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{{Short description|Unusually frequent need to urinate at night}}
{{Infobox symptom |
{{More citations needed|date=April 2024}}
Name = Nocturia |
{{Use dmy dates|date=April 2024}}
ICD10 = {{ICD10|R|35||r|30}} |

ICD9 = {{ICD9|788.43}} |
'''Nocturia''' is defined by the [[International Continence Society]] (ICS) as "the complaint that the individual has to wake at night one or more times for [[Urination|voiding]] (''i.e., to urinate'')".<ref name=Definition>{{cite journal |doi=10.1002/nau.10053 |title=The standardisation of terminology in nocturia: Report from the standardisation sub-committee of the International Continence Society |year=2002 |last1=Van Kerrebroeck |first1=Philip |last2=Abrams |first2=Paul |last3=Chaikin |first3=David |last4=Donovan |first4=Jenny |last5=Fonda |first5=David |last6=Jackson |first6=Simon |last7=Jennum |first7=Poul |last8=Johnson |first8=Theodore |last9=Lose |first9=Gunnar |last10=Mattiasson |first10=Anders |last11=Robertson |first11=Gary |last12=Weiss |first12=Jeff |journal=Neurourology and Urodynamics |volume=21 |issue=2 |pages=179–83 |pmid=11857672 |author13=Standardisation Sub-committee of the International Continence Society|s2cid=26193237 |doi-access=free }}</ref> The term is derived from [[Latin language|Latin]] ''nox'' – "night", and [[Greek language|Greek]] ''[τα] ούρα'' – "urine". Causes are varied and can be difficult to discern.<ref name=Adults>{{cite journal |doi=10.1002/(SICI)1520-6777(1998)17:5<467::AID-NAU2>3.0.CO;2-B |title=Nocturia in adults: Etiology and classification |year=1998 |last1=Weiss |first1=Jeffrey P. |last2=Blaivas |first2=Jerry G. |last3=Stember |first3=Doron S. |last4=Brooks |first4=Maria M. |journal=Neurourology and Urodynamics |volume=17 |issue=5 |pages=467–72 |pmid=9776009}}</ref> Although not every patient needs treatment, most people seek treatment for severe nocturia, waking up to void more than 2 or 3 times per night.
MeshID = D053158 |
}}
'''Nocturia''' (derived from [[Latin language|Latin]] ''nox, night'', and [[Greek language|Greek]] ''[τα] ούρα, urine''), also called '''nycturia''' (Greek ''νυκτουρία''), is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times to void.”<ref name=Definition>{{cite journal|last=van Kerrebroeck|first=P|coauthors=Abrams P; Chaikin D; Donovan J; Fonda D; Jackson S; Jennum P; Johnson T; Lose G; Mattiasson A; Robertson G; Weiss J|title=The standardisation of terminology in nocturia: Report from the standardisation Sub-committee of the International Continence Society|journal=Neurourol Urodyn|year=2002|volume=21|issue=2|page=179–183|pmid=11857672|url=http://www.ncbi.nlm.nih.gov/pubmed/11857672}}</ref> Nocturia has only recently been recognized as a separate clinical entity within the lower urinary tract symptom complex.<ref name=Definition></ref> The growing recognition that nocturia is a condition in its own right was reflected in the meeting ‘Nocturia - towards a consensus’ that was convened in Athens in 1998.<ref name=Definition></ref> The pathophysiology of nocturia is multifaceted and can be complex and its cause remains unclear in a significant number of patients.<ref name=Adults>{{cite journal|last=Weiss|first=J|coauthors=Blaivas J, Stember D, Brooks M|title=Nocturia in adults: Etiology and classification|journal=Neurourol Urodyn|year=1998|volume=17|issue=5|page=467–472|pmid=9776009|url=http://www.ncbi.nlm.nih.gov/pubmed/9776009}}</ref><ref>{{cite journal|last=Park|first=H|coauthors=Kim, H|title=Current Evaluation and Treatment of Nocturia|journal=Korean J Urol|year=2013|volume=54|issue=8|page=492-498|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742899/}}</ref>
<br>
<br>
In order to diagnose nocturia, the nocturnal urine volume (NUV) of patients must be known. The ICS defines NUV as “the total volume of urine passed between the time the individual goes to bed with the intention of sleeping and the time of waking with the intention of rising.” Thus, NUV excludes the last void before going to bed, but includes the first morning void. A main factor of nocturia is the intention of the patients when wakening; whether the patient is awakened with the intention to void or if the patient voids after being awakened for some other reason. The latter not classified as nocturia. Although every patient does not need treatment, most people seek treatment for severe nocturia, waking up to void more than 2-3 times per night. Another important factor of nocturia is defining the sleep period of the patients. This can affect the evaluation of nocturia because the number of nocturnal voids depends partly on how many hours an individual actually sleeps. On average, sleep time is 8 hours per night but may vary between individuals.


==Prevalence==
==Prevalence==
Studies show that 5-15% of people who are 20-50 years old, 20-30% of people who are 50-70 years old, and 10-50% of people 70 years old and up, experience two or more symptoms of nocturia per night.<ref name=Gender>{{cite journal|last=Schatzl|first=G|coauthors=Temml C, Schmidbauer J, Dolezal B, Haidinger G, Madersbacher S|title=Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project.|journal=Urology|year=2000|month=Jul|volume=56|issue=1|page=75-75|pmid=10869627|url=http://www.ncbi.nlm.nih.gov/pubmed/10869627}}</ref> From these studies, it can be seen that nocturia becomes more common as people grow older. More than 50 percent of men and women over the age of 60 have been measured to have nocturia in many communities. Even more over the age of 80 are shown to experience symptoms of nocturia every night.<ref name=Prev>{{cite journal|last=Lundgren|first=R|title=Nocturia: a new perspective on an old symptom|journal=Scand J Urol Nephrol|year=2004|volume=38|issue=2|page=112-116|pmid=15204390|url=http://www.ncbi.nlm.nih.gov/pubmed/15204390}}</ref> Also, as people get older, the faster nocturia symptoms seem to worsen. Although there are no substantial differences between men and women having symptoms of nocturia, data shows that there is a higher prevalence in younger women than younger men and older men than older women.<ref name=Gender></ref>
Studies have shown that 5–15% of people who are 20–50 years old, 20–30% of people who are 50–70 years old, and 10–50% of people 70+ years old urinate at least twice a night.<ref name=Gender>{{cite journal |pmid=10869627 |year=2000 |last1=Schatzl |first1=G |last2=Temml |first2=C |last3=Schmidbauer |first3=J |last4=Dolezal |first4=B |last5=Haidinger |first5=G |last6=Madersbacher |first6=S |title=Cross-sectional study of nocturia in both sexes: Analysis of a voluntary health screening project |volume=56 |issue=1 |pages=71–5 |journal=Urology |doi=10.1016/S0090-4295(00)00603-8}}</ref> Nocturia becomes more common with age. More than 50 percent of men and women over the age of 60 have been measured to have nocturia in many communities. Even more over the age of 80 are shown to experience symptoms nightly.<ref name=Prev>{{cite journal |doi=10.1080/00365590310020033 |title=Nocturia: A new perspective on an old symptom |year=2004 |last1=Lundgren |first1=Rolf |journal=Scandinavian Journal of Urology and Nephrology |volume=38 |issue=2 |pages=112–6 |pmid=15204390|s2cid=24851592 }}</ref> Nocturia symptoms also often worsen with age. Contrary to popular belief, nocturia prevalence is about the same for both sexes.<ref>{{cite journal |vauthors=van Kerrebroeck P, Hashim H, Holm-Larsen T, Robinson D, Stanley N |title=Thinking beyond the bladder: antidiuretic treatment of nocturia |journal=Int J Clin Pract |volume=64 |issue=6 |pages=807–16 |date=May 2010 |pmid=20337753 |doi=10.1111/j.1742-1241.2010.02336.x |url=}}</ref>


