Nocturia or a Repeated Urination at Night- Causes and Treatment

Nocturia or a repeated urination at night or nocturnal polyuria, all these are the names given to excessive urination at night. Normally, an individual should be able to sleep six to eight hours during the night without feeling urge of urination

Nocturia or a Repeated Urination at Night- Causes and Treatment

Nocturia or a repeated urination at night or nocturnal polyuria, all these are the names given to excessive urination at night. Normally, an individual should be able to sleep six to eight hours during the night without feeling urge of urination

A repeated need to get up at night and go to washroom to urinate is termed as nocturia. It is completely different from bedwetting where person’s bladder empties anyway in bed while sleeping. Normally people without nocturia can enjoy sleep for almost 6-8 hours without urination. According to researchers, one visit per night is quite normal. Men with severe nocturia may get up 5-6 times during night for urination. Nocturia or a repeated urination at night can be a symptoms of several serious health problems.

What exactly is Nocturia?

Nocturia or a repeated urination at night or nocturnal polyuria, all these are the names given to excessive urination at night. During sleep time at night, our body produces less urine which is more concentrated. It means that most people normally don’t feel need to wake up during the night to urinate and can sleep uninterrupted for 6-8 hours. Besides disturbing your sleep, nocturia can also be a sign of some serious medical condition. Its causes can be high fluid intake, sleep disorders and bladder obstruction.

Nocturia can be a symptom of some critical medical conditions including urological infection, a tumor of the bladder or prostate, a condition termed as bladder prolapse, or disorders affecting sphincter control. It is also common in people with heart failure, liver failure, poorly controlled diabetes mellitus, or diabetes insipidus. Diabetes and diuretic medications are also associated with nocturia.

Causes of Nocturia or a repeated urination at night

Causes of Nocturia can be anything from lifestyle choices to medical condition. Though it is common in elder males but it can occur at any age. In this, the body produces less of the antidiuretic hormone that helps us retain fluid. This results in increased urine production, mainly at night. Muscles in the bladder can also become weak, making it more difficult to hold urine in the bladder.

Some other common causes include chronic urinary tract infections, drinking excess fluids (mainly caffeinated) before bed, bacterial infection in the bladder, and medications that encourage urination i.e. diuretics. In some cases, nocturia is a symptom of a medical condition include, chronic kidney failure, congestive heart failure, diabetes, and enlarged prostate. It may also be a symptom of sleep disorders such as obstructive sleep apnea, insomnia, or restless leg syndrome.

  • Bladder infection - The lining of the urethra and bladder becomes inflamed and irritated due to byproducts of an infection. This irritation of the bladder wall causes the urge to empty the bladder frequently. The amount of urine during each emptying is often smaller than a usual amount.
  • Heart disease – When your heart ticker doesn’t pump the normal way, fluid builds up. You can notice mainly in your ankles. When you lie down, your body flushes out the extra fluid. This fills your bladder and wakes you up. You can control the swelling by resting with your feet up during the day or by wearing compression socks.
  • Diabetes - An early symptom of both type 1 and type 2 diabetes can be frequent urination, as the body tries to rid itself of unused glucose through the urine. Diabetes can also damage the nerves that control the bladder, causing frequent urination and difficulty controlling your bladder.
  • Medications - Diuretic medications used to treat high blood pressure flush excess fluid from the body which causes repeated urination.
  • Prostate - An enlarged prostate can press against the urethra and block the flow of urine, causing the bladder wall to become irritated. The bladder contracts even when it contains small amounts of urine, causing more repeated urination.
  • Interstitial cystitis - This condition can be described by pain in the bladder and pelvic region, further leading to repeated urination.
  • Stroke - Damage to nerves that supply the bladder can lead to problems with bladder function, including repeated urges to urinate.
  • Multiple sclerosis - Repeated urination can occur in almost 80 percent of men suffering from multiple sclerosis. Multiple sclerosis lesions can block or interrupt transmission of nerve signals that control the bladder.
  • Too much liquid intake - Drinking more liquid than your body requires can cause the body to urinate more often.
  • Overactive bladder syndrome - Involuntary bladder contractions lead to repeated and often urgent urination, even if the bladder is not full.
  • Caffeine, alcohol and artificial sweeteners – All these can act as a diuretics causing repeated urination. Carbonated drinks and citrus fruits are known to irritate the bladder, causing repeated urination.
  • Edema of lower extremities i.e. swelling of the legs.
  • Sleeping disorders such as obstructive sleep apnea i.e. breathing is interrupted or stops many times during sleep.
  • Certain drugs, including diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.
  • High blood calcium level
  • Behavioral patterns - This is something you have conditioned your body to do as a routine.

