As soon as women begin approaching menopause and men approach mid-life as well, it is not uncommon for both to begin experiencing urinary symptoms that can easily be categorized as urinary urgency and frequency. However, very different causes may be operative, and in some cases may be present in unison, complicating a clear diagnosis. Without an accurate and complete diagnosis, certain interventions and treatment strategies may be less effective than others. An incorrect diagnosis may, in fact, leave a patient with a medication prescribed that does little or no good to relieve symptoms. It may be quite difficult for clinicians in some instances to distinguish enlarged prostate from overactive bladder (OAB) and nocturia in men and OAB from nocturia in women unless there is a physical exam and urodynamics testing. Of course, diagnosis begins with a bladder diary over several consecutive days that captures information about symptoms occurring both day and night, essential details to guide the diagnosing clinician.
The American Urological Association (AUA) defines nocturia as "the need to urinate at least twice during the night." The National Association For Continence (NAFC) has adopted the same definition for nocturia. Of course, there can be many different reasons that a person is awakened from sleep, such as from loud noises in the environment, persistent stress, pain or heavy alcohol consumption prior to falling asleep or sleep apnea. And then, once awakened, the individual may decide to get up and go to the toilet before trying to fall asleep again. However, if these other causal factors have been ruled out and nocturia is suspected as the culprit because urinary symptoms seem to be concentrated solely at night, without urgency and frequency during the day, there are several behavioral strategies that an individual can undertake to see if some relief occurs. Of course, one step is to eliminate those other factors that could aggravate a tendency towards nocturia, such as the elimination or reduction of alcoholic beverages in the evening.
More proactively, the consumption of all beverages should be reduced and even eliminated 2-3 hours prior to retiring to bed, pushing liquids instead earlier in the day for adequate hydration. An additional strategy is to recline with feet elevated above the heart for 45-60 minutes prior to going to bed and then urinating one last time before going to sleep. This allows fluids that may have accumulated during the day while standing to return to the kidneys for processing. Double void that final time: men should sit on the toilet and fully relax to empty their bladder. Women should lean slightly forward on the toilet seat after urinating the first time and try to empty the bladder again. If taking any medications in the afternoon or evening that are known diuretics, ask your pharmacist or doctor about taking them in the morning instead.
Even if you are diagnosed and prescribed a medication for enlarged prostate, nocturia and/or overactive bladder, these behavioral strategies are important to undertake in order to maximize the effectiveness of a comprehensive treatment plan. You have a role to play for yourself and your health!
Nancy Muller, PhD
Key words: nocturia, management of nighttime toileting, double void, overactive bladder, enlarged prostate
Published On: March 26, 2012