Does your bladder wake you up at night? Are you not able to get through the night without visiting the bathroom multiple times?

If yes, you may be suffering from a condition called nocturia. Nocturia is a condition in which you wake up two or more times at night because of the urge to urinate. Nocturia can occur in both men and women and is more common with age.

Nocturia can be a disruptive condition and interfere with the quality of life and health due to the resultant lack of sleep. It may cause you to feel tired through the day and make it difficult to focus at work and carry out your daily activities.

What is normal and what is abnormal?

If you wake up at night because you are thirsty or for any other reason and you visit the restroom because you are anyways awake, then you do not have nocturia. Going to the restroom first thing in the morning is also not a symptom of nocturia. Waking up once in a while to urinate is also common and normal.

It is when you have to wake up two or more times because of the need to urinate and it interferes with your general health and impacts your wellbeing, it is called as nocturia.

What are the causes of nocturia?

A part of the problem is definitely due to aging. As we age, our bodies produce less of a hormone that allows us to retain fluids in our body. So our bladders fill more rapidly. Also the capacity of our bladder to store urine also reduced with age.

However nocturia may occur due to multiple reasons that are not linked to age:

  • Polyuria [production of an increased amount of urine each day (more than 2 liters a day)]: This can occur because of high fluid intake, untreated diabetes (type 1 or 2), diabetes insipidus and gestational diabetes (diabetes during pregnancy)
  • Nocturnal polyuria (production of a large amount of urine only when you sleep): It can occur in patients with
    • heart problems like congestive heart failure
    • swelling of the legs due to collection of fluid (edema)
    • sleeping disorders like obstructive sleep apnea (interruption of breathing many times during sleep)
    • drugs like diuretics (pills to cause urination), cardiac glycosides, lithium, phenytoin, excessive Vitamin D
    • drinking too much liquids before bedtime especially coffee, caffeinated drinks and alcohol
  • Low bladder capacity at night: In this condition, you produce more urine at night than your bladder is able to store. As a result you feel the urge to urinate making you wake up at night. Low bladder capacity can result from
    • Obstruction of the bladder: In men, the main cause is growth of the prostrate called as benign prostatic hyperplasia
    • Overactive bladder condition
    • Bladder infection
    • Painful bladder conditions
    • Cancer of the bladder
  • Mixed Nocturia: This is a condition where you have both nocturnal polyuria and low bladder capacity at night

How is nocturia diagnosed?

Diagnosis of nocturia involves a thorough history with a proper questionnaire which asks detailed questions about your problem; including the amount and number of times you void at night, the duration of the problem, the caffeinated drinks and alcohol you consume, the impact of the problem on your sleep schedule and daily life and any recent changes in your diet or urination output.

You will also be asked for a detailed list of the medication you are taking and history of urinary tract infections and related symptoms.

A very important tool to understand and correctly diagnose your problem in the hands of the urogynecologist is the bladder diary. A bladder diary is a three day diary of your fluid intake and output. Over the course of three days, you will be asked to record the number of times, amount and type of fluids you consume, the number of times and amount of urine you eliminate through the 24 hour day cycle, leakage of urine if any and the situations under which the leakage occurs.

The bladder diary will reveal any obvious red flags that may be responsible for your problems: you may be drinking too much fluid later in the day or through the day.

In addition, a urine test will be performed to rule out urinary tract infections.

How is nocturia treated?

Treatment depends on the cause of nocturia. The following treatment options are definitely helpful:

  • Restriction of consumption of liquids in the evening, especially coffee, caffeinated beverages and alcohol
  • An afternoon nap with legs elevated helps because if there is a collection of fluid in the lower extremities due to standing the entire day, lying down in the afternoon will help to recirculate the fluid back to the heart
  • Elevation of the legs while sitting or lying down and wearing compression stockings as it helps to prevent fluid accumulation
  • Medications such as drugs that reduce overactive bladder symptoms, diuretics that help in regulating production of urine and desmopressin (DDAVP) which helps the kidneys to produce less urine, may be beneficial.

References:

  • National Association for Continence. Nocturia
  • Marinkovic SP, Gillen LM, Stanton SL. BMJ 2004;328:1063. Managing nocturia
  • National Sleep Foundation. Frequent Urination at Night

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