Symptoms of Nocturia or a repeated urination at night

Normally, an individual should be able to sleep six to eight hours during the night without feeling urge of urination. People who have nocturia wake up more than once a night to urinate. This can cause disruptions in a normal sleep cycle.

  • You produce a great amount of urine i.e. more than 2 liters a day (polyuria)
  • Your body produces a large volume of urine while you sleep i.e. nocturnal polyuria
  • You produce more urine at night than your bladder is able to hold i.e. low nocturnal bladder capacity. This causes you to wake up at night because you need to empty your bladder.
  • Some people who have poor sleep and awaken frequently will go to the bathroom whenever they awaken. Typically in these cases, it is not the need to urinate that awakens them.
  • Urinating more than 8 times in a day or more than once overnight.
  • Incomplete evacuation of the bladder during each phase of urination. There may be a sudden stoppage of the urine flow due to spasms in the bladder or urethra or there may be difficulty starting the flow of urine.
  • Uncomfortable feeling of pressure in the bladder that makes you feel you have to go immediately.
  • Inability to control the flow of urine, leading to either constant or intermittent accidental leakage
  • Pain or burning sensation during or immediately following urination. This may be a sign of a urinary tract infection.
  • After finishing urination, urine continues to drip or dribble out.

Treatment of Nocturia or a repeated urination at night

The treatment of nocturia completely depends on its cause. If nocturia is due to any infection, antibiotics may solve the issue. If it is due to medication, doctors may consider changing individual’s medicines or can recommend to take it in the day time. Nocturia caused by certain serious condition like diabetes, cancer or heart disease will require more extensive treatment. Doctors may prescribe medications to treat nocturia. Antidiuretics such as desmopressin can be taken to reduce the amount of urine produced.

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 prescribed medications that are effective for treating nocturia with detrusor over-activity, demonstrating 50 percent cases. The main side effects with anticholinergic medications are dry mouth, dizziness, and blurred vision.

  • Restriction of Fluid Intake - Limiting the intake of fluids before sleep results in a decreased amount of urine produced at night. Stop consuming melon, cucumber, cranberry juice, soda, soup, lemonade, orange juice, grapefruit juice, acidic foods, tomatoes, chocolate etc. before going to bed as they are rich in liquids and acts as diuretics. So, all these should be avoided before sleep.
  • 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 eliminate excess urine.
  • Kegel exercises and pelvic floor physical therapy can strengthen your pelvic muscles and improve bladder control.

We recommend a unique pelvic floor exercise program designed for women, practicing the key exercises will help rapid improvement with just 5 minutes a day.

  • Elevation of Legs - Elevating your legs helps redistribute fluids so it can be reabsorbed into the blood stream.
  • Compression Stockings - 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. See best price on Amazon here
  • Oxybutynin - This medicine relaxes the detrusor muscle of the bladder.
  • Solifenacin - It is more selective antimuscarnic agent with fewer anticholinergic side effects.
  • Darifenacin - This medicine relieves bladder spams and treats overactive bladder.
  • Bumetanide - Bumetanide must be taken with consultation with a healthcare expert.
  • Imipramine - This medicine results a 45 percent success rate but also has a thin line between an effective dose and a toxic dose.

When to see a doctor?

In old age, nocturia can raise the risk of chances of falling and breaking a hip. Your doctor may ask you questions like how you are sleeping, whether you feel tired during the day, what medicines you take, any awkward symptoms you have etc. Consult your doctor if you observe following signs:

  • Fever
  • Abdominal pain
  • Pain in side or back
  • Bloody, dark or cloudy urine
  • Vomiting
  • Excessive thirst
  • Increased appetite
  • Fatigue

Nocturia can be a disturbing problem for many people as it creates chronic sleep disorder. However, with proper management, motivation, and dedication this condition can be overcome for a better quality of life. However, a healthy lifestyle is advised, which includes salt restriction, alcohol moderation, healthy eating, regular exercise, weight control, and smoking cessation.

Allie Leon, Chief Fun Officer

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