Nocturia

Nocturia (nok-TOO-ree-ah) is a condition in which a person wakes up during the night because he or she has to urinate.

What Is Nocturia?

Nocturia (noct meaning “night” and uria meaning “urinate”) is the need to get up two or more times at night to urinate. Nocturia can be normal as one ages and the bladder gets smaller. It is normal to get up one or two times to urinate at night, but more than two times should be evaluated because nocturia can also be a sign of disease.

How Common Is Nocturia?

Nocturia is very common. The National Association for Continence states that greater than one-third of people over 30 years old get up two or more times a night to urinate.

What Are the Causes of Nocturia?

The physical causes of nocturia can be classified into four major types:

Other factors contributing to nocturia include:

Nocturia can be a sign of other diseases, for example:

Who Is at Risk for Nocturia?

The risk for nocturia increases as one gets older, as the bladder loses its elasticity. Pregnant women often have nocturia as the growing fetus puts increased pressure on the bladder.

For others, nocturia may be an indicator of a medical problem, such as heart disease, diabetes, kidney disease, prostate disease, or urinary tract infection.

What Are the Signs of Nocturia?

Nocturia can be a sign of disease. Nocturia is getting up to urinate two or more times at night. Most people who are not affected by nocturia are able to sleep uninterrupted by the need to urinate for 6 to 8 hours at a time. Waking multiple times at night to urinate can have a negative impact on sleep amount and sleep quality, which can result in other health problems.

What Is the Treatment for Nocturia?

Diagnosis * may be waking up multiple times during the night and may be urinating more frequently once awake. However, the need to urinate is not the reason for waking. The healthcare provider obtains a complete health history and asks questions about how much fluid is ingested daily, how often the person urinates throughout the day and night, what medications the person is taking, whether there is any pain associated with urinating, and whether the person has any problem with leaking urine or wetting the bed. The healthcare provider may ask the person to keep a bladder diary for several days to a week, listing fluid intake and urinary output, including times and amounts of fluid taken and urine passed. The healthcare provider may also ask questions about general health to help determine if there is a disease that is causing the nocturia. A urine sample is analyzed to determine if there is a urinary tract infection or if there are indicators of kidney disease, diabetes, or another disease condition. A culture * of the urine may be done to determine what organisms are present and, if present, what medication is appropriate to treat the problem.

Kegel Exercises
  1. Find the muscles that you use to stop urinating. They are located on the floor or bottom of the pelvis. To find the muscles, start urinating and then try to stop. Once you find the muscles, you can start doing Kegel exercises.
  2. Start by squeezing these muscles for 3 seconds. Over time, increase to 10 seconds.
  3. Then relax for 3 seconds. Over time, increase to 10 seconds.
  4. Repeat 10 to 15 times at least three times a day.
  5. Avoid doing Kegel exercises when urinating because they may injure the bladder.

In some cases, a physician specialist called a urologist may be recommended if the problem is related only to kidney or bladder function. A urologist is a physician with specialized knowledge and experience in the diagnosis and treatment of diseases of the kidneys and urinary system.

Treatment

Treatment for nocturia will depend on the cause of the problem. If nocturia is related to a disease such as diabetes, kidney disease, heart disease, prostate disease, or urinary tract infection, treatment will be focused on treating the disease that is causing the problem.

Dietary and lifestyle changes may be recommended to treat nocturia. Adequate fluid intake of at least 2 liters per day is recommended, unless the person has a condition where fluids are restricted. A healthy diet includes fruits, vegetables, and whole grains, remembering that fruits and vegetables contain fluid and contribute to the daily fluid intake. Physical activity helps to maintain body organ function and health. Walking and swimming are good exercises to maintain health.

The person may be taught exercises called Kegel exercises to strengthen the muscles of the pelvic floor. These muscles stretch from the pubic bone at the bottom of the abdomen to the coccyx or tailbone at the end of the spinal column and from side to side. These muscles help to support the bladder, the uterus, and the bowel. Pelvic floor exercises can help to improve bladder and bowel control and prevent bladder leakage.

