Living with nocturia

Dr Maxwell Adeyemi

As you sleep your body produces less urine that is more concentrated. This means that the average person won't need to wake up during the night to urinate and can sleep uninterrupted for six to eight hours. If, however, you need to wake up two or more times per night to urinate, you may have nocturia, a condition that causes excessive urination at night. Apart from being disruptive to your sleep, nocturia can also be a sign of an underlying medical condition.

The urinary tract includes the organs in the body that makes, stores and remove urine. Urine travels from the kidney to the bladder through the ureters. The bladder holds the urine until you are ready to empty it. The brain and the bladder work together to control urinary functions, so when one is ready to urinate the brain sends a signal to the bladder causing the bladder to contract and push the urine out of the bladder. Nocturia is more common among older adults, but it can occur at any age.

Causes of nocturia

- Drinking too much fluids before bedtime, especially diuretics such as alcohol and caffeine.

- Some medications may cause nocturia as a side effect. Water pills which are prescribed to treat high blood pressure can cause nocturia, as can other medications such as cardiac glycosides, phenytoin, lithium and excessive vitamin D.

- A variety of medical conditions can cause nocturia, among them urinary tract or bladder infections; infection or enlargement of the prostate; bladder prolapse; overactive bladder; tumours of the bladder, prostate, or pelvic area; diabetes; anxiety; kidney infection; edema or swelling of the lower legs; obstructive sleep apnea; neurological disorders such as multiple sclerosis, Parkinson’s disease, or spinal cord compression. Nocturia is also common in people with heart or liver failure.

- Nocturia can be an early symptom of pregnancy. It can develop at the beginning of pregnancy, or later, when the growing womb presses against the bladder.

Diagnosis

Diagnosing the cause of nocturia can be difficult. Your doctor will need to get a comprehensive history of your medical issues. It can be useful to maintain a diary for a few days to record what you drink and how much, along with how frequently you need to urinate. Your doctor may conduct relevant physical examination and then order a series of tests such as blood and sugar tests to check for diabetes; tests for blood count and blood chemistry; urinalysis; urine culture; fluid deprivation test; imaging tests such as ultrasounds or CT scans; urological tests; and urodynamic testing to determine how well the bladder stores and releases urine.

Treatments

The management of the underlying caused of nocturia such as the treatment of diabetes, hypertension, congestive heart failure, obstructive sleep apnea and prostatic enlargement and other causes can often alleviate the condition. Nocturia due to an underlying condition will usually stop when the condition is successfully treated. Restriction of fluid intake at nights and reduced consumption of caffeinated drinks and alcohol can also be beneficial.

If the nocturia is caused by a medication, taking the medication earlier in the day may help reduce night time sleep disturbances.

Treatment can sometimes include medication such as anticholinergic drugs which help lessen the symptoms of an overactive bladder, and desmopressin which causes your kidneys to produce less urine at night.

Prevention

There are steps you can take to lessen the impact of nocturia on your life.

- Reduce the amount of fluid you drink two to four hours before going to bed

- Avoid drinks that contain alcohol and caffeine

- Urinate before you go to bed

- Avoid foods that can be bladder irritants, such as chocolate, spicy foods, acidic foods, and artificial sweeteners.

- Kegel exercises and pelvic floor physical therapy can help strengthen your pelvic muscles and improve bladder control.

Contact Dr Maxwell on 363-1807 or 757-5411.