Nocturia is a condition characterized by the need to awaken more than one times per night to void. Although it is a multifactorial condition that can coexist with other lower urinary tract symptoms, the most common causal factor is nighttime overproduction of urine. Trips to the bathroom can cause fragmented sleep, excessive daytime sleepiness, and an elevated risk of dangerous falls. Nocturia has numerous potential causes and can be connected to a range of serious health issues.

Causes

Drinking too much fluid during the evening can cause you to urinate more often during the night. Caffeine and alcohol after dinner can also lead to this problem.

Other common causes of urination at night include:

  • Infection of the bladder or urinary tract
  • Drinking a lot of alcohol, caffeine, or other fluids before bedtime
  • Enlarged prostate gland (benign prostatic hyperplasia)
  • Pregnancy

Other conditions that can lead to the problem include:

  • Chronic kidney failure
  • Diabetes
  • Drinking excessive amount of water 
  • Heart failure
  • High blood calcium level
  • Certain medicines, including water pills (diuretics)
  • Diabetes insipidus 
  • Swelling of the legs

Waking often during the night to urinate can also be linked to obstructive sleep apnea and other sleeping disorders. Nocturia may go away when the sleeping problem is under control. Stress and restlessness can also cause wake up at night.

When to Contact a Medical Professional?

Contact the care provider if:

  • Waking to urinate more often continues over several days.
  • You are bothered by the number of times you must urinate during the night.
  • Have a burning sensation when urinating.

Diagnosis

Health history: Doctor will ask about the symptoms and health history. 

Bladder diary: It is used in order to help with a diagnosis. This diary is used to keep track of things like the kind and amount of liquids drink, trips to bathroom, etc. to track trends over a period of time which can lead to useful treatments.

Urine culture and urinalysis: check for infection, unwanted blood, and other elements in your urine.

Blood test: checks the kidney and thyroid, cholesterol levels and the presence of anemia, diabetes or other problems.

Bladder scan: shows how much urine is still in the bladder after you go to the bathroom.

Cystoscopy: checks for a tumor or other causes of your symptoms by having the doctor insert a narrow tube with a tiny lens inside the bladder.

Urodynamic testing: checks to see how well your lower urinary tract stores and releases urine.

Treatment

Behavioral modifications

Restriction of Fluid Intake – Naturally, limiting the intake of fluids in the evening results in a decreased amount of urine produced at night.

Afternoon Naps – This can help reduce fluid buildup by allowing liquid to be absorbed in the bloodstream. When awakening from a nap, you can use the bathroom and eliminate excess urine.

Elevation of Legs – Like naps, elevating the legs helps to redistribute fluids so it can be reabsorbed into the blood stream.

Compression Stockings – Creating an effect similar to elevating legs, 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.

Management

Mattress Covers – A variety of products exist to protect the bed including vinyl, waterproof, and absorbing mattress covers, or even sheet protectors, which can make cleanup easier.

Absorbent Briefs- These products are a form of modified underwear designed to absorb liquid, therefore preventing leakage. Both reusable and disposable products are available.

Skincare products- Many products exist to protect the skin from irritation and soreness that occur when a person experiences nocturnal enuresis. A range of soaps, lotions, and cleansing cloths exist for various skin types.

Pharmaceutical treatment

Different medicinal options exist to alleviate and even treat nocturia. These may be used alone or combined with some of the behavioral modifications.

  • Medicines to help the kidneys produce less urine. For example, Desmopressin
  • Anticholinergic medicines to treat bladder muscle problems. They relax the bladder if its spasms. These are used to correct overactive bladder. For example, Darifenacin, Oxybutynin, Tolterodine, or Trospium Chloride 
  • Diuretic medicines to regulate urine production and high blood pressure. For example, Bumetanide ,Furosemide(Lasix).

References

https://www.urologyhealth.org/       (UROLOGY CARE FOUNDATION)

https://www.ncbi.nlm.nih.gov/        (NATIONAL LIBRARY OF MEDICINE

https://medlineplus.gov/                  (MEDLINEPLUS)

https://www.nafc.org/nocturia          (NATIONAL ASSOCIATION FOR INCONTINENCE)