Nocturia

Nocturia is excessive night time urination, needing to get up in the night to empty your bladder two or more times. It occurs due to the overproduction of urine in the kidneys. 80% of reported nocturia cases are as a result of nocturnal polyuria, the overproduction of urine at night but normal production during the day. The other 20% are a result of global polyuria, the overproduction of urine all the time.

Nocturia affects up to 40% of the adult population, affecting more people with age. It can often be treated, or reduced, with a few lifestyle changes alone.

If you suffer from nocturia you may think that the biggest issue is the lack of undisturbed sleep and potential for stubbing your toe in the dark. However if you suffer from nocturia you are at a risk of:

  • Obesity
  • Low mood and depression
  • Daytime fatigue - Exhaustion leads you to being more inefficient at everything you do, you will see the impact in your studies, work, relationships and activities.
  • Impaired physical function and early ageing - Frequently having disturbed sleep can physically age you; you may experience weaker strength, slower walking speed, and the inability to be as active as you were before you began suffering.
  • Diabetes - Sleep duration and quality have been connected to glymeic control, the inability to control glucose levels in the body often progresses into diabetes.
  • Cardiovascular disease - Due to lack of undisturbed sleep.
  • Increased risk of falls - You are at twice the risk of fracturing a bone if you suffer from nocturia, as you will likely go 'bump in the dark'. The risk is increased further for the elderly and those that are already more unsteady.
  • Relationship issues - Getting up in the night disturbs your partner and, depending on the location of your bathroom, other individuals in your house. Causing them sleep deprivation and ultimately puts them at risk of the issues above as well.

Symptoms of Nocturia

You may be suffering from nocturia if you get up two or more times from sleeping to urinate. Even if you reduce your intake of liquid in the hours before bed and fully empty your bladder before sleeping.

It is important that you seek diagnosis from your GP as early as possible. It may be that you are experiencing nocturia due to another condition which needs resolving. Such as diabetes mellitus and insipidus (which cause an overproduction of urine), high blood pressure, heart disease and congestive heart failure, vascular disease, restless leg syndrome or sleep disorders (including insomnia and sleep apnoea).


Causes of Nocturia

The overproduction of urine can be caused by:

  • Ageing - The pituitary gland in the brain, produces the antidiuretic hormone as you sleep, telling your kidneys to reduce urine production. You produce less of this hormone as you age.
  • Menopause (in women) - The hormonal changes that occur during menopause cause urine storage issues.
  • Bladder prolapse (in women) - Your bladder is more vulnerable to developing urinary incontinence if it has prolapsed.
  • Benign prostatic hyperplasia aka enlarged prostate (in men) - Your prostate can put pressure on your bladder, causing you to have the urge to go more frequently.
  • Behaviour - You may unconsciously have introduced this into your routine, with poor sleep patterns and routinely drinking too much fluid before bedtime.
  • Diuretics - Medications or food and drink such as caffeine, alcohol.
  • Diminished nocturnal bladder capacity - Your bladder may be unable to hold as much as it could previously.

To read more about these causes, and the events that can lead to you developing any form of urinary incontinence, visit the Causes and Diagnosis page.


How to Stop Nocturia

Specific treatments for nocturia include:

Conservative therapy's - Conservative therapy's, such as lifestyle changes and non-surgical medical treatments, resolve 25% of incontinence cases, and are the first course of treatment.

  • Not drinking as much fluid in the hours before you sleep
  • Emptying your bladder just before going to bed
  • Taking an afternoon nap - As well as making you feel brighter and more rested if you are suffering from undisturbed sleep, whilst you sleep liquid is absorbed back into the bloodstream.
  • Elevating your legs and/or wearing compression stockings - In the evening and when you sleep, elevating your legs can redistribute fluids so they can be more easily reabsorbed into the bloodstream.
  • Taking a prescribed diuretic - Take a diuretic 6 or more hours before bedtime, it will encourage your kidneys to produce more urine so you can get rid of excess water before you go to bed.
  • Taking a prescribed synthetic antidiuretic hormone - Available as a tablet or nasal spray to use before bed to prevent further urine from being created. These products come with many warnings, however, as they are associated with straining your heart.

