Nocturia

For patient information click here

Nocturia
ICD-10	R35
ICD-9	788.43

Template:Search infobox Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1]

Overview

Nocturia (derived from Latin nox, night, and Greek [τα] ούρα, urine), also called nycturia (Greek νυκτουρία), is the need to get up during the night in order to urinate, thus interrupting sleep. Its occurrence is more frequent in the elderly. Nocturia could result simply from too much liquid intake before going to bed, or it could be a symptom of a larger problem, such as chronic renal failure, urinary incontinence, Interstitial Cystitis, diabetes, benign prostatic hyperplasia, Ureteropelvic junction obstruction or prostate cancer.

Historical Perspective

[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].

The association between [important risk factor/cause] and [disease name] was made in/during [year/event].

In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].

In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].

There have been several outbreaks of [disease name], including -----.

In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].

Pathophysiology

The exact pathogenesis of [disease name] is not fully understood.

OR

It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].

OR

[Pathogen name] is usually transmitted via the [transmission route] route to the human host.

OR

Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.

OR

[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].

OR

The progression to [disease name] usually involves the [molecular pathway].

OR

The pathophysiology of [disease/malignancy] depends on the histological subtype.

Causes

Causes by Pathogenesis

Causes of Nocturia

Due to Hormonal imbalance

Due to Vesical problems

Global Polyuria

Nocturanl Polyuria

Sleep disorders

Bladder storage disorders

Causes Due to Hormonal Imbalance

Global Polyuria	Nocturnal Polyuria	Sleep disorders
Defined as a 24-hour urine volume that exceeds 3 liters per day (or 40 mL per kg). The common causes of global polyuria are Diabetes mellitus- caused by low levels of Insulin Diabetes insipidus- caused by low levels of AVP	Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. Nocturnal polyuria may be due to age-related changes in the secretion and action of arginine vasopressin (AVP). There is a diurnal periodicity in AVP release in young, healthy subjects, with higher AVP plasma levels in the evening contributing to decreased nighttime urine output. The diurnal variation in AVP release is absent in many older people. Compared with the normal patients, nocturia patients have a nocturnal decrease in AVP level. Other causes of nocturnal polyuria include diseases such as congestive heart failure, nephrotic syndrome and Hepatic failure or lifestyle patterns such as excessive nighttime drinking.	Sleep disorders have been demonstrated to be a frequent cause of nocturia in men younger than 50 years and in women with symptoms of daytime overactive bladder syndrome. Primary sleep disorders may result in nocturia either because of hormonal changes related to sleep-disordered breathing or due to patient misperception of the reason for awakening due to the sleep disturbance but recall this as an awakening to void. e.g. Obstructive sleep apnea(OSA) Restless leg syndrome OSA may also cause nocturnal polyuria by release of atrial natriuretic peptide (ANP).

Causes Due to Vesical Problems

Bladder storage disorder
Reduced bladder capacity or impaired bladder function results in low-volume voids. Most common causes of low-volume bladder voids are Overactive bladder (e.g. Urge incontinence) Bladder outlet obstruction (e.g. BPH)

Causes by Organ System

Cardiovascular	Heart failure
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Bicalutamide, Cardiac glycosides, Demeclocycline, Diuretics, Excessive vitamin D intake, Lithium, Methoxyflurane, Phenytoin, Propoxyphene, Tiagabine
Ear Nose Throat	No underlying causes
Endocrine	Liver failure
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Interstitial cystitis, Recurrent UTI
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Detrusor hyperactivity, Diabetes insipidus, Neurogenic bladder , Parkinson disease, Restless leg syndrome, Urge incontinence
Nutritional/Metabolic	Diabetes, Obesity
Obstetric/Gynecologic	No underlying causes
Oncologic	Prostate cancer
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Anxiety disorders, Depression, Obstructive sleep apnea, Primary polydipsia
Pulmonary	No underlying causes
Renal/Electrolyte	Chronic renal failure, Diabetes insipidus, Nephrotic syndrome
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Benign prostatic hyperplasia, Bladder outlet obstruction, Detrusor hyperactivity, Granulomatous prostatitis, Interstitial cystitis, Neurogenic bladder, Prostate cancer, Ureteropelvic junction obstruction
Miscellaneous	Learned voiding dysfunction, Venous insufficiency

Causes in Alphabetical Order

• Anxiety disorders
• Benign prostatic hyperplasia
• Bicalutamide
• Bladder outlet obstruction
• Cardiac glycosides
• Chronic renal failure
• Demeclocycline
• Depression
• Detrusor hyperactivity
• Diabetes
• Diabetes insipidus
• Diuretics
• Excessive vitamin D intake
• Granulomatous prostatitis
• Heart failure
• Interstitial cystitis
• Learned voiding dysfunction
• Lithium
• Liver failure
• Methoxyflurane
• Nephrotic syndrome
• Neurogenic bladder
• Obesity
• Obstructive sleep apnea 
• Parkinson disease
• Phenytoin
• Primary hyperaldosteronism
• Propoxyphene
• Primary polydipsia
• Prostate cancer
• Recurrent UTI
• Restless leg syndrome
• Tiagabine
• Ureteropelvic junction obstruction
• Urge incontinence
• Venous insufficiency

Differentiating ((Page name)) from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

OR

In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.

OR

In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.

Patients of all age groups may develop [disease name].

OR

The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.

OR

[Disease name] commonly affects individuals younger than/older than [number of years] years of age.

OR

[Chronic disease name] is usually first diagnosed among [age group].

OR

[Acute disease name] commonly affects [age group].

There is no racial predilection to [disease name].

OR

[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].

[Disease name] affects men and women equally.

OR

[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.

The majority of [disease name] cases are reported in [geographical region].

OR

[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].

Risk Factors

There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

Screening

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

Natural History, Complications, and Prognosis

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Diagnosis

Diagnostic Study of Choice

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

History and Symptoms

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

Physical Examination

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

See also

• Polyuria
• Enuresis