Nocturia resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]


Waking up multiple times during night to urinate is termed as Nocturia. It can be caused by simple increased fluid intake, as consequence of other medical illness or intrinsically overactive bladder. If a patients presents with night time increase urine frequency ask him about his intake of fluids, cardiovascular factors (like hypertension, diabetes, obesity, heart failure) , sleep ( restless leg, OSA ), and patient is an old women menopause can be a contributing factor. It isn't a medical emergency but by simple life style changes and treatment of comorbidities patient can feel better. But if not treated properly it can result in fatigue, memory deficits, depression, increased risk of heart disease, gastrointestinal disorders, and, at times, traumatic injury through falls. Waking up multiple times disturb sleep and healthy sleep is important for a healthy body and active life.[1]


Common Causes

  • Hormonal imbalance which may leads to:
    • Global polyuria
    • Nocturnal polyuria
  • Vesical problems which includes bladder storage disorders:
    • Benign prostatic hyperplasia (BPH)
    • Neurogenic bladder dysfunction
    • Learned voiding dysfunction
    • Anxiety disorders
Common Factors[2] Diseases Associated with Nocturia
Old Age Men: BPH

Women: Interstitial cystitis, menopause, bladder prolapse, pelvic organ prolapse

Endocrine Diabetes Mellitus, diabetes insipidus, High blood pressure.
Cardiovascular Congestive heart failure, Heart disease, vascular disease, Edema in the lower limbs, or leg swelling
Genito-urinary Bladder obstruction (stones), inflammation, or other problems that affect bladder capacity (like bladder surgery or fibrosis from radiation), Overactive bladder symptoms, Prostate obstruction, Vaginal prolapse, Menopause, Childbirth, Reduced bladder capacity, Interstitial cystitis
Sleep disorders insomnia, sleep apnea, Restless leg syndrome
Timing or dose of medicines Diuretic medicine (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
uricosuric agents Increase and night time caffeine or alcohol Intake
Renal CKD, Infections, hypercalcemia, kidney stones
Hepatic hepatic failure
CNS Parkinson Disease, stroke, neurogenic bladder, Multiple sclerosis
psychiatirc anxiety disorders, learned voiding dysfunction, psychogenic polydipsia
Gastrointestinal certain pancreatic cancer


Urinary frequency volume chart
Reduced urinary frequency
{{{24hr Polydipsia}}}
{{{ 24HR Urine volume }}}
{{{ Nocturnal urine volume }}}
May have reduced bladder capacity
{{{ Increased fluid intake }}}
{{{ Global polyuria }}}
{{{Nocturnal polyuria }}}
Check for primary or secondary bladder disorders which include:
  • Post void residual volume
  • Urinalysis
  • Uroflowmetry
  • Urodynamic studies
  • Bladder biopsies
{{{ Check for:
  • Diabetes Insipidus
  • Diabetes Mellitus
  • Amount of fluid intake
  • Type of fluid intake
  • }}}


    Shown below is an algorithm summarizing the treatment of Nocturia according the the [...] guidelines.

    {{{ -}}}
    Start with Conservative Treatment:

    - First, educate the patient about the nature of his disease by drawing flowcharts or simple diagrams.

    - Restrict fluid intake at night.

    - avoid sugary food and coffee before bedtime

    -Manage use of diuretics

    -If previous illness leads to nocturia, then treating that illness will surely help. It's important to treat diabetes, an enlarged prostate (BPH), congestive heart failure, obstructive sleep apnea (OSA), and/or high blood pressure. Changing the timing and dose of prescribed medication may also help sometimes. Always look into the patient's previous records.

    -Scheduled voiding at timed intervals, varying from 15 min to 1 h, based on the patient’s own frequency or incontinence intervals

    - Make a record of their voiding during day and night.

    -Do pelvic muscle strengthening exercises (contracting pelvic floor muscles) to suppress urgency.

    -Elastic compression stockings prevent fluid build-up. So the use of compression stockings can be helpful.

    -Increase compliance determines the success of treatment,
    -Follow-up visits are scheduled every 1 to 2 weeks if the patient's condition is stable and he is responding to conservative therapy
    At some point Patients stops responding to behavioral modifications
    -Continue conservative treatments till it works
    If lifestyle changes alone don't help with your nocturia, some medicines may help.
    -Start Medical Intervention. -If patient experience bed-wetting, he can keep himself and his bed dry by using different products For example, waterproof mattress covers, absorbent briefs and skincare products.
    Medicines to help the kidneys produce less urine. For example, Desmopressin,

    Anticholinergic medicines to treat bladder muscle problems. for example: Darifenacin, Oxybutynin, Tolterodine.

    a-Adrenergic agonists: Increases urethral closure pressure. it includes Ephedrine and Pseudoephedrine.

    Antispasmodic like Baclofen

    Botulinum toxin

    Tricyclic antidepressant: Imipramine, Amitriptyline

    Diuretic medicines to regulate urine production and high blood pressure. For example, Bumetanide, Furosemide

    Women experiencing stress incontinence can use estrogen creams.
    Some patients who are refractory to behavioral and pharmacologic therapies respond to FES. Functional electrical stimulation (FES) increasing pelvic floor muscle and urethral striated muscle contractility.


    • Taking afternoon naps
    • Maintaining a healthy weight, as excess weight can put pressure on your bladder
    • Avoiding beverages with caffeine and alcohol after evening.
    • Always perform voiding diary in patient complaining of Nocturia. The frequency volume chart (FVC) is helpful in diagnosing underlying etiology for disease.
    • Doctors may also suggest that people with Nocturia drink fewer liquids during the evening and before bed.
    • Keeping a food diary is a helpful tool for many people


    • Don't confuse Nocturia with overactive bladder. While people with Overactive Bladder may experience frequent urination at night, people with Nocturia tend to only experience frequent urination at night.


    1. Weiss JP (2012). "Nocturia: focus on etiology and consequences". Rev Urol. 14 (3–4): 48–55. PMC 3602727. PMID 23526404.
    2. Weiss JP (2012). "Nocturia: focus on etiology and consequences". Rev Urol. 14 (3–4): 48–55. PMC 3602727. PMID 23526404.

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