Nocturia (urination at night)

Description

Anyone who wakes up at night because there is an urge to urinate and has to visit the toilet, suffers from nocturia. However, this is only true from a frequency of more than twice and only if there has not been excessive drinking.

Mostly older people are affected. Even if nocturnal urination is often accepted as a complaint of old age, it should be clarified whether this is not due to a disease.

People who are already wet when they wake up suffer from urinary incontinence.

An overly active bladder is often the cause of nocturia. Affected people (mostly women) have to visit a toilet very often, cannot suppress their urge to urinate and also lose urine unintentionally. Day and night are often equally affected.

In older men, nocturnal urination is mainly caused by benign prostate enlargement (prostatic hyperplasia). This exerts pressure on the urethra, so that the bladder cannot be emptied completely and the urge to urinate already occurs with a smaller filling quantity.

People with heart failure often store water or oedema in their legs during the day. They are removed again at night and trigger the urge to urinate.

Other causes:

• Diuretic medications
• Bladder infection
• Pregnancy
• Reversed daily rhythm (most urine is produced at night)
• Sagging pelvic floor muscles (due to childbirth or being overweight)
• Incontinence (weak bladder sphincter)
• Diabetes Mellitus (diabetes)
• Alcohol consumption
• Drinking large amounts before falling asleep
• Reduced bladder capacity

Nightly, frequent urination describes the main symptomatology of nocturia. Waking up to twice and having to go to the toilet is normal. Only what goes beyond that is considered a disorder. The amount of urine excreted is also characteristic. Affected persons pass more than two thirds of the absorbed fluid in a 24-hour rhythm at night.

Nocturia itself is not a disease, but rather a symptom of another disorder in the body. Other symptoms help to find the cause such as:

• Overactive bladder (frequent urination during the day).
• Prostate enlargement (weak urine stream)
• Heart failure (swollen legs during the day)
• Diabetes mellitus (weight loss, pronounced thirst)
• Inflammation of the bladder or urethra (burning pain when urinating)

A questioning of the affected person (anamnesis) is sufficient for a diagnosis. Records of drinking and micturition behaviour are helpful. The amounts and times of fluid intake and output should be noted for at least two days.

More extensive investigations are often needed to find the cause.

Routine tests for nocturia:

• Urine values
• Ultrasound of upper abdomen, bladder, kidney, prostate (if available)
• Blood values
• Cystoscopy
• Cardiac examination (rare)

The therapy is not aimed at urination, but at the cause.

Bladder training helps with an overactive bladder. The time between visits to the toilet is gradually increased and the urge to urinate is suppressed. The bladder gets used to the increased filling volume and symptoms usually improve significantly in two to three months.

Medication may also help:

• Women: Estrogens (female sex hormones) as ointments or suppositories.
• Men: So-called alpha blockers. Alpha blockers which relax the prostate gland (the urinary stream is enlarged and urination is made easier).
• Suppressors of the effect of acetylcholine on nerve endings (acetylcholine triggers bladder emptying)

Depending on the cause or disease, complications such as dehydration may occur. The excessive loss of fluids as well as a restriction of the drinking quantity is responsible for this.

• Anyone suffering from nocturia should avoid diuretic drinks (e.g. beer, coffee, tea) before going to bed.
• A micturition diary helps your doctor with the diagnosis.
• You may drink less in the evening. You must compensate for this deficit by drinking more fluids during the day.
• Under no circumstances should you drastically reduce the amount you drink.
• If symptoms persist, consult your doctor to treat the cause.