What are the symptoms of nocturia?

Normally, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. People who have nocturia wake up more than once a night to urinate. This can cause disruptions in a normal sleep cycle.
Nocturia may result from several different causes:

• You produce a great deal of urine (more than 2 liters) a day (polyuria)
• Your body produces a large volume of urine while you sleep (nocturnal polyuria)
• You produce more urine at night than your bladder is able to hold (low nocturnal bladder capacity). This causes you to wake up at night because you need to empty your bladder.
• A combination of nocturnal polyuria and low nocturnal bladder capacity (mixed nocturia)
• Poor sleep: Some people who have poor sleep and awaken frequently will go to the bathroom whenever they awaken. Typically in these cases, it is not the need to void that awakens them.

What are the causes of nocturia?

There are many possible causes of nocturia, depending on the type:

Causes of polyuria

• High fluid intake
• Untreated diabetes (Type 1 and Type 2)
• Diabetes insipidus, gestational diabetes (occurs during pregnancy)

Causes of nocturnal polyuria

• Congestive heart failure
• Oedema of lower extremities (swelling of the legs)
• Sleeping disorders such as obstructive sleep apnea (breathing is interrupted or stops many times during sleep)
• Certain drugs, including diuretics (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
• Drinking too much fluid before bedtime, especially coffee, caffeinated beverages, or alcohol

Causes of low nocturnal bladder capacity

• Bladder obstruction
• Bladder overactivity
• Bladder infection or recurrent urinary tract infection
• Bladder inflammation (swelling)
• Interstitial cystitis (pain in the bladder)
• Bladder malignancy
• Benign prostatic hyperplasia (men), a non-cancerous overgrowth of the prostate that obstructs the flow of urine

Possible causes of mixed nocturia

Any of the possible causes listed under nocturnal polyuria and low nocturnal bladder capacity

How is nocturia diagnosed?

To help your doctor diagnose nocturia, you can keep a fluid and voiding diary. This is a two-day record of how much you drink, how often you have to go the bathroom and the urine output, any medications you are taking, any urinary tract infections, and any related symptoms. Your doctor will review the diary in order to determine the possible cause(s) of and treatment for the nocturia.
Your doctor may ask you the following questions:

• When did this condition start?
• How many times do you need to urinate each night?
• Is there a large or small volume of urine when you void at night?
• Has there been a change in urination output (increase or decrease)?
• How much caffeine do you drink each day, if any?
• Does frequent urination during the night keep you from getting enough sleep?
• Do you drink alcoholic beverages? If so, how much each day?
• Has your diet changed recently?

In addition to reviewing your voiding diary, your doctor may order a urinalysis to examine the urine for infection.

Is nocturia treatable?

If you think you might have nocturia, see your physician. He or she may refer you to a urologist to treat the condition.
Treatment depends on the type and cause of nocturia. If sleep apnea is considered, you may be referred to a sleep specialist or pulmonologist.
Treatment options for nocturia may include:
Interventions:

• Restrict fluids in the evening (especially coffee, caffeinated beverages, and alcohol).
• Time intake of diuretics (take mid- to late afternoon, six hours before bedtime).
• Take afternoon naps.
• Elevate the legs (helps prevent fluid accumulation).
• Wear compression stockings (helps prevent fluid accumulation).
• 

Medications:

• Anticholinergic medications: reduce symptoms of overactive bladder
• Bumetanide (Bumex^®), Furosemide (Lasix^®): diuretics that assist in regulating urine production
• Desmopressin (DDAVP^®): helps the kidneys produce less urine
  

  References

  • National Association for Continence. Nocturia. Accessed 2/23/2016.
  • Marinkovic SP, Gillen LM, Stanton SL. BMJ 2004;328:1063. Managing nocturia. Accessed 2/23/2016.
  • National Sleep Foundation. Frequent urination at night. Accessed 2/23/2016.

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