Medications may be prescribed to treat nocturia, depending on the cause. Medications for nocturia typically must be taken on a longterm basis as, in most individuals, once the medication is stopped, nocturia recurs. The actions of the drugs used in the treatment of nocturia include relieving bladder muscle spasms, treating an overactive bladder, and relaxation of the bladder muscle.

Can Nocturia Be Prevented?

Nocturia can be prevented by decreasing fluid intake in the evening and before going to bed at night. It is important, however, to get adequate fluids during the day. Redistributing daily fluid intake so that most fluids are taken in the morning and afternoon hours with limited fluid intake during the evening hours ensures that the person gets the recommended amount of fluids while decreasing the problem of nocturia. Decreasing fluid intake overall to prevent nocturia is not recommended and can cause other problems.

For people who are taking medication called diuretics, which increase urine excretion, it is recommended to take the medication later in the day. Taking the medication in the morning can lead to increased thirst and greater fluid intake later in the day, which will result in greater urine output during the night. Results of some studies indicate that taking a diuretic such as furosemide (Lasix) about six hours before bedtime results in a reduction in nocturia.

Some people find that sodas, carbonated beverages, beverages containing caffeine (e.g., coffee, tea), alcohol, and diet beverages that contain artificial sweeteners make the problem worse. Limiting intake of these beverages or avoiding them completely may help relieve the problem. Instead, drink water and fruit juices to get the daily recommended intake of fluid.

See also Aging • Diabetes • Heart Disease: Overview • Incontinence • Kidney Disease • Neurogenic Bladder • Overactive Bladder • Pregnancy • Prostate Problems: Overview • Sleep Disorders: Overview • Urinary Tract Infections

Resources

Books and Articles

Hashim, Hashim and Paul Abrams, eds. Nocturia. Oxford, United Kingdom: Oxford University Press. 2015.

Weiss, Jeffrey P. Nocturia: Causes, Consequences and Clinical Approaches. New York: Springer Publishing, 2014.

Websites

Bladder and Bowel Foundation. “Nocturia.” https://www.bladderandbowelfoundation.org/bladder/bladder-conditions-andsymptoms/nocturia (accessed April 1, 2016).

National Association for Continence. “Nocturia.” http://www.nafc.org/nocturia (accessed April 1, 2016).

Organizations www.bladderandbowelfoundation.org (accessed April 1, 2016).

National Association for Continence. PO Box 1019, Charleston, SC 29402. Telephone: 843-419-5307. Website: www.nafc.org (accessed April 1, 2016).

* diuretics (dye-yoor-EH-tiks) are medications that increase the body's output of urine.

* high blood pressure is a condition in which the pressure of the blood in the arteries is above normal. Also called hypertension.

* congestive heart failure (kon-JES-tiv) is a condition in which a damaged or overworked heart cannot pump enough blood to meet the oxygen and nutrient needs of the body. People with heart failure may find it hard to exercise due to the insufficient blood flow, but many people live a long time with this condition. Also called heart failure.

* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough insulin or the body cannot use the insulin it makes effectively, resulting in increased levels of sugar in the blood. This can lead to increased urination, dehydration, weight loss, weakness, and a number of other symptoms and complications related to chemical imbalances within the body.

* urinary tract infection (YOOR-ih-nair-e) (UTI) is an infection that occurs in any part of the urinary tract.

* kidney disease (KID-nee) is any disease of the kidney that damages or reduces the normal function of the kidney, which is to filter wastes from the body and excrete them through the urinary system.

* prostate disease (PRAH-state) is any disease of the male reproductive gland located near where the bladder joins the urethra. The prostate produces the fluid part of semen.

* sleep apnea is a disorder in which an individual stops breathing and then restarts breathing multiple times, sometimes 30 or more times an hour, during a sleep episode.

* culture (KUL-chur) is a test in which a sample of fluid or tissue from the body is placed in a dish containing material that supports the growth of certain organisms. Typically, within days the organisms will grow and can be identified.

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)