, the doctor will take your medical history and do a physical examination. If needed, other tests will be performed, depending on:
Based on the results of your evaluations, your doctor will identify the cause of your nocturia and recommend the right treatment.
Medical history: The doctor will take a detailed medical history and ask questions about your symptoms like:
Physical examination: Your doctor will do a physical examination. They will be looking for:
Your doctor or nurse may also do a pelvic examination in women, test your blood pressure, and look for signs of heart, lung, or neurological conditions.
Bladder diary: Your doctor may ask you to keep a bladder diary. Here you can note down how much you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better.
Questionnaires: Your doctor may ask you to fill out a questionnaire to better understand your symptoms and their impact on your quality of life.
Investigations: The doctor may do some tests to see if there is lower urinary tract dysfunction. This can include urine analysis in the lab, voiding analysis with a uroflowmeter, or ultrasound examination of the bladder and/or prostate.
A. various treatment options are available for managing nocturia. Together with your doctor you can decide which approach is best for you. Factors which influence this decision include:
Watchful waiting: If your symptoms are only bothering you a little, watchful waiting can be an option. This means that you see your doctor regularly (usually every year) or when the symptoms become worse.
Muscarinic receptor antagonists: Muscarinic receptor antagonists (MRAs) are drugs which reduce the abnormal contractions of the bladder. They may reduce the sudden need to urinate which is difficult to postpone. There are several types of MRAs:
Beta-3 receptor agonist: Mirabegron is a beta-3 receptor agonist. This medicine relaxes the bladder muscle and helps to increase the capacity of the bladder. Because of this, you will feel less need to urinate.
Side effects of MRAs are usually mild. They may include dry mouth and eyes, acid reflux, and constipation. In rare cases they may cause symptoms of the common cold, blurred vision, and dizziness as well as difficulty urinating. In the elderly, long-time use of MRAs may worsen the side effects. You should always follow your doctor’s advice about the duration of treatment.
Loop diuretics: In some patients, nocturia may be caused by improved blood circulation. When you lie down, it is easier for the heart to pump blood around the body, including your kidneys. Your body then produces more urine because the kidneys filter more blood, causing nocturia. To treat this, you can take a mild loop diuretic drug. Taking diuretics in the afternoon will drain excess fluid from your body during the day, rather than at night. There are several loop diuretics available:
Side effects include dehydration, gout, low salt or low potassium levels in your blood, dizziness and low blood pressure.
Desmopressin: If your nocturia is caused by a decrease in the production of the hormone vasopressin, it can be replaced by the drug desmopressin. This drug helps reduce urine production by concentrating the urine and is recommended if you have nocturnal polyuria.
Desmopressin may reduce the number of times you wake up to use the toilet and allow you more hours of uninterrupted sleep. It comes as a tablet, a nasal spray, or a melt-in-the mouth tablet and is taken right before sleeping. It is effective for 8-12 hours. The drug is available in various doses and women often need a lower dose than men.
Desmopressin can cause a drop in blood sodium levels. That is why it is common to have your blood tested before and during your treatment.
Less common side effects are headache, nausea, diarrhoea, pain in the abdomen, dizziness, facial flushing or dry mouth.
In rare cases, desmopressin can cause high blood pressure and swelling of the feet and ankles (known as peripheral oedema).
A. Because of the relationship between the prostate and the bladder, some men are prescribed medication to relax the muscle within the prostate gland or reduce the size of the prostate. This may improve their lower urinary tract symptoms (LUTS) but is less effective in improving nocturia.
In some cases, transurethral resection of the prostate (TURP) is recommended to improve the symptoms of benign prostatic enlargement (BPE) when it affects bladder function. The surgery unblocks the bladder outlet by cutting away parts of the prostate. However, unless you have urinary symptoms during the day was well, TURP is unlikely to improve nocturia.
A. Nocturia is usually bothersome and can have a negative impact on your quality of life. It disrupts your sleep and may cause you to be more tired than usual during the day. General lifestyle changes can help manage your symptoms and improve your quality of life:
A. Nocturia is a major problem for many adults. It is defined as waking up one or more times per night to urinate. It can last for a long time and there is no simple cure. Different people cope differently with their symptoms and the possible side effects of treatment. The impact of nocturia on your life should not be underestimated.
Quality of life involves both physical and psychological health. It is important not only to feel healthy but also to feel free of the psychological pressure of living with nocturia.
There are many ways to keep the symptoms under control. They should not stop you from being happy in your relationships and participating in the social, cultural, and economic life of your community.
Do not be embarrassed to seek help if your symptoms bother you: consult your family doctor, general practitioner, or a urologist.