== Causes ==
==Impact==
Research suggests that more than 60% of people are negatively affected by nocturia.<ref name=Gender /> The resulting [[insomnia]] and [[sleep deprivation]] can cause exhaustion, changes in mood, sleepiness, impaired productivity, fatigue, increased risk of accidents, and cognitive dysfunction.<ref name="sleep dep">{{cite journal |pmid=10674891 |year=1999 |last1=Hetta |first1=J |title=The impact of sleep deprivation caused by nocturia |volume=84 |pages=27–8 |journal=BJU International |issue=Suppl 1 |doi=10.1046/j.1464-410x.84.s1.3.x|s2cid=23611274 }}</ref><ref>{{cite journal |doi=10.1016/j.smrv.2010.03.002 |title=The effect of nocturia on sleep |year=2011 |last1=Ancoli-Israel |first1=Sonia |last2=Bliwise |first2=Donald L. |last3=Nørgaard |first3=Jens Peter |journal=Sleep Medicine Reviews |volume=15 |issue=2 |pages=91–7 |pmid=20965130 |pmc=3137590}}</ref><ref name=Health>{{cite journal |pmid=12581002 |year=2003 |last1=Kobelt |first1=G |last2=Borgström |first2=F |last3=Mattiasson |first3=A |title=Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia |volume=91 |issue=3 |pages=190–5 |journal=BJU International |doi=10.1046/j.1464-410X.2003.04062.x|s2cid=3894775 }}</ref> 25% of falls that older individuals experience happen during the night, of which 25% occur while waking up to void.<ref name=Falls>{{cite journal |pmid=11928835 |year=2002 |last1=Jensen |first1=J |last2=Lundin-Olsson |first2=L |last3=Nyberg |first3=L |last4=Gustafson |first4=Y |title=Falls among frail older people in residential care |volume=30 |issue=1 |pages=54–61 |journal=Scandinavian Journal of Public Health |doi=10.1080/140349401753481592}}</ref>
Causes of nocturia can fall under two categories: irregular levels of hormones that are involved in water balance of the body and vesical problems.


A quality-of-life test for people who experience nocturia was published in 2004. The pilot study was conducted only on men.<ref name=Men>{{cite journal |doi=10.1016/j.urology.2003.10.019 |title=Development and validation of a quality-of-life measure for men with nocturia |year=2004 |last1=Abraham |first1=Lucy |last2=Hareendran |first2=Asha |last3=Mills |first3=Ian W |last4=Martin |first4=Mona L |last5=Abrams |first5=Paul |last6=Drake |first6=Marcus J |last7=MacDonagh |first7=Ruaraidh P |last8=Noble |first8=Jeremy G |journal=Urology |volume=63 |issue=3 |pages=481–6 |pmid=15028442}}</ref>
Two major hormones that regulate the body’s water level are [[arginine vasopressin]] (AVP) and [[atrial natriuretic hormone]] (ANH). AVP is an antidiuretic hormone that is produced in the hypothalamus but stored in and released from the posterior pituitary gland. It is activated when the body needs to retain water and does so by increasing water absorption in the collecting ducts of the kidney nephron; subsequently decreasing urine production. ANH, on the other hand, is released by heart muscle cells in response to high blood volume. When activated, ANH releases water, subsequently increasing urine production.


==Diagnosis==
Nocturia can be separated into four underlying pathophysiological processes: global polyuria, nocturnal polyuria, bladder storage disorders, or mixed etiology.<ref name=Causes>{{cite journal|last=Hennessey|first=C|coauthors=Shen J|title=Sources of unreliability in the multidisciplinary assessment of the elderly|journal=Eval Rev|year=1986|volume=10|page=78}}</ref> The first two processes are due to irregular levels of AVP or ANH, while the third process is a vesical problem.
Nocturia diagnosis requires knowing the patient's nocturnal urine volume (NUV). The ICS defines NUV as "the total volume of urine passed between the time the individual goes to bed with the intention of sleeping and the time of waking with the intention of rising".<ref name="pmid12445092">{{cite journal |vauthors=Van Kerrebroeck P, Abrams P, Chaikin D, etal |title=The standardization of terminology in nocturia: report from the standardization subcommittee of the International Continence Society |journal=BJU Int. |volume=90 |pages=11–5 | date=December 2002 |issue=Suppl 3 |pmid=12445092 |doi= 10.1046/j.1464-410x.90.s3.3.x|s2cid=417670 }}</ref> Thus, NUV excludes the last void before going to bed but includes the first morning void, if the urge to urinate woke the patient. The amount of sleep a patient gets and the amount they intend to get are also considered in a diagnosis.{{citation needed|date=April 2021}}


As with any patient, a detailed history of the problem is required to establish what is normal for that patient. The principal diagnostic tool for nocturia is the voiding bladder diary. Based on information recorded in the diary, a physician can classify the patient as having global polyuria, nocturnal polyuria, or bladder storage problems. A voiding bladder diary should record:{{citation needed|date=April 2021}}
===Global Polyuria===
* number of voids
Global polyuria is the continuous overproduction of urine which is not only limited to sleep hours. Global polyuria occurs in response to increased fluid intake and is defined as urine outputs of greater than 40 mL/kg/24 hours. The common causes of global polyuria are primary thirst disorders such as [[diabetes mellitus]] and [[diabetes insipidus]] (DI). DI is caused by irregular water levels in the body. Urination imbalance may lead to polydipsia or excessive thirst to prevent circulatory collapse. Central DI is caused by low levels of AVP that helps regulates water levels. In nephrogenic DI, the kidneys do not respond properly to the normal amount of AVP.<ref name=NDI>{{cite journal|last=Weiss|first=J|coauthors=Blaivas JG|title=Nocturnal polyuria versus overactive bladder in nocturia|journal=Urology|year=2002|volume=60|page=28-32|pmid=12493348|url=http://www.ncbi.nlm.nih.gov/pubmed/12493348}}</ref> Diagnosis of DI can be made by an overnight water deprivation test. This test requires the patient to eliminate fluid intake for a fixed period of time, usually around 8-12 hours. If the first morning void is not highly concentrated, the patient is diagnosed with DI. Central DI usually can be treated with a synthetic replacement of AVP, called desmopressin. [[Desmopressin]] is taken to control thirst and frequent urination.<ref name=Desmo>{{cite journal|last=Rivkees|first=S|coauthors=Dunbar N, Wilson T|title=The management of central diabetes insipidus in infancy: desmopressin, low renal solute load formula, thiazide diuretics|journal=j pediatr endocrinol metab|year=2007|volume=20|issue=4|page=459-469|pmid=17550208|url=http://www.ncbi.nlm.nih.gov/pubmed/17550208}}</ref> Although there is no substitute for nephrogenic DI, it may be treated with careful regulation of fluid intake.
* timing of voids
* volume voided
* volume and time of fluid intake


