Frequent Nighttime Urination (Nocturia)

The American Urological Association (AUA) defines nocturia as "the need to urinate at least twice during the night." This condition can occur at any age, though it's more frequent for individuals age 60 and older, and becomes more common as the person ages.

Nocturnal Polyuria is an important cause of nocturia in which there's an overproduction of urine at night. According to the International Continence Society, nocturnal polyuria is diagnosed when nighttime urine volume is more than 20 to 30 percent of the total 24-hour urine volume. Global Polyuria is another major cause of nocturia that consists of both day and nighttime urine overproduction.

What causes Nocturia?

Women generally experience nocturia as a result of the consequences from childbirth, menopause and pelvic organ prolapse. Men generally experience nocturia as a direct cause of BPH or an enlarged prostate.

For both men and women, multiple factors can cause nocturia, including:

  • diuretic medications
  • caffeine
  • alcohol
  • overactive bladder treatment
  • excessive fluids before bedtime
  • diminished nocturnal bladder capacity
  • fluid redistribution during sleep

Nocturia can sometimes be a symptom of a greater problem. Possible underlying conditions of nocturia include:

  • diabetes mellitus
  • diabetes insipidus
  • high blood pressure
  • heart disease
  • congestive heart failure
  • vascular disease
  • restless leg syndrome
  • sleep disorders
  • insomnia

How can Nocturia be treated?

The first step in treating nocturia is to keep a journal to chart your daily behavior and fluid intake so that your doctor can make an appropriate diagnosis and track your progress.

  • When do you use the restroom during the day and night?
  • How many times do you wake in order to use the restroom?
  • How much urine do you void in each trip to the restroom?
  • What are your drinking patterns (do you drink a lot of fluid in the later afternoon/evening?)
  • What do you drink (sugary, caffeinated, artificially sweetened, carbonated, alcoholic drinks, etc.)?
  • What medications are you taking and when (do you take diuretics? do you take them in the evening?)
  • Any recurrent urinary tract infections
  • In addition, note any other symptoms that accompany nocturia

When it comes time to meet with your doctor, it's helpful to be prepared to supply this information and details related to personal and family medical history as well as medication usage. Following a full diagnosis, your doctor can recommend a number of treatment options:

Behavioral Therapy

Behavioral therapy can reduce fluid build-up and help alleviate nocturia, but sometimes additional treatment is required. Behavioral therapies include:

  • fluid intake restrictions
  • afternoon naps
  • elevation of legs
  • compression stockings

Medications

Different pharmacological options exist to alleviate symptoms and treat nocturia. Used in conjunction with behavioral therapies, medications have shown to be an effective method of treatment, but can be limited as they address the symptoms of nocturia rather than the underlying condition or causes. Most medications affect the detrusor muscle, decreasing bladder contractions at night or blocking nerves in the bladder that can send constant and inaccurate signals to the brain that the bladder is full.

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