What is Nocturia?
The definition of nocturia is defined as waking at night to void 2 or more times. Half of men and women aged 50-59 years have nocturia. It is a major cause of sleep disturbance and can lead to depression, loss of work, a decline in health and risk of death.
Risk factors for nocturia include obesity, hypertension, diuretic usage, obstructive sleep apnea, restless leg syndrome, benign prostatic hyperplasia (BPH), prostate cancer, antidepressant usage, coronary artery disease, congestive heart failure, and diabetes.
Nocturia Pathway Steps
Nocturia can be an indicator of worsening underlying disease, such as chronic kidney disease, diabetes mellitus, or congestive heart failure.
Why do I have Nocturia?
Nocturia can be caused by the following:
Low-volume voids may be due to either reduced bladder capacity or impaired bladder function. The two most common causes of low-volume bladder voids are an overactive bladder (OAB) and bladder outlet obstruction, often related to benign prostatic hypertrophy (BPH).
An increase in urinary volume at night may be due to an increase in the total 24-hour urine output, or to a higher percentage of the total daily urine output being excreted at night.
The increased urine production at nighttime may be nocturnal polyuria. Overproduction of urine at night, with a normal 24-hour urine output, is called nocturnal polyuria. The definition is age-dependent, and for older adults (>65 years) has been defined as nocturnal urine volume greater than 33 percent of the 24-hour urine volume. You may be asked to complete a 24-hour voiding diary to determine your daytime and nighttime urine production. Download “Nocturia Voiding Diary”
Nocturnal polyuria may be due to age-related changes in the secretion and action of arginine vasopressin (AVP). There is a fluctuation of AVP release in young, healthy subjects, with higher AVP plasma levels in the evening contributing to decreased nighttime urine output. This fluctuation in AVP release is absent in many older patients.
Poorly controlled diabetes and heart disease can also lead to nocturia. For diabetes, excess sugar in the bloodstream after a nighttime meal can cause more urine production at night. The increased blood glucose actually gets excreted in the urine where it “draws in” more water. This results in more urine production at night which causes nocturia.
For heart disease, congestive heart failure (CHF) can cause fluid to accumulate in your legs and around your ankles. At night when you elevate your legs in bed, it is easier for your heart to get rid of the fluid. This can result in nocturia.
Nocturia occurs in approximately 50 percent of patients with obstructive sleep apnea (OSA). Restless leg syndrome and periodic limb movements at night are other conditions.
- Untreated depression and obesity are also associated with nocturia.
- If you have these conditions, you should seek care from your primary care provider to help with depression and strategies for weight loss.
Treatment Pathways for Nocturia
Nocturia evaluation takes several factors into consideration including medical conditions, lifestyle, and fluid intake. Treatment is aimed at addressing these issues. Using electronic care pathways, we ensure patients have access to the most up-to-date educational information. You may speak with a navigator on the phone whose job is to oversee your progress through the pathway and facilitate communication between you and your provider. The electronic nocturia pathway maximizes patient education, compliance, and treatment success.
The clinical pathway for nocturia starts with an office visit where any medical conditions that contribute to nocturia are identified and a treatment plan is created. The next step involves the addition of behavioral and lifestyle changes. If nocturia continues to be a significant bother, then a nocturia specific medication is considered. All of these approaches build on each other. Success for treating nocturia is most commonly achieved by combining interventions.