Patients should include the first morning void in the NUV. However, the first morning void is not included with the number of nightly voids.{{citation needed|date=January 2014}}
===Nocturnal Polyuria===
Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. With the 24-hour urine production within normal limits, nocturnal polyuria can be translated to having a nocturnal polyuria index (NPi) greater than 35% of the normal 24-hour urine volume. NPi is calculated simply by dividing NUV by the 24-hour urine volume.<ref name=Des>{{cite journal|last=Matthiesen|first=T|coauthors=Rittig S, Nørgaard J, Pedersen E, Djurhuus J|title=Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms.|journal=J Urol|year=1996|month=Oct|volume=156|issue=4|page=1292-1299|pmid=8808857|url=http://www.ncbi.nlm.nih.gov/pubmed/8808857}}</ref> Similar to the inability of control urination, a disruption of arginine vasopressin (AVP) levels has been proposed for nocturia. Compared with the normal patients, nocturia patients have a nocturnal decrease in AVP level. Other causes of nocturnal polyuria include diseases such as [[congestive heart failure]], [[nephritic syndrome]] and hepatic failure; or lifestyle patterns such as excessive nighttime drinking. The increased airway resistance that is associated with obstructive [[sleep apnea]] may also lead to nocturnal polyuria. Obstructive sleep apnea have shown to have increases in renal sodium and water excretion that are mediated by elevated plasma ANH levels.<ref name=NDI></ref><ref>{{cite journal|last=Parthasarathy|first=Sairam|coauthors=Fitzgerald, M; Goodwin, J; Unruh, M; Guerra, S; Quan, S|title=Nocturia, Sleep-Disordered Breathing, and Cardiovascular Morbidity in a Community-Based Cohort|journal=PLOS ONE|year=2012|doi=10.1371/journal.pone.0030969|url=http://www.plosone.org/article/metrics/info:doi/10.1371/journal.pone.0030969#citedHeader}}</ref>


==Causes==
===Bladder Storage===
===Polyuria===
Bladder storage disorders are defined as any factors that increase the frequency of small volume voids. These factors are usually related to [[lower urinary tract symptoms]] that affect the capacity of the bladder. Patients with nocturia who do not have either polyuria or nocturnal polyuria according to the above criteria, will most likely have a bladder storage disorder that reduces their nighttime voided volume or a sleep disorder. Nocturnal bladder capacity (NBC) is defined as the largest voided volume during the sleep period. Decreased NBC can be traced to a decreased maximum voided volume or decreased bladder storage. Decreased NBC can be related to other disorders such as prostatic obstruction, [[neurogenic bladder dysfunction]], learned voiding dysfunction, [[anxiety disorders]], or certain pharmacological agents.<ref name=Bladder>{{cite journal|last=Weiss|first=J|coauthors=Blaivas J|title=Nocturia|journal=Curr Urol Rep|year=2003|volume=4|issue=5|page=362-366|pmid=14499058|url=http://www.ncbi.nlm.nih.gov/pubmed/14499058}}</ref>
[[Polyuria]] is excessive, or abnormally large, production or [[Frequent urination|passage]] of urine. Increased production and passage of urine may also be termed [[diuresis]].<ref>{{cite web|title=Definition of Diuresis|url=http://www.medicinenet.com/script/main/art.asp?articlekey=21221|website=MedTerms|access-date=30 December 2014|date=30 October 2013}}</ref><ref>{{cite web|title=Diuresis|url=http://medical-dictionary.thefreedictionary.com/diuresis|website=The Free Dictionary|access-date=30 December 2014}}</ref> Polyuria is usually viewed as a [[symptom]] or [[Medical sign|sign]] of another disorder (not a disease by itself), but it can be classed as a disorder, at least when its underlying causes are not clear.{{citation needed|date=September 2016}}


===Mixed Etiology===
====Global polyuria====
Global polyuria is the continuous overproduction of urine that is not only limited to sleep hours. This occurs in response to increased fluid intake and is defined as urine outputs of greater than 40 mL/kg/24 hours. Common causes of global polyuria are primary thirst disorders, such as [[diabetes mellitus]] and [[diabetes insipidus]] (DI). Urination imbalance may lead to polydipsia or excessive thirst to prevent circulatory collapse. [[Central diabetes insipidus]] is caused by low levels of [[vasopressin]] (also called [[antidiuretic]] hormone (ADH), [[arginine vasopressin]], or argipressin). ADH is produced in the [[hypothalamus]] and stored in and released from the posterior [[pituitary gland]]. ADH increases water absorption in the [[collecting duct system]]s of kidney [[nephron]]s, subsequently decreasing urine production. ADH regulates hydration levels in the body, which helps regulates water levels. In nephrogenic DI, the kidneys do not respond properly to the normal amount of ADH.<ref name=NDI>{{cite journal |pmid=12493348 |year=2002 |last1=Weiss |first1=JP |last2=Blaivas |first2=JG |title=Nocturnal polyuria versus overactive bladder in nocturia |volume=60 |issue=5 Suppl 1 |pages=28–32; discussion 32 |journal=Urology |doi=10.1016/S0090-4295(02)01789-2}}</ref>
A significant number of nocturia cases occur from a combination of etiologies. Mixed nocturia is more common than many realize and is a combination of nocturnal polyuria and decreased NBC. In a study of 194 nocturia patients, 7% were determined to have simple nocturnal polyuria, 57% had decreased NBC, and 36% had a mixed etiology of the two.<ref name=Mixed>{{cite journal|last=Weiss|first=J|coauthors=Blaivas J, Stember D, Brooks M|title=Nocturia in adults: etiology and classification|journal=Neurourol Urodyn|year=1998|volume=17|issue=5|page=467-472|pmid=9776009|url=http://www.ncbi.nlm.nih.gov/pubmed/9776009}}</ref> The etiology of nocturia is multifactorial and often unrelated to an underlying urological conditions. Mixed nocturia is diagnosed through the maintenance and analysis of bladder diaries of the patient. Assessment of etiology contributions are done through formulas.


Diagnosis of DI can be made by an overnight water deprivation test. This requires the patient to eliminate fluid intake for a fixed period of time, usually around 8–12 hours. If the first morning void is not highly concentrated, the patient is diagnosed with DI. Central DI usually can be treated with a synthetic replacement of ADH, called [[desmopressin]]. This is taken to control thirst and frequent urination.<ref name=Desmo>{{cite journal |pmid=17550208 |year=2007 |last1=Rivkees |first1=SA |last2=Dunbar |first2=N |last3=Wilson |first3=TA |title=The management of central diabetes insipidus in infancy: Desmopressin, low renal solute load formula, thiazide diuretics |volume=20 |issue=4 |pages=459–69 |journal=Journal of Pediatric Endocrinology & Metabolism |doi=10.1515/JPEM.2007.20.4.459|s2cid=7139692 }}</ref> Although there is no substitute for nephrogenic DI, it may be treated with careful regulation of fluid intake.{{citation needed|date=April 2021}}
==Diagnosis==
As with any patient, a detailed history of the problem is required to establish what is normal for the patient and what isn’t. The principal diagnostic tool for nocturia is the voiding bladder diary. Based on information recorded in the diary, a physician can classify the patient as having polyuria, nocturnal polyuria, or bladder storage problems. Timing of voids, number of voids, and volume of urine voided should be recorded in the diary. Volume of fluid intake and time of intake should also be recorded. Patients should include the first morning void in the NUV, however, the first morning is not included with the number of nightly voids.


