Deterrence And Patient Education
Patient Guide to the Management of Nocturia
The International Continence Society defines nocturia as “the need for an individual to wake up at night one or more times to void.” Nocturia is typically found in more than 50% of all men and women older than 60 years of age. The prevalence increases with age such that the vast majority of individuals age 80 years and over will get up at least once every night to void. However, nocturia is not a “normal or inevitable” part of aging and can almost always be improved by utilizing a combination of behavioral therapies, medications, exercises, lifestyle adjustments, dietary modifications, procedures, and other therapeutic techniques.
Nocturia has significant effects on general health, vitality, and quality of life. Sleep disruption can result in daytime sleepiness, fatigue, mood changes, memory problems, and cognitive dysfunction with poor concentration and performance. Nocturia is often described as the single most bothersome of all lower urinary tract symptoms, and more than 25% of all falls at home occur at night in relation to toilet visits.
Four basic conditions lead to nocturia. These are:
Managing Nocturia: The Key Points
Oab And Your Prostate
Among men, many cases of OAB are caused by an enlarged prostate gland. Your prostate may get larger as you age. It can block your flow of urine, causing symptoms of OAB.
According to the National Association for Continence, up to 50 percent of men experience symptoms of an enlarged prostate by the time they turn 60. A whopping 90 percent of men experience symptoms by age 85.
Prevention And Treatment Options
Prevention of nighttime urination is typically recommended by healthcare providers. Common lifestyle modifications include the following:
- Restriction of fluids before bed, while ensuring that adequate fluids are taken in throughout the day
- Avoiding beverages with caffeine
- Maintaining a healthy weight excess weight can place pressure on the bladder
- Taking afternoon naps
- Taking diuretics at a time when they will not disrupt sleep
Your healthcare provider may also request that you keep a voiding diary. A voiding diary will help you and your provider pinpoint what is causing symptoms of OAB. Common items to record on a voiding diary include:
- How much fluids are consumed
- What kind of fluids are consumed
- Times of urination
- Whether there was an urge for urination
- Whether incontinence was experienced
If lifestyle modifications are not enough, medications may be prescribed:
- Anticholinergics treat bladder spasms, which reduces the urge to urinate.
- Diuretics, though it may sound counterproductive, if timed appropriately can be very effective. A diuretic taken in the morning can assist with regular urine production, which helps to rid the body of excess fluids earlier in the day.
- Tamsulosin , finasteride , and dutasteride all treat benign prostatic hyperplasia, which reduces pressure on the bladder.
- Desmopressin helps the kidneys produce less urine this medication is helpful when the cause of OAB is diabetes insipidus.
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Full Bladder Wakes 2 In 3 Women At Night
- By Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing
Getting up at night to use the bathroom is often thought of as a problem mainly for older men. Not sotwo in three women over age 40 wake up at least once each night because of a full bladder. And nearly half of them make two or more nighttime trips to the bathroom.
Thats the upshot from a survey of more than 2,000 northern California women ages 40 years and older. They were asked questions related to possible reasons for nocturia, the medical term for getting up to urinate twice or more per night.
Factors that increased the likelihood that a woman woke at night to urinate included older age, having had a hysterectomy, having hot flashes, and using vaginal estrogen. The results were published in the journal Obstetrics & Gynecology.
Until now, many clinicians thought that women who woke at night to urinate had some disorder causing the problem. Thats the case for men, many of whom get up to urinate at night because of an enlarged prostate gland. So it comes as a surprise that many of the women had no other urinary problems, such as an overactive bladder or leaking urine when coughing .
Also surprising was that only 25% of the women in the survey who had nocturia said “yes” to the question “Are you at least moderately bothered by having to get up at night to urinate?”
How Many Times Is Normal To Urinate At Night
Not everyone is the same, and there are factors that determine what is normal for most people. For example, nighttime urination is more common if you have something to drink right before bed, and is also more common in older adults. Most people without nocturia can sleep for 6 to 8 hours without having to urinate, but getting up to go to the bathroom once during the night is still within the realm of normal. If you have to use the restroom two or more times per night, it is a good idea to talk to your urologist about nocturia.
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How Is Nighttime Urination Diagnosed
Your doctor will diagnose nighttime urination by evaluating your symptoms and performing a physical examination. They may ask certain questions to determine potential causes for the condition.
Questions may include how many times you get up to urinate at night, how long youve been experiencing nighttime urination, and questions about your regular activities before bed.
For example, if you drink lots of fluids or take diuretics before bedtime, these can lead to nighttime urination.
Your doctor may order tests to determine the cause of frequent urination. Urinalysis looks at the chemical compounds present in urine. Urine concentration determines if your kidneys properly excrete water and waste products.
Other tests include a urine culture and post-void residual urine measurements. This test takes an ultrasound of the pelvic area to see how much urine remains in the bladder after urination.
