NOCTURIA: NIGHT TIME FREQUENT URINATION

FREQUENCY AND NOCTURIA CAN TROUBLE NOT ONLY THE PATIENT BUT PEOPLE AROUND THEM ALSO

Nocturia is a condition where a gentleman or a lady has to get up in the night for two or  more than two times. The condition occurs far more commonly among older adults than younger people. 

Because nocturia interferes with a good night’s sleep there can be problems with sleepiness or exhaustion during the day. It has also a risk of morbidity and deaths(due to fall in the night).

DAY TIME DROWSINESS/FATIGUE AND  GENERALISED WEAKNESS CAN AFFECT QOL

It is necessary to consult a doctor as there can be underlying serious disorder which can be detected and treated.

Several conditions can cause nocturia;

1)kidney /heart failure

2)Diabetes(triad of polydipsia,polyuria,polyphagia)

3)drinking bladder irritants or more water in evevning and night( can be an element of compulsive water drinking or polydipsia)

4)sleep apneoa

5)Bladder outlet obstruction: BPH /prostate cancer

6) Low bladder capacity like GUTB especially in a country like ours

Prevalence:

In older adults, nocturia is the norm rather than the exception. Studies done between 1990 and 2009 found that 68.9% to 93% of men age 70 and older get up at least once a night to void.The women have a little bit lower incidence of nocturia. But both the sexes are equally bothered.

It has been seen and obserevd that the Indians and the Asians have lesser frequency of noturia as the bladder capacity of Indians.

Why the older people get nocturia?

Age-related structural changes in the urinary system include decreased functional bladder capacity, and inability to concentrate the urine. There are also age related changes in bladder muscle like detrusor ischemia, bladder overactivity and reduced flow rate and increased post void urine because of age related prostatic hypertrophy.In elderly people there is decline of  ADH ( even to the extent of reaching zero level)leading to increased urine output.

In people of fluid overload because of cardiac renal failure ; the oedema fluid gets mobilised in the night and this leads to increased urine output in the night.

Management:

Treatment options for nocturia depend on the underlying causes.  Inmost of the cases change of life style helps a lot. Avoiding bladder irritants like avoiding coffee/tea and  alcohol/fluids in the evening can correct nocturia to a great extent.

Many elderly people are hypertensive( 30% of BPH people are having HTN ; sometimes they are put on diuretics which can lead to increased urine output).
As far as urological issues are concerned; management of prostatic hypertrophy by alpha blockers or combination of alpha blockers with anti-cholinergic medications can help in reduction of nocturia. If necessary the surgical options like LASER prostatectomy should be undertaken.

Role of desmopressin:

Desmopressin in a low oral dose (0.1–0.4 mg) at bedtime can be initiated and the response assessed. Patients with nocturnal polyuria and disorders of the vasopressin system have been found to be more sensitive to desmopressin therapy. 

The frequency of nocturnal voiding declined by as much as 50%, and the voided volume of nocturnal urine decreased by as much as 40%.

In patients with fluid overload status, heart failure,hyponatremia we have to be acreful while giving desmopressin.