To read about the other treatments available for general urinary incontinence, visit our incontinence treatment page.


Sources

Asplund, R. (1995). General Pharmacology. The nocturnal polyuria syndrome (NPS). [online] 26(6), p1203-1209. [viewed 19/04/18]. Available from: https://www.sciencedirect.com/science/article/pii/030636239400310J?via%3Dihub

Blackwell, T. Yaffe, K. Ancoli-Israel, S. Schneider, J. L. Cauley, J. A. Hillier, T. A. Fink, H. A. Stone, K. (2006). The Journals of Gerontology: Series A. Poor sleep is associated with impaired cognitive function in older women: the study of osteoporotic fractures. [online] 61(4), p405-410. [viewed 19/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16611709

British Association of Urological Surgeons. (2017). Nocturnal Polyuria (passing too much urine at night). [online] British Association of Urological Surgeons, 2017 [viewed 19/04/18]. Available from: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Nocturnal%20polyuria.pdf

Dam, T. L. Ewing, S. Ancoli-Israel, S. Ensrud, K. Redline, S. Stone, K. (2008). Journal of the American Geriatrics Society. Association between Sleep and Physical Function in Older Men: The MrOS Sleep Study. [online] 56(9), p1665-1673. [viewed 19/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631084/?report=reader#!po=77.2727

Gonçalves Correia, S. (2008) Urinary incontinence and overactive bladder in the non-institutionalized Portuguese population: national survey and methodological issues.[online] Faculdade de Medicina da Universidade do Porto [viewed 19/04/18] Available from: https://repositorio-aberto.up.pt/bitstream/10216/21944/5/MEpiscorreia200811Tese.pdf

Knutson, K. L. Ryden, A. M. Mander, B. A. Van Cauter, E. (2006). Archives of Internal Medicine. Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus. [online] 166(16), p1768-1774. [viewed 19/04/18]. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410883

Kupelian, V. Wei, J. T. O’Leary, M. P. Norgaard, J. P. Rosen, R. C. McKinlay, J. B. (2012). European urology. Nocturia and Quality of Life: Results from the Boston Area Community Health Survey. [online] 61(1), p78-84. [viewed 19/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226859/#!po=72.2222

Marinkovic, S. P. Gillen, L. M. Stanton, S. L. (2004). The BMJ. Managing Nocturia. [online] 328(7447), p1063-1066. [viewed 19/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC403853/#__ffn_sectitle

National Association For Continence. (2017). Nocturia. [online] NAFC, 2017. [viewed 19/04/18]. Available from: https://www.nafc.org/nocturia

Prince, D. Pedler, K. Rashid, P. (2012). Australian Journal of General Practice. Nocturia: A guide to assessment and management. [online] 41(6), p399-422. [viewed 19/04/18]. Available from: https://www.racgp.org.au/afp/2012/june/nocturia-a-guide-to-assessment-and-management/

Spiegel, K. Leproult, R. Van Cauter, E. (1999). The Lancet.Impact of sleep debt on metabolic and endocrine function. [online] 23(354), p1435-1439. [viewed 19/04/18]. Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01376-8/fulltext

Yaggi, H. K. Araujo, A. B. McKinlay, J. B. (2006) Diabetes Care. Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes. [online] 29(3), p657-661. [viewed 19/04/18]. Available from: http://care.diabetesjournals.org/content/29/3/657.long

Yoshimura, K. Ohara, H. Ichioka, K. Terada, N. Matsui, Y. Terai, A. Arai, Y. (2003). Urology. Nocturia and benign prostatic hyperplasia. [online] 61(4), p786-790. [viewed 19/04/18]. Available from: http://www.goldjournal.net/article/S0090-4295(02)02444-5/fulltext