Your doctor may order further tests if they suspect you have an underlying medical condition. They may order further tests to make a diagnosis. These tests include blood sugar, blood urea nitrogen, blood osmolality, creatinine clearance, and serum electrolytes.
These tests can determine how well the kidneys function. They also measure the concentration of certain chemical compounds in your blood. These tests can determine if nighttime urination is a side effect of kidney disease, dehydration, or diabetes.
How Is Nocturia Classified
Nocturia is classified into 3 types that may overlap:
- Global polyuria
- Defined as production of urine volume more than 40 ml/kg per 24 hours
The bladder diary is crucial in helping define the type and cause of nocturia. The bladder diary determines:
- Total 24 hour urine output
- Nocturnal urine volume
- Proportion of total urine output that occurs at night
Also Check: How Do They Test For Overactive Bladder
What Constitutes An Overactive Bladder At Night
Technically speaking, an overactive bladder at night means getting up at least once a night to urinate2. However, by this definition, most people experience this condition to some extent. Therefore, its generally considered a problem when youre getting up two times a night or more to go to the toilet and/or have difficulty getting back to sleep.3
Nocturia differs from bedwetting , which typically involves the involuntary passing of urine4 and is more common in children5.
Producing Excess Urine At Night
Producing excess urine at night is known as nocturnal polyuria, and it is estimated to be a contributing cause for up to 88% of cases of nocturia.
For some people, excess urine production occurs throughout the day and night. This condition, called global polyuria, is most often tied to excess fluid intake, diabetes, and/or poor kidney function. Diuretics, including medications and substances like alcohol and caffeine, can cause enhanced urine production as well.
Elevated amounts of urine production that occurs only at night can occur when fluid intake goes up at night. It can also occur when peripheral edema swelling or fluid accumulation in the legs relocates after a person moves into a lying position. Coexisting medical problems can contribute to peripheral edema and thus raise the risk of nocturnal polyuria.
Some research indicates that changes to the bodys circadian rhythm cause older adults to have a greater proportion of their daily urine production occur at night, which may be a contributing factor to their higher rates of nocturia.
Read Also: Why Does My Bladder Feel Sore
Drinking Too Many Fluids
When youre continually hydrating, your body gets rid of what its not using, which naturally results in peeing more often. Your hydration needs will differ depending on your activity level and environment. But if youre peeing frequently, you could simply be drinking more liquids than you need.
Especially if youre having trouble peeing too often during the night, limiting how much you drink before bed can help.
How Is Overactive Bladder Diagnosed
A healthcare provider can diagnose overactive bladder by reviewing your symptoms and conducting a physical examination of the organs around your pelvis and rectum. They may ask you questions such as:
- What are your symptoms?
- How long have you had these symptoms?
- Do you have a family history of overactive bladder?
- What over-the-counter and prescription drugs do you take?
- What kinds of fluids do you drink during the day?
- What time of day do you drink certain fluids?
- What do you eat during the day?
They may also refer you to a urologist. A urologist is a doctor who specializes in diseases and conditions that affect your urinary tract and reproductive system.
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Nocturia: Frequent Night Urination Causes & Treatment
Nocturia is a condition that causes sleep disruption as a result from frequent urination at night. Learn more about its causes and treatment options.
Bladder leakage at night can happen whether or not you feel the urge to go, so you may not always know beforehand that you have to use the bathroom. This means you may even wake up to wet sheets. Use this guide to better understand Nocturia, what causes those frequent urges to use the restroom at night, and how to prevent or treat the symptoms of nocturia.
Does Frequent Urination Disrupt Sleep
Multiple research studies, including a Sleep in America Poll by the National Sleep Foundation, have consistently found that nocturia is one of the most commonly reported causes of sleep disruptions. Especially in older adults, it is frequently listed as a cause of poor sleep and insomnia.
Many people, perhaps over 40%, have trouble quickly getting back to bed, which can mean reduced sleep time and more fragmented, lower-quality sleep. Not surprisingly, nocturia is commonly associated with excessive daytime sleepiness which can translate to impaired physical and mental function, irritability, and a higher risk of accidents.
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Tips For Getting Your Groove Back
There are some things you can do to ward off discomfort or embarrassment during sex.
Talk about it. First, know that your partner will probably be a lot more understanding than you expect. Then bring it up before you have intercourse. âDonât wait until it happens and say, âOh, guess what?ââ Denson says. âItâs better to be upfront and honest ahead of time.â
Plan. Prepare for sex, just as you do for bedtime. Double-void, cut back on fluids, and avoid foods and beverages that are likely to irritate your bladder.
Keep up the Kegels. Doing these several times a day — and even during intercourse — will help prevent urine leakage during sex.
All of these approaches can help you manage your overactive bladder at night, letting you get a better nightâs sleep and have a more active and satisfying sex life. But Sanz adds that if your overactive bladder is really causing you problems, thereâs no reason you need to live with it.
