What is nocturia?
Urination at night (waking up to urinate, then going back to bed with the intention of sleeping more) is known as nocturia. It is normal to wake once at night to go to the toilet, any more than this is considered abnormal, although it doesn't necessarily need treatment.
It is a common problem as we get older; nocturia occurs in:
- 50% of women aged 50-59 years
- 66% of men aged 50-59 years
- 70% of women aged over 80 years
- 90% of men aged over 80 years
You can see from this that is not just a prostate issue in men – women do not have a prostate and still get nocturia.
Interrupted sleep can mean you do not function well during the day, and this can be a vicious cycle – if you sleep during the day, it makes sleeping at night even harder. A good night's sleep may be quite important for your general health. For older people, getting up at night can be a risk for falls, particularly if they are frail and unsteady on their feet.
The body has a number of mechanisms to allow you to sleep at night, and a reduction in urine output at night is one of them. Hormonal reflexes control this. An example is the hormone ADH, which inhibits urine production by the kidneys. Normally, this works at night so that we produce less urine per hour while asleep. As we age, these mechanisms do not work as effectively as when we are younger – the control mechanism is not as efficient as it was, and this can lead to urinating more at night.
Also, as we age the heart becomes less efficient. If you suffer from peripheral oedema (swollen ankles), when you lie down at night, some of this fluid redistributes into blood vessels, and this causes the body to have slightly too much fluid in the circulatory system. The heart stretches, and sends a signal to kidney via a hormone called ANP (atrial natriuretic peptide), which increases urine production.
Some of the causes of nocturia
Often there is no one single cause for nocturia, but a combination of underlying causes. For example, you may have some prostate problems that contribute, but you may also be diabetic. It is important to consider these multiple possible causes, which include:
- increased age
- heart problems and peripheral oedema (swollen ankles)
- taking diuretic (fluid) tablets in the evening
- drinking large amounts of fluid (alcohol is particularly bad as it is a diuretic) in the evening
- diabetes (high blood glucose)
- upset or over-sensitive bladder, for example urine infection
- prostate problems – due to an enlarged prostate
- overactive bladder (this is normally associated with frequency during the day)
- poor sleep pattern – it is tempting to go to the toilet just because you are awake
- habit – some people get into the habit of waking at set times
- diabetes insipidus (a rare hormone problem that causes severe thirst and urine loss)
What can you do about nocturia?
- Talk to your doctor if you are troubled.
- Try to cut back your fluid intake in the evening – try not to drink any large volumes after 6pm
- If you have a poor sleep pattern, see your doctor about this, and try to avoid sleeping in the day
- If you have peripheral oedema, talk to your doctor about wearing support stockings during the day. Certainly rest with your legs up in the afternoon for a few hours
- If you take fluid tablets (diuretics) talk to your doctor about the time of day that you take these. Do not make changes to this without talking to your family doctor first
- Make sure your light the path to the toilet at night
- If you are frail, consider having a commode or bucket by the bed
What might your urologist do?
If you see Associate Professor Nick Brook in Adelaide about your nocturia, he will ask specific questions about your waterworks, and any other medical conditions. Other investigations may include:
- completing a bladder diary
- completing Prostate Symptom Score (men)
- performing a urinary flow rate and residual urine scan
- examine your prostate and abdomen
- testing your urine for infection
- arranging for blood tests
- occasionally, a look inside the bladder may be needed
If prostate or bladder problems may be a contributing cause, you may be started on treatment for these, depending on what the underlying issue is. Nocturia can be frustrating for the patient, and usually something can be done to help; it is hard to eradicate it completely, but often the number of times you get up at night can be reduced significantly.
This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.