Symptom Information: Nocturia

Symptom:

Nocturia or night-time urination frequency.  (Other names: night-time urination, excessive urination at night, night frequency, micturition night).

General Description:

Nocturia is the need to wake up and pass urine more than once at night.  This is different to nocturnal enuresis where urine is passed unintentionally during sleep. One episode of nocturia a night is considered normal.  It is a common symptom in men and women and can have a significant impact on quality of sleep and therefore quality of life as you can feel tired and irritable during waking hours.  As you get older the incidence of waking at night to pass urine increases, in under 60 year olds the incidence overall is 28%, in over 60 year olds this rises to 41%.

Causes:

Some causes of nocturia include:

• Producing a lot of urine/polyuria: If you produce more than 2 litres of urine a day this is called polyuria.
• Nocturnal polyuria: Your body produces a lot of urine whilst you sleep.
• Poor sleep: You wake often at night and will frequently go to the bathroom at night when awake.  This is normally a habit and not because you actually need to pass urine.
• Excessive drinking before bedtime: If you experience nocturia it can be due to drinking too much in the evening before going to bed.  Excessive caffeine and alcohol consumption can also cause the nocturia symptoms to be exacerbated.
• Low nocturnal bladder capacity: You produce more urine at night than your body is able to hold.
• Benign prostatic hyperplasia/BPH: This is a common condition in men over 50 which results in nocturia due to obstruction of the urethra (the tube that connects the urinary bladder to the genitals so the urine can be removed from the body.  Other symptoms of this include changes in urine stream, low back pain, fatigue and fever.
• Diabetes insipidus and diabetes mellitus: Other symptoms include excessive urination day and night, weight loss, weakness, excessive thirst.
• Urinary tract infection: This can cause you to wake at night and pass urine several times during the day; you will also experience some other symptoms which may include fever, pain when passing urine or strong smelling urine.
• Medications: Some medications used in treatment of heart conditions called diuretics can cause nocturia as well as some medications used in the treatment of dementia. 

Risk factors:

Factors that may increase your chances of developing nocturia include advanced age, if you are on certain medications, or if you have urinary tract problems or cardiac disease, obesity or sleep apnea.

How you can help your doctor:

Before your consultation with you doctor, think about the following questions they may ask you.

• How long have you been experiencing the symptom of nocturia?
• On average how many times a night do you wake up and pass urine?
• Do you drink large volumes of fluid before you go to sleep?  It's a good idea to keep a fluid intake diary where you record what type of fluid and how much you drink every day and at what time.  Keep the diary for 7 days and take to your appointment. 
• Have you changed your medications recently?
• Have you also had any pain or burning whilst passing urine or any other symptoms like stomach pain and stomach tenderness?

Nocturia is a symptom which, for many older people, adversely affects their quality of life and has been linked to increased morbidity problems due to the elderly falling more often especially when tired but, with help from your doctor and understanding what the cause of your nocturia is, then it can often easily be rectified.