Nocturia

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Latest Edit: Hector 2014-02-14 (EDT)

Nocturia refers to the passage of urine at night. It is a common problem, increasing with age, and can be bothersome to individuals experiencing even one episode of nocturia per night.[1] Nocturia is also one of the most bothersome lower urinary tract symptoms and has a significant impact on quality of life.

Article Addressing Nocturia in Seniors, Vital Link; 2007 Spring/Summer

Naturopathic Assessment

An appropriate workup to investigate the common causes nocturia is required to initiate proper treatment.

Causal Factors

The etiology of nocturia is complex and depends on the conditions with which it is associated. There are however several causal factors that can lead to nocturia on their own.

Lifestyle

  • Food intolerances can cause or aggravate nocturia.
  • Excessive intake of fluid in the evening or before going to bed may cause nocturia.[1]
  • Increased consumption of alcohol may lead to nocturia.[2]
  • Caffeine intake is associated with increased frequency of nocturia.[3]
  • Foods or drinks high in sugar can worsen nocturia.
  • Regular exercise decreases the changes or frequency of nocturia.[4]
  • Nocturia not only disrupts sleep but poor sleep is a risk factor for nocturia.[5]
  • Urinary voiding habits that involve straining or not voiding regularly can increase the risk of nocturia with age.

Social

  • Mental Health
  • Both overall physical and mental health was associated with increased nocturnal voiding.[4]
  • Pain is a independent risk factor for nocturia.[4]
  • Major depression is associated with a six-fold increase in nocturia in men and a three-fold increase in women, after accounting for age and health.[4]

External

Medical Interventions

  • Prescription Medications
  • Use of diuretics later in the day or in the evening can cause nocturia.[2]
  • Antidepressant medications, especially SSRIs, are associated with increased occurrence of nocturia.[6]

Diagnosis

  • A 24 hour urine collection can be used to assess the proportion of daily volume produced at night, and to identify if polyuria is the underlying cause of nocturia.[1]
  • Laboratory studies to rule out possible underlying conditions as listed below may be necessary.

Associated Conditions

The frequency of nocturia increases with age. It is also common in the following conditions:[1] [2], [4]

Characteristics

  • Nocturia generally occurs due to increased production of urine at night (polyuria) or low functional bladder capacity or through a combination of both.

Naturopathic Treatments

It is important to identify the root cause and associated conditions in order to treat effectively. Some of the treatments that are specific to nocturia include:

  • Ensure adequate voiding during the day.
  • Limit the amount of fluids a couple of hours prior to bedtime.
  • As the kidneys function optimally when you are lying down, Spend time later in the afternoon lying down with your legs raised in order to decrease the production of urine at night.
  • Ensure regular exercise every day.

References

Reviewed by Iva Lloyd, BScH, RPE, ND [1]

  1. 1.0 1.1 1.2 1.3 Drake M (2011) Wein:Campbell-Walsh Urology 10th ed Chap 67 Nocturia Saunders
  2. 2.0 2.1 2.2 Carter C, Stallworth J, Holleman R (2011) Rakel: Textbook of Family Medicine 8th ed Chap 40 Urinary Tract Disorders Saunders
  3. Liao YM, Dougherty MC, Biemer PP, Liao CT, Palmer MH, Boyington AR, Connolly A (2008) Factors related to lower urinary tract symptoms among a sample of employed women in Taipei. Neurourol Urodyn.;27(1):52-9. PMID: 17610269.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 Asplund R, Aberg HE (Sep 2004) Nocturia in relation to body mass index, smoking and some other life-style factors in women. Climacteric.;7(3):267-73. PMID: 15669551. Cite error: Invalid <ref> tag; name "Asplund" defined multiple times with different content
  5. Asplund R (Oct 2002) Nocturia in relation to sleep, somatic diseases and medical treatment in the elderly. BJU Int.;90(6):533-6. PMID: 12230611.
  6. Asplund R, Johansson S, Henriksson S, Isacsson G (Apr 2005) Nocturia, depression and antidepressant medication. BJU Int.;95(6):820-3. PMID: 15794790.