Nocturia is a condition characterised by frequent urination during the night. This condition is more common with increasing age and tends to occur in both men and women. Having to wake up once a night to urinate is common for many people but if the frequency of urination during nighttime is increased, it might be an indication of an underlying medical problem. Nocturia can either occur independently or is associated with daytime urinary frequency.
Depending on the type of nocturia, it has many different causes. The main types of nocturia are nocturnal polyuria, polyuria, and nocturnal urinary frequency.
Those with polyuria urinate more than 3,000 ml urine in twenty-four hours. This usually occurs as a result of excessive filtration of water by the kidneys. It can also occur if some component of the urine such as glucose is pulling the excess water out.
The potential causes of polyuria include untreated or poorly treated diabetes, high fluid intake, gestational diabetes, diabetes insipidus, and nocturnal polyuria.
Patients who have nocturnal polyuria notice a high urinary volume only during the night. During day time, their urine volume is normal or decreased. The reason behind this might be fluid retention during the day is often accumulated in the lower limbs. When the person lies down to sleep, the gravitational force no longer retains the fluid in the lower limbs. Therefore, it tends to re-enter the veins and is filtered by the kidneys, forming urine.
The causes of nocturnal polyuria include swelling of the legs, congestive heart failure, sleeping disorders like obstructive sleep apnea, and drugs like cardiac glycosides, diuretics, lithium, demeclocycline, phenytoin, methoxyflurane, excessive Vitamin D, and propoxyphene. Other causes include a diet high in sodium and drinking too much fluid before sleeping.
Those with this condition tend to urinate small amounts of urine more frequently during the night. The overall volume of urine formed is not high. This usually occurs due to inability of the urinary bladder to fully evacuate or the inability of the bladder to fill up completely before developing the urge to urinate. It can also occur as a result of sleeping disorders causing the person to wake up for some random reason and then going to the bathroom while they’re awake. The patient may however think that he actually woke up to urinate.
There are different causes responsible for the inability of the bladder to completely evacuate. These include benign prostatic hyperplasia and bladder obstruction. The causes responsible for the inability of the bladder to completely fill up include bladder infection, bladder over activity, recurrent urinary tract infection, interstitial cystitis, bladder inflammation, obstructive sleep apnea, and bladder malignancy.
A normal person usually sleeps for around 6-8 hours during the night without having to frequently go to the bathroom. Those with nocturia wake up more often during the night to urinate, which tends to disrupt their normal sleep cycle. Following are the symptoms of nocturia:
If you have nocturia, you must maintain a fluid and voiding diary that includes records of how much water and other fluids you consumed on a given day, how often you went to the toilet, and how much you urinated. This will help your healthcare provider better manage your condition. You should also let your doctor know about any medications you are taking and any infections of the urinary tract you have or had in the past. After knowing all your symptoms and evaluating your overall condition, your doctor will determine the potential cause of your nocturia and formulate an effective treatment plan that best suits your needs.
Following are some of the questions your doctor may ask you to reach the diagnosis and to determine the cause:
Apart from reviewing your voiding diary and asking you these questions, your healthcare provider may order a urinalysis test to analyse your urine for any signs of infection.
If you suspect you have nocturia, you must see a doctor who might help you. If you are located in Indore, you can visit the Nocturia and Enuresis Clinic at Kokilaben Dhirubhai Ambani Hospital, Indore and get an appointment with an expert doctor who will guide you to the next step.
The treatment for nocturia is usually targeted towards the cause behind the condition. If you are found to have sleep apnea, you might need to consult a pulmonologist or a sleep specialist. If the cause of nocturia is an enlarged prostate, additional medications or surgery may be needed to treat the condition.
Another condition related to nighttime urination is enuresis. Those who suffer from Nocturia need to wake up at night to urinate. Enuresis is different from this as those suffering from it pass urine involuntarily in bed while sleeping. While nocturia is commonly seen in elderly people, enuresis is more common in children and toddlers.
Both the conditions adversely affect the quality of life as the person needs to put extra effort to go to the toilet multiple times during the night when they should be otherwise sleeping. This leads to insomnia and an unproductive life routine. Those suffering from enuresis even get embarrassed due to involuntary bedwetting. This adversely affects their self-esteem and hampers the overall personality development of the person.
The exact cause of bedwetting in children and adults is not known. Some probable causes include inability to perceive a full bladder, small bladder size, hormonal imbalance, urinary tract infection, stress, sleep apnoea, chronic constipation, diabetes, a structural defect in the nervous system or the urinary tract. All these conditions need to be timely addressed to prevent future problems.
In our continued efforts to prevent human suffering and help them achieve better quality lives, this aspect of disorders is covered by our Nocturia and Enuresis Clinic. Our Clinic is equipped with state-of-the-art medical equipment and all the facilities needed to deliver high quality care to such patients. All the treatment plans are tailored to the individual needs of the patients by highly experienced and qualified medical staff.
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