Summary
Things you should know:
- Nocturia, which is the need to get up in the night to urinate, is a common problem for both men and women.
- It occurs more commonly in older people.
- it is important to find the cause so that the correct treatment can be used.
- People with nocturia may also have sleep apnoea or insomnia.
- Nocturia can also affect general health, quality of life, and daytime activities.
- These disturbances may cause difficulties for partners and family as well.
What is Nocturia?
Nocturia is the need to get up during the night to urinate, thereby interrupting sleep. Sleep occurs before and after each time you wake up.
What are the most common types of nocturia?
There are three main types of nocturia: 1) nocturnal polyuria (or overproduction); 2) bladder storage problems; and 3) mixed nocturia.
- Nocturnal polyuria: People with nocturnal overproduction (polyuria) make excessive urine during sleep and less during the day. This may be due to a problem with the body clock or sleep apnoea. There are a few other conditions that can also play a part, e.g., diabetes, kidney problems, heart trouble, too much caffeine and some drugs.
- Bladder storage problems: In this case, the bladder either cannot store enough urine or does not empty completely. The result is that you go to the toilet more often but pass little urine each time. In men, it may be due to having an overly large prostate (which blocks the bladder outlet).
- Mixed nocturia: The third type of nocturia is known as ‘mixed nocturia’. This is a mix of both nocturnal polyuria and bladder storage problems. It is often associated with chronic medical problems.
Common causes of nocturia?
How to treat nocturia depends on the cause. This needs to be worked out in order to plan treatment. Some of the possible causes of nocturia are:
- Prostate problems, a very common cause in men.
- Hormonal imbalance, such as a lack of oestrogen in women.
- Pregnancy. Pregnant women often have to go to the toilet several times during the night because the womb presses on the bladder. This resolves after the baby is born.
- Side effects of some medications.
- Problems with the kidney and/or bladder.
- Heart disease.
- Sleep disorders, such as sleep apnoea, body clock problems, insomnia.
- Lifestyle factors, such as having too much caffeine and alcohol.
- Drinking too much fluid, particularly at night. This may sometimes be due to medications taken at night.
- Menopause, which weakens bladder control.
What is the impact of nocturia?
Nocturia can be an indicator of a medical problem and underlying causes need to be looked for. As well as this, nocturia can cause problems due to broken sleep. This will affect how people function during the day. It may lead to tiredness, undue sleepiness, irritability, or not being able to concentrate. These are all problems for work, study, health and enjoyment of life.
Is nocturia the cause or the result of poor sleep?
Sometimes other causes of disturbed sleep, such as sleep apnoea and insomnia can cause nocturia simply because waking up prompts you to go to the toilet. In such cases, treating the cause of the disturbed sleep fixes the problem. To get to the bottom of why you have nocturia, it is best to discuss the matter with your doctor.
What might you do?
Many people think that nocturia is a ‘normal part of getting old’ and that little can be done to treat it. This is not true. Sometimes it can occur suddenly, and it is obvious that there is a problem. Often it comes on gradually and is too readily accepted.
There are some things that you can do to try to help tackle your nocturia. For example, you should try cutting down how much alcohol and caffeine you have; quit smoking; lose weight; post-menopausal women can do pelvic floor exercises; manage constipation; reduce the stress in your life and deal with poor sleep patterns. Limiting fluids in the 2 hours before bed can help, but restricting fluids should not be overdone. If a ready answer is not there then you should discuss the problem with your doctor. Sometimes specialist help is needed.
Where and when should you seek help?
Not every person with nocturia needs treatment. Whether or not a person seeks help often depends on how much it is getting in the way of good sleep. Most people find it is a problem if they need to get up to go the toilet twice or more each night.
If it does not bother you, then you may not need treatment. But you should still keep in mind the link between nocturia and other health issues.
How is it checked out?
Your doctor will need to work out the cause. This will require a medical history including screening for sleep problems (especially sleep apnoea), a physical check and a urine test. The doctor may ask you to keep a record of your trips to the toilet during the night. This is often known as a frequency volume chart or voiding bladder diary. In it, you record when you go to the toilet at night and how much urine you pass. You should keep it for at least 24 hours, and ideally for at least three days. You also need to record what fluids you have and when you have them. Based on this, your doctor can work out what type of nocturia you have and can refer you to the right service or specialist e.g., a urologist, sleep specialist or endocrinologist.
Where can I find out more?
The Continence Foundation of Australia has useful additional information at http://www.continence.org.au/