As we take advantage of sharpening our knowledge of osteoporosis throughout the month of publicity surrounding National Osteoporosis Awareness and Prevention Month, some may not realize the close connection between bladder control problems and falls.
Recently, NAFC featured as part of our six-month series of webinars (visual seminars broadcast over a web site) Harvard-educated and now UCSF-based geriatrician Carolyn Welty, MD, in a highly informative presentation on risk factors for falls and fractures, combining the importance of addressing nocturia, or routinely getting up from sleep more than once every night to use the toilet, with the threatening condition of osteoporosis. Thinking about the combination of risk factors is important because so often they compound, or increase exponentially, our exposure to risks of such accidents as falls and bone fractures.
I've already written several blogs about nighttime toileting but this one focuses on risk factors of other medical conditions associated with nocturia. The place to start is with causal factors of nocturia, which may be due to the symptoms of overactive bladder (OAB) associated with nocturnal polyuria, or excessive production of urine at nighttime, enlarged prostate, or other factors. If we can identify the causal factors and tackle eliminating or reducing their threats, the symptoms of nocturia might become lighter and the risk of falling accordingly lower.
Nocturia is defined as being awakened at night one or more times in order to pass urine. This can occur at any age, although it is less frequent in the age range below 60 years, and becomes more common as the person becomes older just as symptoms of OAB in general. A common pattern seen among people with this condition is an increased number of times to wake to pass urine per decade of life (i.e. once in your fifties, twice in your sixties, three times in your seventies, etc.). Though this is not a consistent pattern among all individuals with nocturia, it is seen among many.
Nocturnal Polyuria is an important cause of nocturia in which there is an overproduction of urine at night. According to the International Continence Society, it is defined to be nighttime urine volume that is greater than 20-30% of the total 24 hour urine volume and is an age dependent observation. Global Polyuria is another major cause of nocturia that consists of both day and nighttime urine overproduction.
Nocturia occurs in women and men differently since the anatomy between the two genders is different. Women generally experience nocturia as a result of the consequences from childbirth, menopause, and pelvic organ prolapse. Unlike women, nocturia in men can be directly attributed to benign prostatic hyperplasia (BPH), also known as enlarged prostate. With the oversized prostate gland blocking the flow of urine from the bladder, the bladder retains urine and continues to send signals at night that it needs emptying. Hence, the problem of frequency that often surfaces for men. Since the prostate gland naturally enlarges as men grow older, most men ultimately do face the problems of enlarged prostate and thus nocturia.
For both men and women there are multiple, additional factors that could cause nocturia including:
- Behavioral patterns
- Diuretic medications
- Excessive fluids before bedtime
- Diminished nocturnal bladder capacity- This can be due to decreased functional or nocturnal bladder capacity. Urine production will then exceed the bladder capacity causing the individual to be awakened in order to void.
- Fluid redistribution- When a person lies down to sleep, fluid is reabsorbed into the blood stream. During the day, gravity causes fluid to accumulate in the body's lower extremities. When this happens, the kidneys clean the increased fluid in the blood by producing more urine. This leads to excess fluid in legs, ankles, and fingers causing them to swell.
Still, nocturia can occur because of an even greater problem. Certain conditions can alter the way in which your body functions causing urine to be passed in the evening and during sleep. Such conditions include:
- Diabetes mellitus
- Diabetes insipidus
- High blood pressure
- Heart disease
- Congestive heart failure
- Vascular disease
- Restless leg syndrome
- Sleep disorders
The key is to be watchful for the symptoms, document all of the possible variables that could be factors, and seek a diagnosis from your provider. Aging may make you vulnerable but is not a cause for acceptance.
Published On: May 26, 2010