====Nocturnal polyuria====
Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. With the 24-hour urine production within normal limits, nocturnal polyuria can be translated to having a [[nocturnal polyuria index]] (NPi) greater than 35% of the normal 24-hour urine volume. NPi is calculated simply by dividing NUV by the 24-hour urine volume.<ref name=Des>{{cite journal |pmid=8808857 |year=1996 |last1=Matthiesen |first1=TB |last2=Rittig |first2=S |last3=Nørgaard |first3=JP |last4=Pedersen |first4=EB |last5=Djurhuus |first5=JC |title=Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms |volume=156 |issue=4 |pages=1292–9 |journal=The Journal of Urology |doi=10.1016/S0022-5347(01)65572-1}}</ref> Similar to the inability to control urination, a disruption of arginine vasopressin (AVP) levels has been proposed for nocturia. Compared with normal patients, nocturia patients have a nocturnal decrease in AVP level. {{citation needed|date=April 2021}}


Other causes of nocturnal polyuria include diseases such as
== Management ==
* [[congestive heart failure]]
===Lifestyle Changes===
* [[nephritic syndrome]]
Although there is no cure for nocturia, there are many actions people can take to manage their symptoms. Prohibiting the intake of caffeine and alcohol has helped some individuals with the disorder. <ref name=Definition></ref> Compression stocking worn through the day also help in preventing fluid accumulating in the legs causing less urinary output. Drugs that increase the passing of urine can help decrease the third spacing of fluid, but they could also increase nocturia. A common action patients take is to not consume any fluids hours before bedtime, which especially helps people with urgency incontinence.<ref name=Life>{{cite journal|last=Griffiths|first=D|coauthors=Neurourol Urodyn|title=Relationship of fluid intake to voluntary micturition and urinary incontinence in geriatric patients|journal=McCracken P, Harrison G, Gormley E|year=1993|volume=12|issue=1|page=1-7|pmid=8481726|url=http://www.ncbi.nlm.nih.gov/pubmed/8481726}}</ref> However, a study on this showed that it reduced voiding at night by only a small amount and is not ideal for managing nocturia in older people.<ref name=Life></ref> For people suffering from nocturnal polyuria, this action does not help at all because of irregular AVP levels and the inability to respond with the inhibition of increased voiding. Fluid restriction also does not help people who have nocturia due to gravity-induced third spacing of fluid because fluid is mobilized when they lie in a reclining position.
* [[liver failure]]
* lifestyle patterns such as excessive nighttime drinking
* [[sleep apnea]] increasing obstructive airway resistance. Obstructive sleep apnea sufferers have been shown to have increases in renal sodium and water excretion that are mediated by elevated plasma [[atrial natriuretic hormone]] (ANH) levels.<ref name=NDI /><ref>{{cite journal |doi=10.1371/journal.pone.0030969 |title=Nocturia, Sleep-Disordered Breathing, and Cardiovascular Morbidity in a Community-Based Cohort |year=2012 |editor1-last=Bayer |editor1-first=Antony |last1=Parthasarathy |first1=Sairam |last2=Fitzgerald |first2=Marypat |last3=Goodwin |first3=James L. |last4=Unruh |first4=Mark |last5=Guerra |first5=Stefano |last6=Quan |first6=Stuart F. |journal=PLOS ONE |volume=7 |issue=2 |pages=e30969 |pmid=22328924 |pmc=3273490|doi-access=free }}</ref> ANH is released by [[cardiac muscle cells]] in response to high blood volume. When activated, ANH releases water, subsequently increasing urine production.{{citation needed|date=January 2014}}


===Surgery===
===Bladder storage===
Normal human bladder storage capacity varies from person to person and is considered 400–600 mL.<ref name=webmbbla>[https://www.webmd.com/urinary-incontinence-oab/picture-of-the-bladder "Picture of the Bladder" Matthew Hoffman MD, webmd.com]</ref> A bladder storage disorder is any factor that increases the frequency of small volume voids. These factors are usually related to [[lower urinary tract symptoms]] that affect the capacity of the bladder. Some patients with nocturia have neither global nor nocturnal polyuria, according to the above criteria. Such patients most likely have a bladder storage disorder that impacts their nighttime voiding, or a [[sleep disorder]]. Nocturnal bladder capacity (NBC) is defined as the largest voided volume during the sleep period. {{citation needed|date=April 2021}}
If the cause of nocturia is related to the obstruction of the prostate or an overactive bladder, surgical actions may be sought out. Transurethral [[prostatectomy]]/incision of the prostate and surgical correction of the [[pelvic organ prolapse]], [[sacral nerve stimulation]], clam cystoplasty, and detrusor myectomy are both treatment options and can help alleviate the symptoms of nocturia.


Decreased NBC can be traced to a decreased maximum voided volume or decreased bladder storage. Decreased NBC can be related to other disorders, such as:
===Pharmacotherapy===
* [[benign prostatic hyperplasia]], also known as prostate enlargement
Desmopressin is a synthetic replacement for vasopressin, which is a hormone that reduces the production of urine. It is widely used for the treatment of many disorders including [[nocturnal enuresis]] and coagulation disorders. It is slowly becoming accepted as the drug needed to treat nocturia. Clinical trials testing desmopressin on nocturia patients showed that 33% of men and 46% of women treated with the drug reported a significant reduction in the number of episodes per night. Overall, the number of episodes a night and the amount of time between each episode changed significantly in favor of the patients who took desmopressin over the placebo. <ref name="Desmo Men">{{cite journal|last=Mattiasson|first=A|coauthors=Abrams P, Van Kerrebroeck P, Walter S, Weiss J|title=Efficacy of desmopressin in the treatment of nocturia: a double-blind placebo-controlled study in men|journal=BJU Int|year=2002|volume=89|issue=9|page=855-862|pmid=12010228|url=http://www.ncbi.nlm.nih.gov/pubmed/12010228}}</ref><ref>{{cite journal|last=Lose|first=G|coauthors=Lalos O, Freeman R, van Kerrebroeck P|title=Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women|journal=Am J Obstet Gynecol|year=2003|volume=189|issue=4|page=1106-1113|pmid=14586363|url=http://www.ncbi.nlm.nih.gov/pubmed/14586363}}</ref> Also, for the patients that took the drug, many of the negative impacts of nocturia were relieved. The longer the patients were on desmopressin, the more that reported a positive effect of the drug. The only substantial negative of taking the drug seen in the trials was dilutional [[hyponatremia]]. Using this treatment in older patients and patients at risk for hyponatremia means having to monitor the serum sodium concentration because there are severe risks if the concentration falls.<ref>{{cite journal|last=Rembratt|first=A|coauthors=Riis A, Norgaard J|title=Desmopressin treatment in nocturia; an analysis of risk factors for hyponatremia|journal=Neurouro Urodyn|year=2006|volume=25|issue=2|page=105-109|pmid=16304673|url=http://www.ncbi.nlm.nih.gov/pubmed/16304673}}</ref> The treatment could also induce hyponatremia in patients who are not initially at risk for it.
* [[neurogenic bladder dysfunction]]
* [[learned voiding dysfunction]]
* [[anxiety disorders]]
* [[urinary tract infection]]
* certain pharmacological agents.<ref name=Bladder>{{cite journal |pmid=14499058 |year=2003 |last1=Weiss |first1=JP |last2=Blaivas |first2=JG |title=Nocturia |volume=4 |issue=5 |pages=362–6 |journal=Current Urology Reports |doi=10.1007/s11934-003-0007-1}}</ref>


===Mixed causes===
Other drugs that are often used to treat nocturia include oxybutynin, tolterodine, solifenacin, and other antimuscarinic agents. These drugs are especially used in patients who suffer from nocturia due to an overactive bladder and urgency incontinence because they help bladder contractility.<ref>{{cite journal|last=Rovner|first=E|coauthors=Wein, A|title=Update on overactive bladder: pharmacologic approaches on the horizon|journal=Curr Urol Rep|year=2003|volume=4|issue=5|page=385-390|pmid=14499063|url=http://www.ncbi.nlm.nih.gov/pubmed/14499063}}</ref>
A significant number of nocturia cases occur from a combination of causes. Mixed nocturia is more common than many realise and is a combination of nocturnal polyuria and decreased nocturnal bladder capacity. In a study of 194 nocturia patients:
* 7% were determined to solely have nocturnal polyuria
* 57% solely had decreased NBC
* 36% had a mixed cause of the two<ref name="Adults" />


