NIGHT TIME URINATION: NIGHTMARE FOR ELDERLY PEOPLE

Night time urination i.e. nocturia is defined as getting up for multiple times in the night to pass urine.

This is a disturbing development as it can interrupt the sleep and make the person lethargic and drowsy the whole day and also it can have more serious implications like  falls while running to bathroom in the darkness. Nocturia can lead to disturbed sleep and disturbed sleep can lead to nocturnal urination. These two things are often interwoven.Proper  history is must to help people who have disturbed sleep and hence they pass urine in the night.They usually don't have any medical illnesses causing nocturnal polyuria and also they don't have any altered bladder function.

Nocturia can be because of various reasons from the physiological ones like drinking a lot of water in the evening ( habitual polydipsia) or serious pathological disorders like congestive cardiac failure, hyperparathyroidism,benign prostatic hyperplasia,bladder infection,interstitial cystitis,chronic renal failure etc. The sleep apnoea syndrome also is one of the causes of nocturia.

In elderly people the nocturnal is very common, the prevalence reaching to 80% in above years age group.It has been found that the elderly people have more than 33% urine output in the night time although the whole day urine output remains the same.The  anti-diuretic hormone levels are low in the night time in the elderly.In the elderly there is also decreased renal function, prostatomegaly and disturbed sleep pattern.These all factors lead to accentauation of nocturnal urination. 

The patients need a thorough evaluation to rule out the underlying disorders.A proper voiding dairy , urine routine and culture,USG KUB and PVR ,uroflowmetry and urodynamic studies etc are needed in cases where medical causes have been ruled out.
A  dedicated history, voiding diary,meticulous examination( including Focussed neurological Examination), involvement of physician and directed tests ( as per the merits of the case)  helps in coming to conclusion and help in proper management.

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
• Imipramine (Tofranil): decreases urine production
• Desmopressin (DDAVP): helps the kidneys produce less urine.

Desmopressin, a synthetic antidiuretic hormone analogue, is the only drug currently approved for the treatment of nocturia associated with nocturnal polyuria or multiple sclerosis (MS). Compared with vasopressin, desmopressin has a longer lasting and more potent antidiuretic effect and is devoid of vasopressor and uterotonic effects. In two large, randomised, double-blind phase III trials in adults with nocturia associated with nocturnal polyuria, 3 weeks of oral desmopressin therapy was significantly more effective than placebo in reducing the mean number of nocturnal voids and in normalising the rate of nocturnal urine production. Beneficial effects of desmopressin on nocturia were maintained and increased in patients completing 10 or 12 months of further treatment in a non-blind extension of short-term trials.

Surgical management:

In select cases Prostatectomy can help.