Nocturia

Nocturia is the excessive need to urinate at night. Under typical circumstances, the body produces less urine at night, such that one can sleep soundly through the night without waking up to urinate. However, in the case of nocturia, a person is woken up two or more times throughout the night with the urge to void. Nocturia can be very disruptive to one’s quality of sleep and has many potential causes.

Potential Causes of Nocturia:

Causes of nocturia can range from lifestyle habits to underlying medical conditions including:

• Too much fluid consumed too close to bedtime.
• A developed habit. If you wake up at night without the urge to urinate but decide you might as well go, you can train your bladder and brain to habitually urinate at night.
• A urinary tract infection increases urinary frequency during both the day and night. See your physician if you suspect you have an infection or if you have any pain or burning with urination.
• Some medications have diuretic effects. Speak to your physician and/or pharmacist to see if your medication may be contributing to nocturia and ask if these pills can be taken earlier in the day.
• Overactive bladder is a condition where the bladder muscle suddenly contracts resulting in a strong, sudden urge to urinate that is very hard to postpone.
• Incomplete emptying of the bladder due to factors such as bladder prolapse or cystocele in females, infection or enlargement of the prostate in males, or an obstruction (e.g. Tumor).
• Swelling or edema in the legs.
• Sleep apnea.
• Congestive heart failure.
• Neurological disorders.

Treatment for Nocturia:

Treatment will depend entirely upon the cause of nocturia. Therefore, it is important to regularly see your physician to rule out any medical conditions that could be the underlying cause of your symptoms. For example, high blood pressure, an overactive bladder, a bladder or kidney infection, sleep apnea, diabetes, bladder obstruction, and other conditions may require specific medical interventions which will also address your symptoms of nocturia.

In the absence of a medical condition, however, there are many lifestyle modifications you can make to better manage your symptoms including:

• Bladder retraining: Your therapist will review urge suppression techniques for you to implement when you feel the urge to urinate at night. Because the feeling of needing to void is a sensation that is produced by the brain, we are able to retrain these signals, as well as our body’s response to them. For example, when you feel the strong urge to urinate, your therapist may ask you to do deep breathing, relaxation, reverse Kegels, or distraction techniques such as counting backwards from 100 by 7’s. The goal of these techniques is to learn to suppress the urgency and postpone the need to urinate, and they need to be practiced regularly.
• Stay hydrated throughout the day, but limit fluids 2-3 hours before bed.
• Consume caffeine early in the day.
• Decrease your caffeine and alcohol intake.
• Always make sure to void (empty) your bladder last thing before you climb into bed.
• Practice good sleep hygiene so you are not tempted to use the bathroom if you are awake at night.
• Medication such as desmopressin helps the kidneys produce less urine (discuss with your physician).
• Discuss with your physician and/or pharmacist if you can take medication that may be acting as a diuretic earlier in the day.
• Use compression stockings or elevate your legs if you have edema or swelling in order to aid in circulation and help to avoid fluid build-up in the lower extremities.
• Lie down for half an hour in the evening in order to help your body get rid of some excess fluid before bedtime. Your heart most effectively eliminates fluid from your legs when lying down versus standing up, producing more urine. Therefore, if you lie down and elevate your legs before bed, void your bladder, and then go to bed for the night, you may not get up to void as frequently throughout the night.

As a result of the many causes of nocturia, it is important to have any medical cause ruled out. In the absence of an underlying medical cause, there are many simple lifestyle modifications that you can adopt as a part of your regular routine to minimize the number of times you are waking up at night with the urge to urinate, helping you to achieve a higher quality of both sleep and life.