Multifactorial nocturia is often unrelated to an underlying urological condition. Mixed nocturia is diagnosed through the maintenance and analysis of bladder diaries of the patient. Assessment of cause contributions is done through formulas.{{citation needed|date=April 2024}}
==Impact==
Although nocturia is not a well-known disease to the general population, more than 60% of people reported it affecting their lives in a negative way.<ref name=Gender></ref> Nocturia can have a great impact on the quality of life for many individuals, especially those in an older age group who experience more symptoms. It is linked to the lack and disruption of sleep, which can cause many other issues including exhaustion, changes in mood, sleepiness, impaired productivity, less energy, increase in accidents, and cognitive dysfunctions.<ref name="sleep dep">{{cite journal|last=Hetta|first=J|title=The impact of sleep deprivation caused by nocturia|journal=BJU Int|year=1999|month=Dec|volume=84|page=27-28|pmid=10674891|url=http://www.ncbi.nlm.nih.gov/pubmed/10674891}}</ref><ref>{{cite journal|last=Ancoli-Israel|first=S|coauthors=Bliwise, D; Norgaard, J|title=The effect of nocturia on sleep|journal=Sleep Medicine Reviews|year=2011|volume=15|issue=2|page=91-97|doi=10.1016/j.smrv.2010.03.002|url=http://nocturia.elsevierresource.com/article/S1087-0792(10)00042-0/fulltext}}</ref> Twenty-five percent of falls that older individuals experience happen during the night, and 25% of these falls occur because of having to wake up to void.<ref name=Falls>{{cite journal|last=Jensen|first=J|coauthors=Lundin-Olsson L, Nyberg L, Gustafson Y|title=Falls among frail older people in residential care|journal=Scand J Public Health|year=2002|volume=30|issue=1|page=54-61|pmid=11928835|url=http://www.ncbi.nlm.nih.gov/pubmed/11928835}}</ref> A recent study in Sweden tested nocturia by observing and comparing people with and without nocturia. It showed that people with the disorder experienced many of the symptoms talked about above more than the controls.<ref name=Health>{{cite journal|last=Kobelt|first=G|coauthors=Borgström F, Mattiasson A.|title=Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia|journal=BJU Int|year=2003|volume=91|issue=3|page=190-195|pmid=12581002|url=http://www.ncbi.nlm.nih.gov/pubmed/12581002}}</ref> In addition, nocturia can also cause a higher risk for mortality and morbidity.<br>
A quality of life test for people who experience nocturia was recently developed. Before this test, there was no way to measure the extent of the disorder different people experienced. So far, the test can separate men who experience a different number of episodes per night. However, it has not been successfully authenticated for use in women.<ref name=Men>{{cite journal|last=Abraham|first=L|coauthors=Hareendran A, Mills I, Martin M, Abrams P, Drake M, MacDonagh R, Noble J|title=Development and validation of a quality-of-life measure for men with nocturia|journal=Urology|year=2004|volume=63|issue=3|page=481-486|pmid=15028442|url=http://www.ncbi.nlm.nih.gov/pubmed/15028442}}</ref>


== See also ==
==Management==
===Lifestyle changes===
Although there is no cure for nocturia, many actions can manage the symptoms.
* Limiting [[caffeine]] and [[Alcohol (drug)|alcohol]] intake. Both are diuretic.<ref name=Definition />
* Beverage consumption regulation. In regard to nocturia, this specifically means avoiding consuming fluids for three or more hours before bedtime and thus giving the bladder less fluid to store overnight. This especially helps people with [[Overactive bladder|urgency incontinence]].<ref name=Life>{{cite journal |pmid=8481726 |year=1993 |last1=Griffiths |first1=DJ |last2=McCracken |first2=PN |last3=Harrison |first3=GM |last4=Gormley |first4=EA |title=Relationship of fluid intake to voluntary micturition and urinary incontinence in geriatric patients |volume=12 |issue=1 |pages=1–7 |journal=Neurourology and Urodynamics |doi=10.1002/nau.1930120102|s2cid=33718389 }}</ref> However, one study regarding geriatric patients showed that this measure reduced voiding at night by only a small amount and is thus suboptimal for managing nocturia in older people.<ref name=Life /> Fluid restriction does not help people who have nocturia due to gravity-induced [[Fluid compartments#Third spacing|third spacing]] of fluid, because fluid is mobilized when they lie in a reclining position.<ref>{{cite journal|pmc=2684373|year=2008|last1=Jin|first1=M. H.|last2=Moon|first2=D. G.|title=Practical management of nocturia in urology|journal=Indian Journal of Urology |volume=24|issue=3|pages=289–294|doi=10.4103/0970-1591.42607|pmid=19468456 |doi-access=free }}</ref>
* [[Compression stockings]] may be worn through the day to prevent fluid from accumulating in the legs, unless heart failure or [[Compression stockings#Contraindications|another contraindication]] is present.
* Drugs that increase the passing of urine can help decrease the third spacing of fluid, but they could also increase nocturia.{{citation needed|date=April 2024}}

