Managing nocturia – a review of diagnosis and treatment

This study reviewed the management of nocturia.

Nocturia is a condition where patients wake frequently at night to urinate. If untreated, it can have a negative effect on quality of life (QOL). Nocturia can be caused by a number of factors. In some cases there is excess production of urine at night, This is called nocturnal polyuria (NPU). Other conditions such as diabetes, prostate cancer, and sleep apnea are also linked to nocturia. 

Managing nocturia is important for QOL. It also affects sleep and this can increase the risk of disease. Accurate diagnosis and treatment of nocturia are of great importance. 

This study reviewed 628 reports on the management of nocturia. The aim of nocturia management is to reduce the number of nightly voids (urinations) and improve QOL. To do this, a number of approaches can be used. These include medication or behavioral strategies. A combination of both is often useful. 

One cause of nocturia is NPU. NPU can be caused by obstructive sleep apnea (OSA). OSA can lead to increases in urinary volume. Increased urine production can lead to NPU and nocturia. To treat this, there are 3 options.

A diuretic drug such as furosemide (Lasix) can be taken 6 hours before bedtime. This will cause increased urination before bedtime. Another option is a tricyclic antidepressant (TCA) such as imipramine (Tofranil). It should be taken at bedtime. TCAs stimulate a chemical called vasopressin (VP). VP leads to salt and water being reabsorbed at the kidneys. Less urine is then produced. Another treatment is desmopressin (DP; Noctiva).  DP is a synthetic form of VP. It is very effective in treating nocturia and NPU. DP can cause low sodium (salt) in the blood due to increased water volume. 

Another cause of nocturia is diminished bladder capacity (DBC). DBC can be caused by obstructions in the bladder. Obstruction in the bladder is often caused by a blockage in the prostate gland. Drugs that relax the smooth muscle in the bladder and prostate can improve DBC. Enlargement of the prostate (benign prostatic hyperplasia, BPH) may also cause DBC. A combination of an alpha-1 adrenoreceptor blocker and a 5-alpha-reductase inhibitor may be effective. Overactive bladder (OAB) can be a consequence of DBC. OAB is characterized by an increased urge to urinate. Urgency (immediate need) to urinate is also part of OAB. Treatment of OAB is difficult. Medication can be prescribed to relax the bladder muscle. 

This study reviewed the management of nocturia.

If you have any concerns regarding nocturia management, please consult with your doctor.