What are the Causes of Nocturia?

Awakening to Urinate

Nocturia, the need to wake from sleep and urinate at least once a night, can lead to serious health complications. It may also indicate a serious, pre-existing health condition. Affecting both men and women of middle-age and older, nocturia should not be ignored or written off as “normal.”

Nocturia’s Serious Health Complications

The sleep disturbances caused by nocturia can lead to a myriad of complications that significantly affect quality of life. Inadequate sleep resulting from nocturia can cause depression. [1] Sleep disorders can cause physical health to suffer by way of dizziness, hypertension and increased sedentary lifestyle. This increased feeling of fatigue ruins daytime productivity and overall quality of life.

Causes of Nocturia

Nocturia may be a symptom of a variety of health conditions. It may represent a developing condition like chronic kidney disease. [2] It may also be a symptom of obstructive sleep apnea, overactive bladder, diabetes, or, especially in older men — benign prostate enlargement. [3] Advanced age and inadequate sleep can also cause problems for proper bladder function.

Ailments Associated with Nocturia

Cardiovascular disease and erectile dysfunction, as well as an increased risk of stroke have been linked to nocturia. [4] Studies have also reported an increased risk of coronary heart disease in younger men…and an increased risk of hip fractures and death in older men. [5] [6] Frequent bouts of nocturia may further create a testosterone deficiency in men. [7]

Coping With Nocturia

Several strategies have proven successful in reducing and even eliminating the occurrence of nocturia. These range from drugs, nutritional supplements, surgery, and even simple lifestyle changes.

Pharmaceutical Options

Desmopressin, a drug used to treat bedwetting for children, has been prescribed more frequently for adults in recent years. However, like many pharmaceuticals, there are several concerns regarding this drug’s side effects. These include potential hyponatremia, as well as headache, nausea, vomiting, loss of consciousness and death. [8] Another drug more frequently used to treat overactive bladder is botox (short for Botulinum toxin). While the effects may last for several months, serious questions remain about its safety. [9]

Surgical Solutions for Nocturia

Surgery should be the last resort, and for some men suffering from BPH (benign prostate hypoplasia) surgery has proven successful. Men who had part or all of their prostate removed have reported improved sleep and quality of life. [10] Despite this, surgery should remain a last resort only after all less invasive methods have been exhausted, especially those that focus on nutrition or lifestyle changes.

Lifestyle Changes

In many cases, lifestyle changes have proven as effective as drugs. Studies have found that simple changes such as reducing fluid intake before bed, exercising daily, keeping warm while sleeping and not spending too many hours in bed can reduce the need to get up and empty the bladder. [11] Pelvic floor exercises have also been used to strengthen the muscles around the prostate and bladder, reducing or eliminating the need to empty the bladder during the night. Additionally, for men, protecting prostate health also appears to be a significant factor in avoiding nocturia.

Considering the potential complications that accompany consistent nocturia, following these protocols can go a long way to ensuring quality sleep and maintaining an enjoyable quality of life.

– Dr. Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM

References:

  1. Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Raison CL, Master VA. Nocturia associated with depressive symptoms. Urology. 2011 Jan;77(1):183-6. doi: 10.1016/j.urology.2010.04.048.
  2. Boongird S, Shah N, Nolin TD, Unruh ML. Nocturia and aging: diagnosis and treatment. Adv Chronic Kidney Dis. 2010 Jul;17(4):e27-40. doi: 10.1053/j.ackd.2010.04.004.
  3. Plantinga L, Rao MN, Schillinger D. Prevalence of self-reported sleep problems among people with diabetes in the United States, 2005-2008. Prev Chronic Dis. 2012;9:E76. Epub 2012 Mar 22.
  4. Kemmer H. The relationship between sleep apnea and overactive bladder. Curr Urol Rep. 2009 Nov;10(6):448-50.
  5. Lightner DJ, Krambeck AE, Jacobson DJ, McGree ME, Jacobsen SJ, Lieber MM, Roger VL, Girman CJ, St Sauver JL. Nocturia is associated with an increased risk of coronary heart disease and death. BJU Int. 2012 Sep;110(6):848-53. doi: 10.1111/j.1464-410X.2011.10806.x. Epub 2012 Jan 10.
  6. Galizia G, Langellotto A, Cacciatore F, Mazzella F, Testa G, Della-Morte D, Gargiulo G, Ungar A, Ferrara N, Rengo F, Abete P. Association between nocturia and falls-related long-term mortality risk in the elderly. J Am Med Dir Assoc. 2012 Sep;13(7):640-4. doi: 10.1016/j.jamda.2012.05.016. Epub 2012 Jul 3.
  7. Kim MK, Zhao C, Kim SD, Kim DG, Park JK. Relationship of sex hormones and nocturia in lower urinary tract symptoms induced by benign prostatic hyperplasia. Aging Male. 2012 Jun;15(2):90-5. doi: 10.3109/13685538.2012.659715. Epub 2012 Mar 2.
  8. ten Doesschate T, Reichert LJ, Claassen JA. [Desmopressin for nocturia in the old: an inappropriate treatment due to the high risk of side-effects?]. Tijdschr Gerontol Geriatr. 2010 Dec;41(6):256-61.
  9. Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD005493. doi: 10.1002/14651858.CD005493.pub3.
  10. Zhou LL, Li HX, Wang B, You M, Wu SS, Tang P, Jiang SJ, Ou RB, Deng XR, Xie KJ. [The effect of prostatectomy on nocturia in patients with benign prostatic hyperplasia]. Zhonghua Wai Ke Za Zhi. 2010 Dec 1;48(23):1778-80.
  11. Soda T, Masui K, Okuno H, Terai A, Ogawa O, Yoshimura K. Efficacy of nondrug lifestyle measures for the treatment of nocturia. Urol. 2010 Sep;184(3):1000-4. doi: 10.1016/j.juro.2010.05.038.

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