===Medications===
* ADH replacements, such as [[desmopressin]]<ref>{{cite journal|last1=Ebell|first1=MH|last2=Radke|first2=T|last3=Gardner|first3=J|title=A systematic review of the efficacy and safety of desmopressin for nocturia in adults.|journal=The Journal of Urology|date=Sep 2014|volume=192|issue=3|pages=829–35|pmid=24704009|doi=10.1016/j.juro.2014.03.095}}</ref> and [[vasopressin]]
* Selective [[alpha-1 blocker]]s are the most commonly used medicine to treat BPH.<ref>{{Cite journal|last1=Sokhal|first1=Ashok Kumar|last2=Sankhwar|first2=Satyanarayan|last3=Goel|first3=Apul|last4=Singh|first4=Kawaljit|last5=Kumar|first5=Manoj|last6=Purkait|first6=Bimalesh|last7=Saini|first7=Durgesh Kumar|date=30 August 2017|title=A Prospective Study to Evaluate Sexual Dysfunction and Enlargement of Seminal Vesicles in Sexually Active Men Treated for Benign Prostatic Hyperplasia by Alpha Blockers|journal=Urology|volume=118|pages=92–97|doi=10.1016/j.urology.2017.08.025|pmid=28860050}}</ref> Alpha-1 blockers are first-line treatment for the symptoms of BPH in men.<ref name=":6">{{Cite journal|last1=Nickel|first1=J. Curtis|last2=Méndez-Probst|first2=Carlos E.|last3=Whelan|first3=Thomas F.|last4=Paterson|first4=Ryan F.|last5=Razvi|first5=Hassan|date=October 2010 |title=2010 Update: Guidelines for the management of benign prostatic hyperplasia|journal=Canadian Urological Association Journal|volume=4|issue=5|pages=310–316|issn=1911-6470|pmc=2950766|pmid=20944799|doi=10.5489/cuaj.10124}}</ref><ref name=":2">{{Cite journal|last=Lepor|first=Herbert|date=2007|title=Alpha Blockers for the Treatment of Benign Prostatic Hyperplasia|journal=Reviews in Urology|volume=9|issue=4|pages=181–190|issn=1523-6161|pmc=2213889|pmid=18231614}}</ref><ref name=":7">{{Cite journal|last1=Stanaszek|first1=W. F.|last2=Kellerman|first2=D.|last3=Brogden|first3=R. N.|last4=Romankiewicz|first4=J. A.|date=April 1983|title=Prazosin update. A review of its pharmacological properties and therapeutic use in hypertension and congestive heart failure|journal=Drugs|volume=25|issue=4|pages=339–384|issn=0012-6667|pmid=6303744|doi=10.2165/00003495-198325040-00002|s2cid=46973044}}</ref><ref name=":8">{{Cite journal|last=Carruthers|first=S. G.|date=July 1994|title=Adverse effects of alpha 1-adrenergic blocking drugs|journal=Drug Safety|volume=11|issue=1|pages=12–20|issn=0114-5916|pmid=7917078|doi=10.2165/00002018-199411010-00003}}</ref> [[Doxazosin]], [[terazosin]], [[alfuzosin]], and [[tamsulosin]] have all been well established in treatment to reduce lower urine tract symptoms caused by benign prostatic hyperplasia. They are all believed to be similarly effective for this purpose. First-generation alpha-1 blockers, like prazosin, are not recommended to treat lower urinary tract symptoms because of their blood-pressure-lowering effect. Later-generation drugs in this class are used for this purpose.<ref name=":6" /><ref name="Tanguay S92–S100">{{Cite journal|last1=Tanguay|first1=Simon|last2=Awde|first2=Murray|last3=Brock|first3=Gerald|last4=Casey|first4=Richard|last5=Kozak|first5=Joseph|last6=Lee|first6=Jay|last7=Nickel|first7=J. Curtis|last8=Saad|first8=Fred|date=June 2009|title=Diagnosis and management of benign prostatic hyperplasia in primary care|journal=Canadian Urological Association Journal|volume=3|issue=Suppl 2|pages=S92–S100|doi=10.5489/cuaj.1116|issn=1911-6470|pmc=2698785|pmid=19543429}}</ref> In some cases, alpha-1 blockers have been used in combined therapy with 5-alpha reductase blockers. [[Dutasteride]] and tamsulosin are on the market as combined therapy, and results have shown that they improve symptoms significantly versus [[monotherapy]].<ref name="Tanguay S92–S100"/><ref>{{Cite journal|last1=Roehrborn|first1=Claus G.|last2=Siami|first2=Paul|last3=Barkin|first3=Jack|last4=Damião|first4=Ronaldo|last5=Major-Walker|first5=Kim|last6=Morrill|first6=Betsy|last7=Montorsi|first7=Francesco|date=1 February 2008|title=The Effects of Dutasteride, Tamsulosin and Combination Therapy on Lower Urinary Tract Symptoms in Men With Benign Prostatic Hyperplasia and Prostatic Enlargement: 2-Year Results From the CombAT Study|journal=The Journal of Urology|volume=179|issue=2|pages=616–621|doi=10.1016/j.juro.2007.09.084|pmid=18082216}}</ref>
* If urinary tract infection is causative, it can be treated with urinary [[antimicrobial]]s.<ref>{{Citation|title=Voiding symptoms cleared by treating infection|last1=Swamy|first1=S.|last2=Gill|first2=K.|last3=Kupelian|first3=A.|last4=Sathiananthamoorthy|first4=S.|last5=Horsley|first5=H.|last6=Collins|first6=L.|last7=Malone-Lee|first7=J.|institution=[[International Continence Society]]|year=2013|url=https://www.ics.org/2013/abstract/507}}</ref>
* [[Muscarinic antagonist|Antimuscarinic]] agents such as [[oxybutynin]], [[tolterodine]], and [[solifenacin]] are especially used in patients who suffer from nocturia due to an overactive bladder and urgency incontinence, because they help bladder contractility.<ref>{{cite journal |pmid=14499063 |year=2003 |last1=Rovner |first1=ES |last2=Wein |first2=AJ |title=Update on overactive bladder: Pharmacologic approaches on the horizon |volume=4 |issue=5 |pages=385–90 |journal=Current Urology Reports |doi=10.1007/s11934-003-0013-3|s2cid=30475019 }}</ref>

===Surgery===
{{Unreferenced section|date=April 2024}}

If the cause of nocturia is related to [[benign prostatic hyperplasia]] or an [[overactive bladder]], surgical actions may be sought out.{{citation needed|date=April 2021}}
* [[Surgery for benign prostatic hyperplasia]] includes increasingly popular and minimally invasive [[laser surgery]].
* Surgical correction of the [[pelvic organ prolapse]]
* [[sacral nerve stimulation]]
* Bladder augmentation
* [[Detrusor muscle]] myectomy

==See also==
* [[Polyuria]]
* [[Polyuria]]
* [[Enuresis]]
* [[Enuresis]]


==References==
==References==
{{Reflist}}
<references />



==External links==
==External links==
* [http://www.bergenurological.com/nocturia.shtml Bergen Urological]
* [https://www.ebu.com/ European Board of Urology]

* http://nocturia.elsevierresource.com/
{{Medical resources
* [http://nocturia.elsevierresource.com/ Nocturia Resource Centre]", linked to the journal [http://www.europeanurology.com/ '''''European Urology '''''], has been providing a continuous update on nocturia, causes, consequences and clinical approaches.
| ICD10 = {{ICD10|R|35||r|30}}
| ICD9 = {{ICD9|788.43}}
| MeshID = D053158
}}
{{wikt|nocturia}}


{{Urinary system symptoms and signs}}
{{Urinary system symptoms and signs}}

Latest revision as of 08:06, 8 December 2024

Nocturia is defined by the International Continence Society (ICS) as "the complaint that the individual has to wake at night one or more times for voiding (i.e., to urinate)".[1] The term is derived from Latin nox – "night", and Greek [τα] ούρα – "urine". Causes are varied and can be difficult to discern.[2] Although not every patient needs treatment, most people seek treatment for severe nocturia, waking up to void more than 2 or 3 times per night.

Prevalence

[edit]

Studies have shown that 5–15% of people who are 20–50 years old, 20–30% of people who are 50–70 years old, and 10–50% of people 70+ years old urinate at least twice a night.[3] Nocturia becomes more common with age. More than 50 percent of men and women over the age of 60 have been measured to have nocturia in many communities. Even more over the age of 80 are shown to experience symptoms nightly.[4] Nocturia symptoms also often worsen with age. Contrary to popular belief, nocturia prevalence is about the same for both sexes.[5]

Impact

[edit]

Research suggests that more than 60% of people are negatively affected by nocturia.[3] The resulting insomnia and sleep deprivation can cause exhaustion, changes in mood, sleepiness, impaired productivity, fatigue, increased risk of accidents, and cognitive dysfunction.[6][7][8] 25% of falls that older individuals experience happen during the night, of which 25% occur while waking up to void.[9]

A quality-of-life test for people who experience nocturia was published in 2004. The pilot study was conducted only on men.[10]

Diagnosis

[edit]

Nocturia diagnosis requires knowing the patient's nocturnal urine volume (NUV). The ICS defines NUV as "the total volume of urine passed between the time the individual goes to bed with the intention of sleeping and the time of waking with the intention of rising".[11] Thus, NUV excludes the last void before going to bed but includes the first morning void, if the urge to urinate woke the patient. The amount of sleep a patient gets and the amount they intend to get are also considered in a diagnosis.[citation needed]

As with any patient, a detailed history of the problem is required to establish what is normal for that patient. The principal diagnostic tool for nocturia is the voiding bladder diary. Based on information recorded in the diary, a physician can classify the patient as having global polyuria, nocturnal polyuria, or bladder storage problems. A voiding bladder diary should record:[citation needed]

  • number of voids
  • timing of voids
  • volume voided
  • volume and time of fluid intake

Patients should include the first morning void in the NUV. However, the first morning void is not included with the number of nightly voids.[citation needed]

Causes

[edit]

Polyuria

[edit]

Polyuria is excessive, or abnormally large, production or passage of urine. Increased production and passage of urine may also be termed diuresis.[12][13] Polyuria is usually viewed as a symptom or sign of another disorder (not a disease by itself), but it can be classed as a disorder, at least when its underlying causes are not clear.[citation needed]

