Nocturia: Causes & Treatments of Overactive Bladder During Night

Nocturia, also known as Nocturnal Polyuria, is known as excessive urination due to an overactive bladder during the night. There are various causes leading to Nocturia which may interrupt your sleep during the night and make you wake up to urinate several times during your sleep time.¹ In this article we will talk about the causes and various treatment procedures of Nocturia, or the condition of an overactive bladder during the night.

Our body during the sleeping hours produces less urine that is more concentrated. This implies that most people do not require waking up during the night for urinating and can complete an uninterrupted sleep of 6- 8 hours.

However, people suffering from Nocturia, or the condition of an overactive bladder, during night usually have to wake up at the night to urinate several times. There may be various underlying medical conditions that may lead to Nocturia and also the lifestyle choices of an individual contribute to the causes. We will talk more about the causes and know about the effective treatments for nocturia in our following arrays.

Though nocturia can affect people of any age group; most commonly it affects older adults. It may also be experienced by pregnant women during their early pregnancy.²

Here let us take a look on various causes for Nocturia or an overactive bladder during the night.

There are many medical conditions that cause nocturia or overactive bladder at night. UTI or Urinary tract infection or infection in the bladder can be one such medical condition leading to nocturia. Apart from this, bladder prolapse, tumor in prostrate, bladder or pelvic area can also lead to nocturia. Infection of prostrate, infection of kidney, diabetes, edema or swelling of lower legs, anxiety, multiple sclerosis, Parkinson’s disease or other neurological disorders, etc. can also be some causes leading to nocturia or an overactive bladder during night.^{3, 4}

Pregnancy is a phase where women may experience nocturia or overactive bladder during night. Nocturia usually develops during the early stages of pregnancy and is more commonly experienced when the womb during the later stages of pregnancy presses against the bladder.

Sometimes Nocturia is also experienced as a symptom of obstructive sleep apnea. In case the bladder is not full, such symptoms can be experienced. Symptoms of nocturia subside once sleep apnea is controlled.⁵

Some specific medications like the diuretics prescribed to treat high BP, may cause nocturia or overactive bladder during night.

Nocturia can also be experienced in people consuming more alcohol or caffeinated beverages which are diuretics leading to increased urination during night-time.⁶

It is known that older people mostly suffer from nocturia. There are various reasons for this such as.

Decreased Bladder Elasticity. One of the reasons for nocturia or overactive bladder in older people is that the older one becomes, the bladder loses its elasticity resulting in nocturia in older individuals.

Hormonal Causes. Our body makes a hormone during night, which reduces the function of kidney while we are sleeping. So we normally make less urine during night time. However, as we grow older less amount of this hormone is produced and this in turn may lead to nocturia as we get older.

Enlarged Prostate Glands. Prostate glands in men usually get enlarged as they grow old. This in turn restricts the bladder outlet and thus not the entire amount of urine from the bladder is passed out. This means the bladder gets filled quickly again and thus may make the person go for frequent urination. It is known that about 60% to 80% of men above 80 years of age have an enlarged prostate gland causing nocturia in them.

Less Efficient Circulatory System. A less efficient circulatory system during older age may also be a reason for nocturia in older people. The kidneys filter our blood, as it passes through them and then collect the waste products along with extra fluids from around our body. Then they form the urine from the waste products and excess fluid and pass it to the bladder. However as we grow old, the circulatory system has a reduced function or becomes less efficient. This means, some amount of fluid are left behind in the body tissues, especially in the ankles in the lower legs. As we lie down it becomes easier for the circulatory system to function. Thus, the fluids from ankles pass in to the bloodstream and reach the kidney and then again pass to the bladder as urine. This means, your bladder fills quickly as we sleep. Thus, this is why nocturia is common in older people.⁷

Diagnosis for the cause of Nocturia or an overactive bladder during night can be difficult at times. However your doctor would require certain things to know about your medical history, your lifestyle choices, your medications etc. and then you may need to undergo certain tests. Below we will talk about the tests you might undergo in doctor’s office for diagnosis of nocturia or overactive bladder during night.

Physical Examination. Your doctor would look for the following in order to diagnose the cause of nocturia.

Check if there is leg edema present.

The doctor will also check for an enlarged bladder by percussing the abdomen.

Other relevant examinations depending on the suspected cause for nocturia; like neurological cause, cardiovascular cause etc. are looked into

Various Tests for Nocturia. Following are some of the tests your doctor would perform on you to know about the cause of Nocturia or overactive bladder during night. blood sugar test, blood urea test, fluid deprivation test, urine culture and various imaging tests like ultrasound.⁸

Treatment for nocturia or an overactive bladder usually begins with a change in lifestyle. Apart from this, treating the cause of nocturia is the main line of treating nocturia. Medications do help treating nocturia or overactive bladder during the night. Surgical procedures may be used to treat the symptoms of nocturia based on the underlying medical conditions causing the same. Here we will look on the treatments in a more precise manner.

Managing certain lifestyle choices, one can manage reducing symptoms of nocturia. Prohibiting the consumption of alcohol or caffeine can help some people in reducing symptoms of nocturia or overactive bladder during night. Apart from this, one can get some help in treating the nocturia symptoms by not taking any fluids one hour before sleeping. There are also conditions like swelling of legs, which may cause nocturia. Wearing compression stockings during day and preventing fluid accumulation in the legs can be helpful in reducing swelling of legs and thus may reduce symptoms of nocturia.⁹

Adults having issues of nocturia or overactive bladder during night may find some benefit from Desmopressin, Oxybutynin, Solifenacin etc. are some other medications, which may be used to treat nocturia.

Surgical Treatments Available for Nocturia or Overactive Bladder During Night. Surgical treatments for nocturia are usually rare. However, in case the underlying cause for nocturia is associated with the obstruction of bladder, then surgery may help in treating the condition.¹⁰

Apart from all the treatments, treatments for nocturia may involve treating the underlying cause of the symptoms.

Some of the ways one can prevent nocturia include the following.

• Reduce drinking more fluids during night, especially 1-2 hours before sleeping.
• Do not consume alcohol or caffeine which may cause nocturia.
• Chocolates, spicy foods etc. can act as diuretics and may lead to nocturia if taken during night time before sleeping.
• Go for the exercises, which can help you strengthen your pelvic muscles and enhance the bladder control and hence prevent nocturia.
• Talk to your doctor in case you have symptoms of various medical conditions that may lead to nocturia and get appropriate treatment.

So, above we talked about the condition of nocturia or an overactive bladder during night. It surely is difficult to live with nocturia. In case you are experiencing nocturia, then talk to your doctor immediately and go for appropriate management of the condition.

References: