Nocturia: What you should know

Nocturia is a condition in which individuals wake up frequently during the night to urinate. Referred to as excessive nighttime urination, nocturia becomes more common as people get older. Nocturia occurs in individuals who wake up more than once a night to urinate, which can cause disruptions to a normal sleep cycle. The condition is different from enuresis — better known as bed-wetting — in which an individual’s bladder empties while still asleep.

Nocturia causes

Women may experience nocturia due to menopause, pelvic organ prolapse or childbirth. Among men, nocturia may be caused by an enlarged prostate, or benign prostatic hyperplasia.

In both men and women, nocturia may be the result of excessive intake of alcohol, caffeine or other fluids before bedtime. Other causes include:

untreated diabetes;

gestational diabetes;

congestive heart failure;

leg swelling;

sleep disorders;

diuretic use;

bladder obstruction;

bladder overactivity;

bladder infection; and

bladder pain.

Diagnosis

If an individual believes they are suffering from nocturia, a daily diary of fluid intake will help their physician make a diagnosis. This should include a list of medications being taken, fluid intake, urination frequency and volume of urine, as well as any related symptoms. A physical exam, a urinalysis and urine culture are typically used to make the diagnosis. Referral to a urologist may be necessary if nocturia is confirmed.

Treatment options

Treatment depends on the type and possible cause of nocturia. If the physician determines an underlying condition is causing nocturia, then the patient will be referred to a specialist. For example, if sleep apnea is identified as the underlying cause of nocturia, a patient will be referred to a sleep specialist or pulmonologist for treatment.

If there no underlying cause is determined, there are several non-pharmacologic and pharmacologic treatment options to alleviate and treat nocturia. Non-pharmacological remedies focus heavily on limiting fluid intake before bed and utilizing various options to redistribute and absorb fluid to limit fluid build-up.

Recommendations include taking afternoon naps, elevating the legs or wearing compression stockings to help redistribute excess fluid, and timing the intake of diuretics hours before going to sleep. Pharmacologic treatments focus on reducing the production of urine during nighttime, as well as preventing bladder spasms and treating unstable bladders. The most commonly prescribed agents include:

anticholinergic medications;

bumetanide;

darifenacin;

desmopressin;

furosemide; and

oxybutynin.

In addition, the FDA recently approved Noctiva (desmopressin acetate, Allergan, Serenity Pharmaceuticals) nasal spray for adults who wake at least two times per night to urinate.

Additional Information can be found on these websites:

https://my.clevelandclinic.org/health/articles/nocturia

https://www.nafc.org/nocturia/