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Nocturia Treatment

Nocturia, a condition characterised by the frequent need to wake up and urinate during the night, can significantly disrupt sleep patterns and overall well-being. Distinguishing nocturia from frequent urination helps diagnosing the sickness. While both involve an increased urge to urinate, nocturia specifically refers to waking up at night to urinate, whereas frequent urination pertains to the need to urinate often during the daytime hours as well.

Understanding the nuances between these conditions, their causes, symptoms, and treatment options helps those who are affected.

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Causes of Nocturia

Medical conditions

  • Urinary Tract Infections (UTIs): These infections can irritate the bladder, leading to a frequent urge to urinate.
  • Bladder Prolapse: This condition, where the bladder descends into the vaginal canal, can affect its storage capacity and function.
  • Bladder or Prostate Inflammation: Inflammation can reduce the bladder’s urine storage capacity or cause an overactive bladder.
  • Diabetes: High sugar levels can lead to increased urination.
  • Heart and Liver Conditions: These can result in fluid accumulation in the body, leading to increased nighttime urination when lying down.

Lifestyle factors

  • Fluid Intake: Consuming large amounts of fluids, especially before bedtime, can lead to nocturia. Beverages containing caffeine or alcohol can also increase urine production.
  • Sleep Disorders: Conditions like sleep apnea can increase nighttime urination.

Medications and diuretics

Some medications, especially diuretics used for conditions like high blood pressure or heart conditions, can increase urine production.Some medications, especially diuretics used for conditions like high blood pressure or heart conditions, can increase urine production.

Aging

The bladder’s capacity can decrease with age, and the body may produce less of the antidiuretic hormone that helps retain fluid.

Symptoms

Primary Symptom

Nighttime Urination: The hallmark of nocturia is waking up multiple times during the night to urinate. The frequency can vary, with some individuals waking up once, while others may wake up several times.

Associated Symptoms

  1. Increased Daytime Urination: Some individuals with nocturia may also experience an increased urge to urinate during the day.
  2. Urgency: A sudden and strong need to urinate immediately.
  3. Nocturnal Polyuria: An excessive production of urine at night.
  4. Reduced Bladder Capacity: The feeling of a full bladder even when it’s not holding much urine.
  5. Difficulty Starting Urination: A delay or difficulty in starting the urine stream.
  6. Weak Urine Stream: The flow of urine is slower and less forceful than usual.
  7. Dribbling: Leaking of small amounts of urine after urinating.

Related Symptoms

Depending on the underlying cause of nocturia, individuals might also experience symptoms such as pain or burning during urination, cloudy or bloody urine, pelvic or lower abdominal pain, or increased thirst.

Diagnosis

Importance of Seeking Medical Advice

Consult a urologist if nocturia disrupts sleep regularly or if other associated symptoms are present. Early diagnosis can lead to more effective treatment and improved quality of life.

Diagnostic Tests and Procedures

Diagnosis typically involves a thorough medical history, physical examination, and urine tests to check for infections or other abnormalities. In some cases, bladder function tests, blood tests, or imaging studies might be recommended to determine the underlying cause.

 

Treatment Options

Behavioural Therapies

  • Fluid Management: Adjusting the timing and amount of fluid intake can help reduce nighttime urination. It’s advisable to limit fluid intake in the hours leading up to bedtime and avoid caffeine or alcohol, which can increase urine production.
  • Bladder Training: This involves gradually increasing the time between urinations to train the bladder to hold more urine. Over time, this can reduce the frequency of nighttime awakenings.

Medications

  • Anticholinergic Drugs: These medications help relax the bladder muscles and prevent bladder spasms, which can contribute to nocturia. Examples include oxybutynin and tolterodine.
  • Desmopressin: This is a synthetic form of the antidiuretic hormone. It reduces urine production at night, helping to decrease the frequency of nighttime urination.
  • Diuretics: Ironically, some people benefit from taking a diuretic in the afternoon. This increases urine production in the afternoon, allowing individuals to expel more fluid before bedtime.