Global polyuria

[edit]

Global polyuria is the continuous overproduction of urine that is not only limited to sleep hours. This occurs in response to increased fluid intake and is defined as urine outputs of greater than 40 mL/kg/24 hours. Common causes of global polyuria are primary thirst disorders, such as diabetes mellitus and diabetes insipidus (DI). Urination imbalance may lead to polydipsia or excessive thirst to prevent circulatory collapse. Central diabetes insipidus is caused by low levels of vasopressin (also called antidiuretic hormone (ADH), arginine vasopressin, or argipressin). ADH is produced in the hypothalamus and stored in and released from the posterior pituitary gland. ADH increases water absorption in the collecting duct systems of kidney nephrons, subsequently decreasing urine production. ADH regulates hydration levels in the body, which helps regulates water levels. In nephrogenic DI, the kidneys do not respond properly to the normal amount of ADH.[14]

Diagnosis of DI can be made by an overnight water deprivation test. This requires the patient to eliminate fluid intake for a fixed period of time, usually around 8–12 hours. If the first morning void is not highly concentrated, the patient is diagnosed with DI. Central DI usually can be treated with a synthetic replacement of ADH, called desmopressin. This is taken to control thirst and frequent urination.[15] Although there is no substitute for nephrogenic DI, it may be treated with careful regulation of fluid intake.[citation needed]

Nocturnal polyuria

[edit]

Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. With the 24-hour urine production within normal limits, nocturnal polyuria can be translated to having a nocturnal polyuria index (NPi) greater than 35% of the normal 24-hour urine volume. NPi is calculated simply by dividing NUV by the 24-hour urine volume.[16] Similar to the inability to control urination, a disruption of arginine vasopressin (AVP) levels has been proposed for nocturia. Compared with normal patients, nocturia patients have a nocturnal decrease in AVP level. [citation needed]

Other causes of nocturnal polyuria include diseases such as

Bladder storage

[edit]

Normal human bladder storage capacity varies from person to person and is considered 400–600 mL.[18] A bladder storage disorder is any factor that increases the frequency of small volume voids. These factors are usually related to lower urinary tract symptoms that affect the capacity of the bladder. Some patients with nocturia have neither global nor nocturnal polyuria, according to the above criteria. Such patients most likely have a bladder storage disorder that impacts their nighttime voiding, or a sleep disorder. Nocturnal bladder capacity (NBC) is defined as the largest voided volume during the sleep period. [citation needed]

Decreased NBC can be traced to a decreased maximum voided volume or decreased bladder storage. Decreased NBC can be related to other disorders, such as:

Mixed causes

[edit]

A significant number of nocturia cases occur from a combination of causes. Mixed nocturia is more common than many realise and is a combination of nocturnal polyuria and decreased nocturnal bladder capacity. In a study of 194 nocturia patients:

  • 7% were determined to solely have nocturnal polyuria
  • 57% solely had decreased NBC
  • 36% had a mixed cause of the two[2]

Multifactorial nocturia is often unrelated to an underlying urological condition. Mixed nocturia is diagnosed through the maintenance and analysis of bladder diaries of the patient. Assessment of cause contributions is done through formulas.[citation needed]

Management

[edit]

Lifestyle changes

[edit]

Although there is no cure for nocturia, many actions can manage the symptoms.

  • Limiting caffeine and alcohol intake. Both are diuretic.[1]
  • Beverage consumption regulation. In regard to nocturia, this specifically means avoiding consuming fluids for three or more hours before bedtime and thus giving the bladder less fluid to store overnight. This especially helps people with urgency incontinence.[20] However, one study regarding geriatric patients showed that this measure reduced voiding at night by only a small amount and is thus suboptimal for managing nocturia in older people.[20] Fluid restriction does not help people who have nocturia due to gravity-induced third spacing of fluid, because fluid is mobilized when they lie in a reclining position.[21]
  • Compression stockings may be worn through the day to prevent fluid from accumulating in the legs, unless heart failure or another contraindication is present.
  • Drugs that increase the passing of urine can help decrease the third spacing of fluid, but they could also increase nocturia.[citation needed]

Medications

[edit]
  • ADH replacements, such as desmopressin[22] and vasopressin
  • Selective alpha-1 blockers are the most commonly used medicine to treat BPH.[23] Alpha-1 blockers are first-line treatment for the symptoms of BPH in men.[24][25][26][27] Doxazosin, terazosin, alfuzosin, and tamsulosin have all been well established in treatment to reduce lower urine tract symptoms caused by benign prostatic hyperplasia. They are all believed to be similarly effective for this purpose. First-generation alpha-1 blockers, like prazosin, are not recommended to treat lower urinary tract symptoms because of their blood-pressure-lowering effect. Later-generation drugs in this class are used for this purpose.[24][28] In some cases, alpha-1 blockers have been used in combined therapy with 5-alpha reductase blockers. Dutasteride and tamsulosin are on the market as combined therapy, and results have shown that they improve symptoms significantly versus monotherapy.[28][29]
  • If urinary tract infection is causative, it can be treated with urinary antimicrobials.[30]
  • Antimuscarinic agents such as oxybutynin, tolterodine, and solifenacin are especially used in patients who suffer from nocturia due to an overactive bladder and urgency incontinence, because they help bladder contractility.[31]

Surgery

[edit]

If the cause of nocturia is related to benign prostatic hyperplasia or an overactive bladder, surgical actions may be sought out.[citation needed]

See also

[edit]

