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NOCTURIA

Read about the causes of nocturia - urinating more than 2 times per night - and ways to treat it.

What Is NOCTURIA?

Nocturia is defined as needing to empty your bladder 2 or more times at night. It is a condition that affects 40 million adults in the United States.  

Nocturia can occur 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. 

Learn more about the causes of nocturia in this short video: 


Effects Of Nocturia

You may think that waking up a few times at night to use the bathroom is not a big deal. But in fact, it is a huge bother for those who live with nocturia and the effects it can have spill over into everything from overall health, risk of falls, daytime functioning, and money spent dealing with the repercussions. Even your partner can be affected. 

 
 The need to pee multiple times a night impairs functioning, quality of life and productivity.

Health

Nocturia has a profound impact on sleep and has been shown to negatively impair functioning, quality of life, overall health, and productivity. Lower sleep quality, fragmented sleep, and loss of sleep have been associated with things like increased risk of poor physical function, obesity, diabetes, and cardiovascular disease.  

Nocturia has also been associated with an increased prevalence of depression.

 
 
 Frequent nighttime urination is associated with increased risk for falls and fractures.

Risk Of Falls

Multiple trips to the bathroom also increase the risk of falls among older adults with nocturia. Patients who make at least 2 or more trips to the bathroom at night have a greater than 2-fold increase in the risk of fractures and fall-related fractures.

 
 When you get up to pee your partner is likely getting up with you.

Interrupted Sleep for Partners

Nocturia can disrupt the sleep of the sufferers partner or spouse. Every time a nocturia patient wakes up to use the bathroom, they are potentially compromising the sleep of their partner. Studies have shown that spouses of nocturia sufferers report sleep disturbances and daytime fatigue. 

 

 

Financial Impact

Nocturia costs an estimated $62.5 billion dollars to Americans each year due to lost productivity and sick leave associated with nocturia, and as a result of falls and fractures from nocturia. 

     Click the image above to download the infographic.

    Click the image above to download the infographic.


    What CAUSES Nocturia?

    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. Nocturnal Polyuria is present in about 88% of nocturia cases.
    • Global Polyuria.  A major cause of nocturia that consists of both day and nighttime urine overproduction.

    Nocturia is it's own condition and should be treated as such. While underlying causes may be a factor, the most common cause is nocturia polyuria, a condition in which the kidneys produce too much urine at night, which occurs in over 80% of nocturia cases.  

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

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

    • Excessive fluids before bedtime
    • Diminished nocturnal bladder capacity. (The bladder is unable to hold as much urine as it once was, causing the individual to awaken in order to void.)
    • Fluid redistribution
    • Behavioral patterns. This is something you have conditioned your body to do as a routine
    • Diuretic medications
    • Caffeine
    • Alcohol
    • Overactive bladder treatment
     

    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:

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

    It's important to note that while nocturia can occur with other conditions, it is a distinct condition and should be treated on it's own.


    TREATMENT OPTIONS

     Click Here To Download The Nocturia Symptom Tracker

    Click Here To Download The Nocturia Symptom Tracker

    Luckily, you don't have to live with nocturia symptoms. There are many treatment options available to you, including behavioral changes you can make, or medications that target the condition.

    As with many incontinence issues it makes sense to create a diary, recording the circumstances surrounding nighttime bathroom trips. Download the free NAFC bladder diary, made specifically for tracking your nocturia symptoms, here

     Click Here To Download The  Tips Sheet For Preparing For Your Doctor's Visit

    Click Here To Download The  Tips Sheet For Preparing For Your Doctor's Visit

    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. Download the NAFC Checklist for talking with your doctor to help you prepare for your visit. 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.

    Because nocturia is most commonly caused by nocturnal polyuria, the overproduction of urine by the kidneys, it's important to treat it as a distinct condition and not just a by-product of another condition. If you're only focused on treating overactive bladder or prostate issues, you're only targeting the bladder and prostate, not the kidneys, which is the source of the problem. Both conditions should be treated individually to effictively manage their respective symptoms.

     

    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

     1 in 3 adults over age 30 make at least 2 trips to the bathroom every night.

    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 new medication designed specifically for nocturia has recently been approved for use by the FDA. Noctiva nasal spray is approved for adults who awaken at least two times per night to urinate. Noctiva is the first FDA approved treatment for this condition. Noctiva is taken daily, approximately 30 minutes before going to bed. It works by increasing the absorption of water through the kidneys, which leads to less urine production. One side effect of Noctiva is a potential for low sodium levels in the blood (hyponatremia). Severe cases of hyponatremia can be life-threatening if not treated so sodium levels should be checked before starting Noctiva, and throughout treatment. Talk to your doctor about this medication for nocturia to see if it may be right for you.

    Anticholinergic medications are prescription medications that have been shown to be 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.

     

    References: 1. Fitzgerald MP, Litman HJ, Link CL, McKinlay JB; BACH Survey Investigators. The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol. 2007;177(4):1385-1389. 2. Sonia Ancoli-Israel, Donald L. Bilwise, Jens Peter Norgaard. The effect of nocturia on sleep. Sleep Med Review. 2011 April; 15(2): 91-97. 3. Fiske J, Scarpero HM, Xue X, Nitti VW. Degree of bother caused by nocturia in women. Neurourol Urodyn. 2004;23(2):130–3. 4. Kupelian V, Wei JT, O'Leary MP, Norgaard JP, Rosen RC, McKinlay JB. Nocturia and quality of life: results from the Boston Area Community Health Survey. Eur Urol. 2012;61(1):78-84. 5. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and metoanalysis of prospective studies. Eur Heart J. 2011;32(12):1484-1492. 6. Kupelian V, Wei JT, O'Leary MP, Norgaard JP, Rosen RC, McKinlay JB. Nocturia and quality of life: results from the Boston Area Community Health Survey. Eur Urol. 2012;61(1):78-84. 7. Nakagawa H, Ikeda Y, Niu K, Kaiho Y, Ohmori-Matsuda K, Nakaya N, et al. Does nocturia increase fall-related fractures and mortality in a community-dwelling elderly population aged 70 years and over? Results of a 3-year prospective cohort study in Japan. Neurourol Urodyn. 2008;27:674–5.  8. Asplund R. Hip fractures, nocturia, and nocturnal polyuria in the elderly. Arch Gerontol Geriatr. 2006 Nov;43(3):319–26. [PubMed] 9. Nakagawa H, Ikeda Y, Niu K, Kaiho Y, Ohmori-Matsuda K, Nakaya N, et al. Does nocturia increase fall-related fractures and mortality in a community-dwelling elderly population aged 70 years and over? Results of a 3-year prospective cohort study in Japan. Neurourol Urodyn. 2008;27:674–5.   10. Asplund R. Hip fractures, nocturia, and nocturnal polyuria in the elderly. Arch Gerontol Geriatr. 2006 Nov;43(3):319–26. [PubMed] 11. Sells H, Donovan J, Ewings P, MacDonagh RP. The development and validation of a quality-of-life measure to assess partner morbidity in benign prostatic enlargement. BJU Int. 2000 Mar;85(4):440–5. 12. Holm-Larsen T. The economic impact of nocturia. Neurourol Urodyn. 2014;33(suppl 1):S10-S14