nocturia

What is the Nicturia?

The term nocturia defines the need to get up several times during the night rest to give vent to the repeated urge stimulation.

Normally, adults should be able to sleep six to eight hours without having to wake up to urinate. In the case of nocturia, people interrupt the rest cycle more than once a night (a single episode of nocturia falls within normal limits), with a consequent impact on the quality of sleep. Nocturia is a symptom and it is important to evaluate the underlying causes that cause it.

Causes

Quite simply, nocturia could be an expression of excessive fluid intake before going to bed (transient nicturia); sometimes, however, it represents the symptom of a pathological condition.

Pathological causes	Non-pathological causes
Metabolic problems and alterations of the water balance: diabetes, hyperparathyroidism, chronic renal failure, heart failure and other causes of peripheral edema.	Nutrition (high-protein diet, intake of stimulating drinks or coffee); Pregnancy; Old age; Anxiety and stress; Menopause; Diuretic drugs.
Neurological disorders affecting bladder control : multiple sclerosis, Parkinson's disease, spinal cord compression and cauda equina syndrome.
Lower urinary tract disorders or bladder dysfunctions : urinary incontinence, bladder infections, interstitial cystitis, ureteral obstruction, benign prostatic hypertrophy, prostate cancer, poor bladder capacity, detrusor overactivity, decreased bladder distensibility, uterine fibroids, etc.

The cause that causes nocturia can be identified through an accurate medical evaluation, which can include:

Anamnesis: evaluation of symptoms, drugs and fluids (including alcohol) + research into ongoing systemic diseases that could contribute to nocturia;
Examination of the abdomen, pelvic (women) and rectal (men);
Blood tests: electrolytes, glucose, calcium, assessment of renal function, etc .;
Urine analysis and urine culture: to exclude local infections, hematuria and proteinuria;
Urodynamics: evaluates urinary flow, residual volume and other parameters related to altered bladder function.

Symptoms

Urinary symptoms associated with nocturia	Possible causes
Polyuria Production of a large quantity of urine per day (over 2, 500-3, 000 ml in 24 hours).	Excessive fluid intake; Untreated diabetes (type 1 and type 2); Diabetes insipid; Gestational diabetes (during pregnancy); hypercalcemia; Kidney failure.
Night polyuria The body produces a large volume of urine during sleep (normal amount of urine in the 24 hours with night volume greater than 35% compared to the total).	Redistribution of fluid during the night due to heart failure and other causes of edema, such as venous stasis; Sleep disorders, such as obstructive sleep apnea; Some medications (may depend on the time of day they are taken): diuretics, cardiac glycosides, demeclocicline, lithium, methoxyflurane, phenytoin, propoxyphene and excessive vitamin D; Excessive fluid intake before bedtime, in particular caffeinated beverages and alcohol; Altered secretion of vasopressin (antidiuretic hormone), more common in the elderly.
pollakiuria Increased frequency of urination with emissions of small amounts of urine.	Obstruction of the ureteral canal; Benign prostatic hyperplasia; Inflammation or neoplasia affecting the bladder, urethra or prostate.
Low night bladder capacity At night, more urine is produced than the bladder can contain. The need to empty the bladder causes night awakening.	Decreased bladder distensibility; Overactive bladder; Pregnancy; Recurrent bladder or urinary tract infections; Inflammation - for example, interstitial cystitis; Urethral pathology; Bladder cancer; Prostatic disease: benign prostatic hypertrophy, prostate cancer.
Mixed Nursery Combination of nocturnal polyuria and low night bladder capacity.	One of the possible causes listed for nocturnal polyuria associated with low nocturnal bladder capacity.

Treatment

Treatment depends on the type of nocturia and its cause. Treatment options for nocturia may include:

drugs:

Antidepressant drugs with anticholinergic action: they reduce the symptoms of overactive bladder, acting at the level of the destrusor muscle and improving bladder emptying.
Drugs that reduce urine production:
Bumetanide and furosemide: diuretics that act by regulating urine production;
Imipramine: tricyclic antidepressant which decreases the production of urine, also indicated for nocturnal enuresis;
Desmopressin: an analogue of vasopressin that helps the kidneys to produce less urine.

Interventions:

Limit evening consumption of coffee, alcohol and other beverages containing caffeine or theine (due to their diuretic effect);
Adjust the intake time of diuretic drugs: prefer late afternoon, about six hours before bedtime so that their therapeutic effect is complete before going to bed;
Elevate the legs and wear compression stockings (to help prevent fluid retention).