References

[edit]
  1. ^ a b Van Kerrebroeck, Philip; Abrams, Paul; Chaikin, David; Donovan, Jenny; Fonda, David; Jackson, Simon; Jennum, Poul; Johnson, Theodore; Lose, Gunnar; Mattiasson, Anders; Robertson, Gary; Weiss, Jeff; Standardisation Sub-committee of the International Continence Society (2002). "The standardisation of terminology in nocturia: Report from the standardisation sub-committee of the International Continence Society". Neurourology and Urodynamics. 21 (2): 179–83. doi:10.1002/nau.10053. PMID 11857672. S2CID 26193237.
  2. ^ a b Weiss, Jeffrey P.; Blaivas, Jerry G.; Stember, Doron S.; Brooks, Maria M. (1998). "Nocturia in adults: Etiology and classification". Neurourology and Urodynamics. 17 (5): 467–72. doi:10.1002/(SICI)1520-6777(1998)17:5<467::AID-NAU2>3.0.CO;2-B. PMID 9776009.
  3. ^ a b Schatzl, G; Temml, C; Schmidbauer, J; Dolezal, B; Haidinger, G; Madersbacher, S (2000). "Cross-sectional study of nocturia in both sexes: Analysis of a voluntary health screening project". Urology. 56 (1): 71–5. doi:10.1016/S0090-4295(00)00603-8. PMID 10869627.
  4. ^ Lundgren, Rolf (2004). "Nocturia: A new perspective on an old symptom". Scandinavian Journal of Urology and Nephrology. 38 (2): 112–6. doi:10.1080/00365590310020033. PMID 15204390. S2CID 24851592.
  5. ^ van Kerrebroeck P, Hashim H, Holm-Larsen T, Robinson D, Stanley N (May 2010). "Thinking beyond the bladder: antidiuretic treatment of nocturia". Int J Clin Pract. 64 (6): 807–16. doi:10.1111/j.1742-1241.2010.02336.x. PMID 20337753.
  6. ^ Hetta, J (1999). "The impact of sleep deprivation caused by nocturia". BJU International. 84 (Suppl 1): 27–8. doi:10.1046/j.1464-410x.84.s1.3.x. PMID 10674891. S2CID 23611274.
  7. ^ Ancoli-Israel, Sonia; Bliwise, Donald L.; Nørgaard, Jens Peter (2011). "The effect of nocturia on sleep". Sleep Medicine Reviews. 15 (2): 91–7. doi:10.1016/j.smrv.2010.03.002. PMC 3137590. PMID 20965130.
  8. ^ Kobelt, G; Borgström, F; Mattiasson, A (2003). "Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia". BJU International. 91 (3): 190–5. doi:10.1046/j.1464-410X.2003.04062.x. PMID 12581002. S2CID 3894775.
  9. ^ Jensen, J; Lundin-Olsson, L; Nyberg, L; Gustafson, Y (2002). "Falls among frail older people in residential care". Scandinavian Journal of Public Health. 30 (1): 54–61. doi:10.1080/140349401753481592. PMID 11928835.
  10. ^ Abraham, Lucy; Hareendran, Asha; Mills, Ian W; Martin, Mona L; Abrams, Paul; Drake, Marcus J; MacDonagh, Ruaraidh P; Noble, Jeremy G (2004). "Development and validation of a quality-of-life measure for men with nocturia". Urology. 63 (3): 481–6. doi:10.1016/j.urology.2003.10.019. PMID 15028442.
  11. ^ Van Kerrebroeck P, Abrams P, Chaikin D, et al. (December 2002). "The standardization of terminology in nocturia: report from the standardization subcommittee of the International Continence Society". BJU Int. 90 (Suppl 3): 11–5. doi:10.1046/j.1464-410x.90.s3.3.x. PMID 12445092. S2CID 417670.
  12. ^ "Definition of Diuresis". MedTerms. 30 October 2013. Retrieved 30 December 2014.
  13. ^ "Diuresis". The Free Dictionary. Retrieved 30 December 2014.
  14. ^ a b Weiss, JP; Blaivas, JG (2002). "Nocturnal polyuria versus overactive bladder in nocturia". Urology. 60 (5 Suppl 1): 28–32, discussion 32. doi:10.1016/S0090-4295(02)01789-2. PMID 12493348.
  15. ^ Rivkees, SA; Dunbar, N; Wilson, TA (2007). "The management of central diabetes insipidus in infancy: Desmopressin, low renal solute load formula, thiazide diuretics". Journal of Pediatric Endocrinology & Metabolism. 20 (4): 459–69. doi:10.1515/JPEM.2007.20.4.459. PMID 17550208. S2CID 7139692.
  16. ^ Matthiesen, TB; Rittig, S; Nørgaard, JP; Pedersen, EB; Djurhuus, JC (1996). "Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms". The Journal of Urology. 156 (4): 1292–9. doi:10.1016/S0022-5347(01)65572-1. PMID 8808857.
  17. ^ Parthasarathy, Sairam; Fitzgerald, Marypat; Goodwin, James L.; Unruh, Mark; Guerra, Stefano; Quan, Stuart F. (2012). Bayer, Antony (ed.). "Nocturia, Sleep-Disordered Breathing, and Cardiovascular Morbidity in a Community-Based Cohort". PLOS ONE. 7 (2): e30969. doi:10.1371/journal.pone.0030969. PMC 3273490. PMID 22328924.
  18. ^ "Picture of the Bladder" Matthew Hoffman MD, webmd.com
  19. ^ Weiss, JP; Blaivas, JG (2003). "Nocturia". Current Urology Reports. 4 (5): 362–6. doi:10.1007/s11934-003-0007-1. PMID 14499058.
  20. ^ a b Griffiths, DJ; McCracken, PN; Harrison, GM; Gormley, EA (1993). "Relationship of fluid intake to voluntary micturition and urinary incontinence in geriatric patients". Neurourology and Urodynamics. 12 (1): 1–7. doi:10.1002/nau.1930120102. PMID 8481726. S2CID 33718389.
  21. ^ Jin, M. H.; Moon, D. G. (2008). "Practical management of nocturia in urology". Indian Journal of Urology. 24 (3): 289–294. doi:10.4103/0970-1591.42607. PMC 2684373. PMID 19468456.
  22. ^ Ebell, MH; Radke, T; Gardner, J (September 2014). "A systematic review of the efficacy and safety of desmopressin for nocturia in adults". The Journal of Urology. 192 (3): 829–35. doi:10.1016/j.juro.2014.03.095. PMID 24704009.
  23. ^ Sokhal, Ashok Kumar; Sankhwar, Satyanarayan; Goel, Apul; Singh, Kawaljit; Kumar, Manoj; Purkait, Bimalesh; Saini, Durgesh Kumar (30 August 2017). "A Prospective Study to Evaluate Sexual Dysfunction and Enlargement of Seminal Vesicles in Sexually Active Men Treated for Benign Prostatic Hyperplasia by Alpha Blockers". Urology. 118: 92–97. doi:10.1016/j.urology.2017.08.025. PMID 28860050.
  24. ^ a b Nickel, J. Curtis; Méndez-Probst, Carlos E.; Whelan, Thomas F.; Paterson, Ryan F.; Razvi, Hassan (October 2010). "2010 Update: Guidelines for the management of benign prostatic hyperplasia". Canadian Urological Association Journal. 4 (5): 310–316. doi:10.5489/cuaj.10124. ISSN 1911-6470. PMC 2950766. PMID 20944799.
  25. ^ Lepor, Herbert (2007). "Alpha Blockers for the Treatment of Benign Prostatic Hyperplasia". Reviews in Urology. 9 (4): 181–190. ISSN 1523-6161. PMC 2213889. PMID 18231614.
  26. ^ Stanaszek, W. F.; Kellerman, D.; Brogden, R. N.; Romankiewicz, J. A. (April 1983). "Prazosin update. A review of its pharmacological properties and therapeutic use in hypertension and congestive heart failure". Drugs. 25 (4): 339–384. doi:10.2165/00003495-198325040-00002. ISSN 0012-6667. PMID 6303744. S2CID 46973044.
  27. ^ Carruthers, S. G. (July 1994). "Adverse effects of alpha 1-adrenergic blocking drugs". Drug Safety. 11 (1): 12–20. doi:10.2165/00002018-199411010-00003. ISSN 0114-5916. PMID 7917078.
  28. ^ a b Tanguay, Simon; Awde, Murray; Brock, Gerald; Casey, Richard; Kozak, Joseph; Lee, Jay; Nickel, J. Curtis; Saad, Fred (June 2009). "Diagnosis and management of benign prostatic hyperplasia in primary care". Canadian Urological Association Journal. 3 (Suppl 2): S92–S100. doi:10.5489/cuaj.1116. ISSN 1911-6470. PMC 2698785. PMID 19543429.
  29. ^ Roehrborn, Claus G.; Siami, Paul; Barkin, Jack; Damião, Ronaldo; Major-Walker, Kim; Morrill, Betsy; Montorsi, Francesco (1 February 2008). "The Effects of Dutasteride, Tamsulosin and Combination Therapy on Lower Urinary Tract Symptoms in Men With Benign Prostatic Hyperplasia and Prostatic Enlargement: 2-Year Results From the CombAT Study". The Journal of Urology. 179 (2): 616–621. doi:10.1016/j.juro.2007.09.084. PMID 18082216.
  30. ^ Swamy, S.; Gill, K.; Kupelian, A.; Sathiananthamoorthy, S.; Horsley, H.; Collins, L.; Malone-Lee, J. (2013), Voiding symptoms cleared by treating infection, International Continence Society
  31. ^ Rovner, ES; Wein, AJ (2003). "Update on overactive bladder: Pharmacologic approaches on the horizon". Current Urology Reports. 4 (5): 385–90. doi:10.1007/s11934-003-0013-3. PMID 14499063. S2CID 30475019.
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