While little appeared in scientific literature about nocturia until recent years, the topic is receiving more attention because so many aging Americans are now complaining about their lack of sleep or the poor quality of their sleep.
One of the first papers published to specifically address nocturia, defined as excessive urination at night, and to distinguish it from symptoms of overactive bladder was by Drs. Rodney Appell, a longtime supporter of the National Association For Continence (NAFC), and Peter Sands. (1) In the paper, nocturia was described as being caused by one, or a combination, of three factors: diurnal polyuria, nocturnal polyuria, and low bladder capacity. "Polyuria" is the production or passage of abnormally large quantities of urine, in an adult—two and a half to three quarts of urine over a 24-hour period. "Diurnal" refers to daytime hours, whereas "nocturnal" refers to nighttime hours.
Some of the leading causes of nocturia may include: urinary tract infections; diabetes; bladder or prostate tumors; drinking excessive fluids; the diuretic effects of caffeine and alcohol; exposure to cold temperatures, and high altitudes. Also, some medications, particularly diuretics often prescribed to treat high blood pressure, can cause nocturia as a side effect and it can be a symptom of sleep apnea. There is also the theory that as the body ages and the production of growth hormones wanes, the pituitary gland at the base of the brain begins influencing greater production of urine, particularly at night during the body's sleep cycle.
Obtaining an accurate diagnosis when multiple urinary symptoms are present, as they often are in the aging adult, is critically important for obtaining the right prescription drug or a combination of medications. For example, symptoms of nocturia may appear in older men due to an enlarged prostate, blocking the flow of urine from the bladder when it is being emptied. The retention of urine above a level of 100 cc or so can send frequent signals to the brain that the bladder needs to be emptied. This condition may be exacerbated at night when a man is horizontal in bed and water retained in the feet during the day is no longer pooled but available for processing by the kidneys and storage in the bladder.
If you frequently experience the need to urinate at night, you should not hesitate to discuss this with your doctor. Before meeting with him or her, it is helpful to keep track of such things of how often you urinate at night and what and how much you drink during the day.
Here are questions a physician typically will ask:
- When did nocturia start?
- How many times a night do you urinate?
- Are you producing more or less urine than in the past?
- Do you ever wet the bed?
- Does anything make the problem worse?
- What medications are you taking?
- How much fluid do you drink before bedtime?
- How much caffeine do you drink each day?
- Have you changed your diet recently?
- Do you have a family history of diabetes or bladder problems?
- Do you have increased thirst, pain or burning on urination, abdominal pain or back pain?
1 Appell, R. A. & Sands, P. K. (2008). Nocturia: etiology, diagnosis, and treatment, The Journal of Neurourology & Urodynamics, 27 (1): 34-39.
Published On: March 26, 2012