Addressing Underlying Conditions

  • Infections: If nocturia is caused by a UTI or bladder infection, antibiotics will be prescribed.
  • Enlarged Prostate: In men, an enlarged prostate can press against the urethra and block urine flow. Medications or surgeries can be used to reduce the size of the prostate or alleviate symptoms.
  • Overactive Bladder: Medications that relax the bladder can be beneficial. Examples include mirabegron and beta-3 adrenergic agonists.

Surgical Options

  • Urethral Stents: These are small tube-like devices inserted into the urethra to prevent it from closing, improving urine flow.
  • Bladder Neck Incision: This involves making a small cut in the bladder neck to improve urine flow, especially in men with prostate issues.
  • Pelvic Organ Prolapse Surgery: In women, nocturia can result from a prolapsed bladder. Surgery can help reposition the bladder and alleviate symptoms.

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Complications and Risks

Sleep Disturbances

  • Fragmented Sleep: Constantly waking up during the night to urinate can lead to fragmented and non-restorative sleep.
  • Daytime Fatigue: Disrupted sleep can result in fatigue during the day, affecting concentration, mood, and overall well-being.
  • Sleep Disorders: Chronic nocturia can exacerbate or contribute to other sleep disorders such as insomnia or sleep apnea.

Physical Health Risks

  • Increased Risk of Falls: Especially in older adults, waking up multiple times at night in a groggy state can increase the risk of falls, leading to fractures or other injuries.
  • Cardiovascular Strain: Chronic sleep disruption has been linked to an increased risk of cardiovascular diseases, including hypertension and heart disease.

Mental Health Impacts

  • Mood Disorders: Persistent sleep disturbances due to nocturia can lead to mood disorders such as depression or anxiety.
  • Cognitive Impairment: Over time, lack of restorative sleep can affect cognitive functions, leading to memory issues or decreased alertness.

Impact on Quality of Life

  • Social Impacts: Individuals with severe nocturia might avoid social activities or travel due to the fear of not having timely access to a bathroom.
  • Relationship Strain: If one partner is frequently waking up during the night, it can disrupt the sleep of the other, potentially causing strain in the relationship.

Potential Risks of Untreated Nocturia

  • Progression of Underlying Conditions: If nocturia is a symptom of an underlying condition, not addressing it can allow the primary condition to progress, leading to more severe health issues.
  • Kidney Function: Chronic nocturia, especially when associated with conditions like diabetes, can strain the kidneys over time, potentially leading to decreased kidney function.

Conclusion

Nocturia, while common, can have a profound impact on an individual’s quality of life. Recognising the symptoms, understanding the causes, and seeking appropriate treatment are important steps in managing this condition.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK
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Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    Are there specific foods or drinks that can exacerbate nocturia?
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    Yes, certain foods and drinks can exacerbate nocturia. Beverages containing caffeine (like coffee, tea, and some sodas) and alcohol can increase urine production. Additionally, foods high in liquid content, such as soups or watermelon, consumed in large quantities before bedtime, might lead to increased nighttime urination.

    How does body weight influence nocturia?
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    Being overweight or obese can put additional pressure on the bladder, leading to increased urination. Additionally, obesity can be associated with sleep apnea, which in turn can exacerbate nocturia. Maintaining a healthy weight can help in reducing the symptoms.

    Can exercises or physiotherapy help in managing nocturia?
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    Yes, pelvic floor exercises, also known as Kegel exercises, can strengthen the muscles that control urination and improve bladder function. A physiotherapist specializing in pelvic floor rehabilitation can provide guidance on these exercises.

    Is nocturia more common in men or women?
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    Both men and women can experience nocturia, but the causes might differ. In men, an enlarged prostate can be a common cause, while in women, bladder prolapse or hormonal changes during menopause might contribute to nocturia.

    Are there any alternative or complementary therapies for nocturia?
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    Some individuals find relief from nocturia using alternative therapies like acupuncture or herbal remedies. However, consult with a urologist before trying any alternative treatments to ensure they are safe and appropriate for your specific condition.