Nocturia is a condition in which you feel the need to wake and pass urine during the night. Medically, it is defined as getting up more than once at night to urinate, with sleep both before and after the visit to the toilet. It affects both men and women and becomes more common with age.
There are several possible reasons for it. Broadly, the problem is either an overproduction of urine at night or difficulty holding on to the urine that is produced.
Causes of nocturia
- Excess urine production at night.
- Low bladder capacity or incomplete bladder emptying.
- Poor sleep, as people who sleep badly tend to go to the toilet whenever they wake.
- High fluid intake, especially in the evening.
- Untreated diabetes.
- Congestive heart failure.
- Oedema of the lower limbs (swelling of the legs).
- Certain medicines, including cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, excessive vitamin D and diuretics (water tablets).
- Drinks such as coffee, other caffeinated beverages or alcohol.
- Neurological diseases that affect bladder control.
- Kidney failure.
Symptoms
- Disturbed sleep because of the repeated need to pass urine.
- In men, a small leakage of urine at the end of the stream is common.
- Many women leak a little urine when they cough.
- Hesitancy, a poor or intermittent stream, and terminal dribbling.
Sometimes the bladder is simply unable to hold the urine it stores overnight, a state known as low nocturnal bladder capacity. This can occur for several reasons:
- Bladder obstruction.
- Overactive bladder.
- A bladder infection or repeated urinary tract infections.
- Bladder inflammation (swelling).
- Interstitial cystitis (a painful bladder condition).
- Bladder cancer.
- A non-cancerous enlargement of the prostate that obstructs the flow of urine, which affects men.
Diagnosis
When you see a doctor, you can expect to be asked about the following:
- How long you have had the problem.
- How many times you feel the need to urinate each night.
- Whether the volume passed each time is large or small.
- Whether there has been any change in your overall urine output, either an increase or a decrease.
- Whether you drink coffee, caffeinated beverages or alcohol, and how much each day.
- Whether your diet has changed recently.
You may also be asked to keep a diary for two or three days, recording how much fluid you take in, how often you pass urine and the volume each time. The doctor will ask about any history of urinary tract infections or other bladder problems and may arrange some tests.
Treatment
If you have the symptoms described above, you should see a urologist, who will advise treatment based on the underlying cause. If the problem stems from poor sleep, you may be referred to a sleep specialist or a pulmonologist, and if a heart problem is suspected, a cardiologist may be asked to review you.
Lifestyle measures
- Restrict fluids in the evening, especially coffee, caffeinated drinks and alcohol.
- Time any diuretics carefully, taking them in the mid to late afternoon, around six hours before bedtime.
- Take an afternoon nap.
- Elevate the legs to help prevent fluid building up.
- Wear compression stockings, which also help prevent fluid accumulation.
Medications
These should be prescribed only by a medical practitioner, after careful assessment and consideration of the possible side effects.
- Anticholinergic medicines, which reduce the symptoms of an overactive bladder.
- Furosemide (Lasix), a diuretic that helps regulate urine production.
- Desmopressin (DDAVP), which helps the kidneys produce less urine.
Every treatment plan starts with a proper assessment, so you only get the care your condition actually needs. If you have symptoms or a question about your health, book a consultation with Dr. Anish Gupta.