All about nocturia

Nocturia is a term used to describe the waking up due to the urge to urinate, specifically at night, that can occur for a variety of different reasons. In this article, a consultant urologist explains the possible causes of nocturia, what differentiates it from regular urinary habits, and what can be done to manage it.

Nocturia is also called nocturnal urinary frequency. It is when a person urinates or feels the urge to urinate a lot during the night, leading them to wake up frequently in order to relieve themselves. It is not the same as bedwetting (nocturnal enuresis), where the urination happens during unconsciousness, or feeling the urge often during the daytime.

This condition affects more those who are older than 60, which is normal with ageing, but even though the condition does not seem to be harmful, it can originate with a serious issue, and in turn can also lead to damage and dysfunction.

Ideally, a person sleeps uninterrupted for six to nine hours at night. It is not anything to be concerned about at all if a person wakes up to urinate once a night. But flags are raised when a person is consistently getting up more than once a night to urinate. This is because it is disrupting the sleep cycle, which will result in fatigue and drowsiness during the day.

What causes nocturia?

Causes of nocturia can differ based on anatomy; be it an enlarged prostate or menopause, a thorough investigation is necessary to determine the reason behind the nocturia – and how to treat it.

Sometimes the cause is simple: taking medications that contain diuretics (pills that cause patients to urinate more often due to excess fluid), drinking a lot of water or other beverages before sleeping, a smaller or reduced bladder (because of swelling, infections, or obstructions), or mere routine.

However, other underlying, more severe conditions can contribute to developing nocturia, such as:

Diabetes
Hypertension (high blood pressure)
Heart disease
Polyuria (the body produces more urine than can fit in the bladder)
Obstructive sleep apnoea
Pelvic organ prolapse (can happen after childbirth)
Oedema
Neurological conditions such as Parkinson's, multiple sclerosis, or prior strokes

How is nocturia diagnosed?

The process for diagnosing nocturia can only begin once the patient (or their partners and/or family) notice their nighttime behaviour. If they suspect something is abnormal with their urinary habits, they are encouraged to keep notes on how often they feel the urge. Further helpful details could be noting what the last thing they drank before bed, how much they voided, and at what times they got up. Getting the volume of urine can be a difficult task, but there are urine catchers available for purchase at most pharmacies, or one can be sourced from a urologist.

The urologist is also likely to order a urinalysis or urine culture to examine for harmful or foreign microorganisms, proteins, and other such elements. They may also conduct urodynamic testing, where the bladder, the urinary sphincter, and the urethra are analysed through a series of tests on pressure, nerve and muscle function, and behaviour (filling, retention, and voiding).

Possible additional testing that the patient may be asked to undergo as part of the investigation includes blood testing (to check on the kidneys), imaging scans of the bladder to assess its functionality, and a cystoscopy, where a small camera is inserted into the bladder via the urethra for examination of the structures and tissues.

How is nocturia managed?

With nocturia, the best course of treatment is determined by the diagnosis of the underlying condition and thus will vary. Patients with sleep apnoea will need to see a sleep specialist, others with enlarged prostates may be prescribed medication or undergo a minor surgery to treat it, and so forth.

Patients may be recommended to make lifestyle changes in order to reduce the nocturia – regardless of the cause. This could take the form of:

Reducing fluid consumption in the evenings, particularly caffeinated drinks
Afternoon naps, which help the bloodstream absorb liquid and encourage daytime voiding
Pelvic floor exercises to strengthen the pelvic floor muscles
Compression stockings and elevating the legs when sitting, to help with fluid distribution
Taking diuretic medication in the morning or at least a few hours before going to bed (if already on this medication)

Medications that can help manage nocturia will also depend on the patient’s specific case, but some that may be prescribed include:

Anticholinergics, which are used to treat overactive bladders
Diuretics, which are used to regulate how much urine is produced and when
Desmopressin, which encourages the kidneys to produce less urine.