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Nocturia is the medical term used to describe the need to get up frequently at night to urinate. It is a condition that people commonly attribute to older age, but there are other reasons why it can occur.
Some causes are benign and readily resolved with lifestyle changes; others may be persistent or signs of a serious illness. Chronic nocturia can significantly affect a person's well-being and quality of life, causing sleep deprivation , daytime fatigue, impaired concentration, depression, and a loss of productivity. Older age is one of the primary factors associated with nocturia, with the majority of cases affecting people over the age of There may be multiple causes for this, but one of the prime reasons is a condition known as nocturnal polyuria NP in which high volumes of urine are produced during sleep.
The size of a person's bladder also plays a large role in the risk of nocturia. This is especially true in younger people, in whom the volume of urine produced at night can often exceed the organ capacity. The need to urinate at night may be diet-related, triggering nocturia either directly by stimulating the production of urine or indirectly by compressing the bladder. Among some of the more common dietary causes are:. Nocturia can occur during all stages of pregnancy but often for very different reasons.
The times during which nocturia is common include:. Nocturia may be caused by the medications you take. In some cases, a drug may promote the release of acetylcholine, a compound that affects the system and can provoke bladder contractions. At other times, it may impair the release of norepinephrine , a hormone that helps direct the relaxation of smooth muscles, including those of the bladder.
Other drugs simply have a diuretic effect. Some of the drugs commonly associated with nocturia include:. The excessive use of vitamin D can also promote nighttime urination.
The urge to urinate often coincides with the peak concentration of the drug in the bloodstream. Adjusting the timing of the dose may help resolve nocturia in some people. In others, a drug substitution may be needed. Nocturia may occur in tandem with an acute condition involving the urinary tract.
Philadelphia, PA: Elsevier Saunders; chap Evaluation of the urologic patient: history, physical examination, and urinalysis. Campbell-Walsh Urology. Philadelphia, PA: Elsevier; chap 1. Landry DW, Bazari H. Approach to the patient with renal disease.
Goldman-Cecil Medicine. Philadelphia, PA: Elsevier; chap J Urol. PMID: www. Samarinas M, Gravas S. In: Morgia G, ed. Updated by: Sovrin M. Review provided by VeriMed Healthcare Network. Editorial team. Urinating more at night. 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, BPH 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.
To monitor the problem: Keep a diary of how much fluid you drink, how often you urinate, and how much you urinate. Record your body weight at the same times and on the same scale daily. People generally find nocturia most bothersome when it occurs more than twice per night. The severity of the effects of nocturia on quality of life relates directly to the number of times a person has to wake to pass urine at night.
The prevalence of nocturia increases with age. The causes of nocturia are very complex and it is vital to determine the cause as this will greatly influence the treatment. The bladder diary is crucial in helping define the type and cause of nocturia. The bladder diary determines:. The assessment of nocturia includes those factors on history and physical examination discussed in the general assessment of urinary incontinence.
Investigations in patients with nocturia include:. The most common cause of global polyuria is excessive fluid intake. Excessive fluid intake can also be a response to the presence of a chronically dry mouth that is a common side-effect of many medications e.
Global polyuria due to excessive fluid intake can be managed with fluid restriction. Metabolic conditions such as poorly controlled diabetes mellitus or diabetes insipidus benefit from further treatment by an Endocrinologist. Nocturnal polyuria or increased urine production at night is defined as an increased night-time urine output when the total hour urine output is normal. High night-time urine is defined as:.
In bladder storage disorders the ability of the bladder to store urine is reduced causing nocturia rather than due to large volumes of urine being produced at night as occurs in global polyuria and nocturnal polyuria.
The night-time volumes of urine passed are often small as well as frequent in bladder storage disorders. Bladder storage can be affected by conditions that reduce bladder capacity, cause an overactive bladder or that cause bladder irritation. Incomplete bladder emptying due to an underactive bladder or bladder outlet obstruction e. Treatment of nocturia due to bladder storage disorders is directed at the underlying bladder pathology, for example:.
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