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National Association for Continence is a national, private, non-profit 501(c)(3) organization dedicated to improving the quality of life of people with incontinence, voiding dysfunction, and related pelvic floor disorders. NAFC's purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.  

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NOCTURIA

Nocturia can be a debilitating problem as it creates chronic sleep impairment. However, with proper management, this condition can be overcome.

NOCTURIA

1 in 3 adults over the age of 30 make at least two trips to the bathroom every night. And while the majority of those who are dealing with nocturia are usually over the age of 60, it can happen at any age. If you are experiencing this problem, it is best to address it now as the occurrences of bathroom trips increase with age. Researchers have identified two major causes of nocturia:

  • Nocturnal Polyuria. This occurs when there is an overproduction of urine at night. According to the International Continence Society, this type of nocturia is defined by a nighttime urine volume that is greater than 20-30% of the total 24 hour urine volume.
  • Global Polyuria.  A major cause of nocturia that consists of both day and nighttime urine overproduction.

CAUSES

Due to obvious anatomical differences, men and women experience nocturia for different reasons. Women generally experience nocturia as a consequence of childbirth, menopause, and/or pelvic organ prolapse. In men, nocturia can be directly attributed to benign prostatic hyperplasia (BPH), also known as enlarged prostate.

Additional factors that can contribute to nocturia in both sexes include:

  • Behavioral patterns. This is something you have conditioned your body to do as a routine
  • Diuretic medications
  • Caffeine
  • Alcohol
  • Overactive bladder treatment
  • Excessive fluids before bedtime
  • Diminished nocturnal bladder capacity. Urine production exceeds the bladder capacity causing the individual to be awakened in order to void.
  • Fluid redistribution

 

POSSIBLE UNDERLYING CONDITIONS OF NOCTURIA

Nocturia, as described above, can be a result of excess fluids before bedtime, medications, alcohol, caffeine, reduced bladder capacity, or diuretic medications. Yet, while nocturia can occur because of these factors, sometimes it is a symptom of a greater problem. Certain conditions can alter the way in which your body functions causing urine to be passed in the evening and during sleep. Such conditions include:

  • Diabetes mellitus
  • Diabetes insipidus
  • High blood pressure
  • Heart disease
  • Congestive heart failure
  • Vascular disease
  • Restless leg syndrome
  • Sleep disorders
  • Insomnia

TREATMENT OPTIONS

As with many incontinence issues it makes sense to create a diary, recording the circumstances surrounding nighttime bathroom trips. 

This information can help a healthcare provider determine the cause of the problem and the appropriate treatment. At the time of the appointment, you should be prepared to supply information such as personal and family medical history as well as medication usage. In addition to helping you find options to help cure nocturia, it is also important to see a healthcare provider to rule out any other serious problems that may cause nocturia as a side effect.

At the appointment you can expect:

  • A physical examination
  • Urinalysis and urine culture. These are different tests that determine the contents of the urine.

If you believe that you are experiencing nocturia and/or nocturnal polyuria, you should first see a primary care professional such as a family care physician, nurse practitioner, physician’s assistant, or general practitioner. This could also be an internist or geriatrician serving as your primary care provider. Once your provider has determined if, in fact, you have this condition, you should be referred to a specialist.

Considering that nocturia has only recently been researched in more depth, treatment options are currently limited. They are also dependent upon the diagnosis and the underlying cause(s) determined by a healthcare professional.

 

MANAGEMENT

  • Mattress Covers. A variety of products exist to protect the bed including vinyl, waterproof, and absorbing mattress covers or even sheet protectors, which can make cleanup easier.
  • Absorbent Briefs. These products are a form of modified underwear designed to absorb liquid, therefore preventing leakage. Both reusable and disposable products are available. 
  • Skincare Products. Many products exist to protect the skin from irritation and soreness that occur when a person experiences nocturnal enuresis. A range of soaps, lotions, and cleansing cloths exist for various skin types.

 

BEHAVIORAL MODIFICATIONS

  • Restriction of Fluid Intake. Naturally, limiting the intake of fluids in the evening results in a decreased amount of urine produced at night.
  • Afternoon Naps. This can help reduce fluid build up by allowing liquid to be absorbed in the bloodstream. When awakening from a nap, you can use the bathroom and eliminate excess urine.
  • Elevation of Legs. Like naps, elevating your legs helps redistribute fluids so it can be reabsorbed into the blood stream.
  • Compression Stockings. Creating an effect similar to elevating your legs, these elastic stockings exert pressure against the leg while decreasing pressure on the veins. This allows fluids to be redistributed and reabsorbed into the bloodstream.

 

PHARMACEUTICAL TREATMENT

Different medicinal options exist to alleviate and even treat nocturia. These may be used alone or combined with some of the behavioral modifications listed above, which has been proven to be more effective. A word of caution about medications: Used alone, studies have confirmed that the medication works only as long as it is taken. Once off the medication, relapses are quite common.

Anticholinergic medications are prescription medications that are effective for treating enuresis with detrusor overactivity, demonstrating success in 5-40% of cases. The main side effects with anticholinergic medications are dry mouth, dizziness, and blurred vision.

  • Darifenacin. This medication relieves bladder spasms and treats overactive bladder. 
  • Oxybutynin. This medication relaxes the detrusor muscle of the bladder.
  • Tolterodine. This medication is an antimuscarinic and functions much like oxybutynin.
  • Trospium Chloride. This medication treats an unstable bladder by blocking cholinergic receptors that are found on muscle cells in the wall of the bladder. Once the receptors are blocked the bladder then can relax so overactivity does not occur.
  • Solifenacin. This is a recently introduced anticholinergic that is a more selective antimuscarinic agent with fewer anticholinergic side-effects.

If this first line drug therapy is considered ineffective, one or more of the following may be prescribed.

  • Desmopressin. By mimicking ADH or vasopressin, the kidney produces less urine.
  • Imipramine. This medication boasts a 40% success rate but also has a fine line between an effective dose and toxic dose.
  • Furosemide. This loop diuretic helps regulate urine production in the daytime in order to decrease urine production during sleep. Furosemide blocks ion flow in the kidneys, allowing urine production to be more controlled.
  • Bumetanide. This loop diuretic assists in regulating urine production prior to sleep so waking during the nighttime does not occur. Bumetanide must be taken with caution and consultation with a healthcare professional prior to taking this medication is highly recommended.

Nocturia can be a debilitating problem for many people as it creates chronic sleep impairment. However, with proper management, motivation, and dedication this condition can be overcome for a better quality of life.

 
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