âThere is hope. There is treatment,â he says. You need to be evaluated by a urogynecologist, who will talk to you about three types of treatment: behavioral modification, medication, and surgical procedures are available, he says. âYou donât have to let an overactive bladder interfere with your life.â
What Are The Symptoms Of Ibd
The symptoms of IBD, as well as the severity of the symptoms, can vary for everyone.
Common symptoms of IBD include diarrhea or loose stools, blood in the stool, weight loss, fatigue, fever, abdominal pain , and even malnutrition. In addition, some people can develop IBD-associated arthritis, which can cause pain or discomfort in the joints and lower back pain.
Symptoms of IBD may go away for months, or sometimes even years at a time before reoccurring.
The pain felt with IBD can be different for everyone. Some people may feel pain in different areas of their abdomen, some may feel back pain, and others may even feel pain in their joints.
Patients with IBD often experience emotional symptoms, in addition to physical symptoms. Anxiety about when they may have an attack, worries about their appearance, and general frustration and depression around their inability to enjoy everyday activities can affect people with IBD. Learn more about the emotional challenges people with IBD face in this video.
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What Behavioral Changes Can I Make To Help Fix Overactive Bladder
You can make many changes to your behavior to help fix your overactive bladder. These include:
Keeping a bladder diary
A healthcare provider may ask you to keep a bladder diary for a few days. Noting what happened before you had an accident can help the provider determine the cause of your OAB. Youll use your bladder diary to track:
- What you drink.
- Tomatoes and tomato-based products.
- Spicy and acidic foods and drinks.
- Foods and drinks that contain artificial sweeteners, such as diet soft drinks and some chewing gums.
Maintaining bowel regularity
Constipation can place pressure on your bladder and affect your bladder function. You may be able to avoid constipation and reduce bladder symptoms by keeping healthy bowel habits. The following can help you maintain bowel regularity:
- Increase your fiber intake. Incorporate foods such as beans, pasta, oatmeal, bran cereal, whole wheat bread, fresh fruit and fresh vegetables into your diet.
- Drink two to four extra glasses of water each day.
- Exercise regularly.
Managing your weight
Having overweight can put pressure on your bladder, which may contribute to bladder control problems. Maintaining a weight thats healthy for you can reduce pressure on your bladder.
Stop using tobacco products
Cigarettes and other tobacco products can irritate your bladder muscle. Coughing spasms due to smokers cough can also cause leakage.
Bladder retraining teaches you how:
Your Overactive Bladder In Menopause Especially During The Night
It wasnt only the hot flushes and night sweats that were waking up Romany night after night. It was needing to pee as well.
I know that this affects many of you too. Because exactly one year ago before the world when into chaos, I was travelling throughout New Zealand, Australia and the United Kingdom, sharing my live Masterclass on Menopause with you, and hundreds of hands would shoot up in the air when I asked who was waking up because they needed to pee in the night. Perhaps this is you as well.
Discovering that our nerves become more irritable during menopause was another aha lightbulb moment for me you see, your bladder has thousands of nerves that help to control its functions. Our irritable bladder and urge to pee more frequently, is another symptom of menopause, however, a word of caution too it can also be a sign of Urinary Tract Infection too. Hence, if you are experiencing any burning pain on urinating or if you have any pelvic or back pain, then head to your Doctor right away.
The changes to our urinary system during menopause can be such a challenge for many, especially those of us who aspire to continue to stay active as we age. So, lets take a look at whats going on.
The Mystery of your Ageing Bladder in Menopause:
What can I do about it? Here are my 5 pointers to help you:
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Can Nerve Stimulation Help Overactive Bladder
Yes, nerve stimulation can help improve OAB. Your nerves help tell your brain that your bladder is full. By treating your nerves, you can improve your bladder control.
Nerve stimulation is a reversible treatment. Healthcare providers only recommend it if other treatments dont work.
There are several types of nerve stimulation treatments. These include:
Sacral nerve stimulation
Sacral nerve stimulation is a therapy that electrically stimulates the nerves that control your bladder.
A healthcare provider will implant a small device called a neurotransmitter under the skin near your upper buttock area. The neurotransmitter sends mild electrical impulses through a wire near your sacral nerve. Your sacral nerve is a nerve in your lower back. The impulses help you control your bladder.
Sacral nerve stimulation can reduce the number of times you have to use the bathroom or the number of times you accidentally leak pee. Its overall very effective. Its also an outpatient procedure, so you can go home afterward.
Percutaneous tibial nerve stimulation
Percutaneous tibial stimulation sends small nerve impulses to a nerve branch near your ankle. It helps stimulate bladder control.
Percutaneous tibial nerve stimulation is an outpatient procedure. Many people need 12 weekly sessions and then monthly maintenance sessions afterward.
Botulinum toxin injections
Botox® is the most well-known botulinum toxin brand. A healthcare provider injects Botox into your bladder wall using a cystoscope.