Nocturia

Nocturia is a condition in which you wake up during the night because you have to urinate, with the main intention to urinate itself. Waking up at night to urinate is by far the most bothersome lower urinary tract symptom. It means that somebody has arisen from intended sleep time because of the desire to pass urine.

Causes of nocturia include high fluid intake, sleep disorders and bladder obstruction (like BPH / “prostate enlargement”). Treatment of nocturia depends on the underlying disease itself. Some lifestyle changes may be instituted including certain activities, such as restricting fluids and medications that reduce symptoms of nocturia.

Nocturia is a symptom. It is not a disease or a diagnosis. Your doctor needs to find out why nocturia occurs before successfully treating it.

When you get up from sleep, and then since you are awake, you decide to pass urine – this is not considered nocturia. It is sleep disturbance or sleep fragmentation, a completely different disease or disorder.

Bothersome nocturia on the other hand is highly subjective in terms of how many times it takes for it to be bothersome enough is up to the patient. Most of the literature considers 2 times to be significant. There are patients with nocturia as a single time or episode considers it to be bothersome and view it as a chief complaint to their aliments.

If you get up in the night, without the desire to urinate, then it would not be considered nocturia.

Diagnosis

Your doctor will take a detailed history and physical examination.

Important questions include the following:

Drinking habits – types of fluids, amount of caffeine, and amount of alcohol.

General sleep pattern – some people sleep during the day or have trouble sleeping at night; some work in the night shifts.

History of hypertension – and whether they have dipping or non-dipping hypertension. Non-dipping hypertension can cause nocturnal polyuria, although there is no proof to a cause and effect relationship (nocturnal polyuria results from large volumes of urine passed in the night; as compared to nocturia which is higher frequency / number of times passed urine in the night).

Any swelling of the feet (peripheral edema) – this could be due to third spacing. People who stand a lot and people who eat a lot of sodium may get some fluid accumulation in the lower extremities during the day and excrete this amounts at night. The causes of peripheral edema can be heart failure and venous disease.

Any renal / kidney impairment

Any medications – including diuretics

Nocturia may occur due to:

Polyuria – people who urinate > 3,000mL in 24 hours. These may be due to high fluid intake, untreated diabetes (Type 1 and Type 2), and Diabetes insipidus.
Nocturnal polyuria – people who experience a high urine volume only at night. Their urine volume during the day is normal or reduced. This is usually due to fluid retention during the day that often accumulated in the feet or legs, and this fluid is excreted in the night. The causes of nocturnal polyuria can include heart failure, edema of lower extremities (swelling of the legs), sleep disorders like obstructive sleep apnea, taking certain medications that make you pass urine in the night, and drinking too much fluid before bedtime.
Nocturnal urinary frequency – where people urinate in small amounts or urinate more frequently at night, but the total amount of urine volume produced is not higher than normal. The causes include bladder obstruction, BPH (“prostate enlargement”), nocturnal overactive bladder and UTI (urinary tract infection).

Your doctor will be able to differentiate between the above causes by conducting a urine test, bladder diary, and if necessary a PSA, uroflowmetry and ultrasound of the bladder and kidneys, and at times urodynamic study.

Urological causes of nocturia

BPH (“prostate enlargement”)

Nocturnal overactive bladder

Overdistended bladder with overflow incontinence

Drinking lots of water, fluids, coffee, caffeinated beverages or alcohol, and tea at night before sleeping

Taking certain medications like diuretics

Non-urological causes of nocturia

Obstructive sleep apnea

Restless leg syndrome

Heart failure

Diabetes mellitus

Diabetes insipidus

Edema of the lower legs (swelling of the feet)

Certain medications – including diuretics (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.

Having a diet that’s high in sodium.

When to see your doctor

When you get up at night to pass urine, even more so if it is bothersome.

Nocturia disrupts your sleep or everyday activities

Remember, nocturia is a symptom, not a disease or a diagnosis. Your doctor needs to find out why nocturia occurs before successfully treating it.

Informative links:

https://www.urologyhealth.org/urologic-conditions/nocturia

https://my.clevelandclinic.org/health/diseases/14510-nocturia

https://www.healthline.com/health/urination-excessive-at-night

https://www.sleepfoundation.org/articles/nocturia-or-frequent-urination-night