From the Guidelines
Nocturia increases with age due to a combination of physiological changes, medical conditions, and lifestyle factors, and managing it typically involves addressing underlying conditions and modifying lifestyle habits, as recommended by the most recent study 1. The most significant physiological changes contributing to nocturia in older adults include decreased production of antidiuretic hormone (ADH), reduced bladder capacity, and increased detrusor muscle overactivity. Medical conditions that become more prevalent with age, such as benign prostatic hyperplasia, diabetes, heart failure, and sleep apnea, also play a crucial role in the development of nocturia. Additionally, certain medications commonly prescribed to older adults, such as diuretics, can exacerbate nocturia, especially when taken in the evening. Some key points to consider when managing nocturia include:
- Addressing underlying medical conditions, such as those related to sleep, cardiovascular, renal, endocrine, and neurology, as identified in the PLANET study 1
- Modifying lifestyle habits, such as timing fluid intake earlier in the day, avoiding bladder irritants like caffeine and alcohol in the evening, and reducing sedentary lifestyle
- Using medications like desmopressin to reduce nighttime urine production in appropriate candidates, as suggested in the study 1
- Completing a frequency-volume chart (FVC) to diagnose polyuria or nocturnal polyuria, and treating accordingly, as recommended in the study 1 The most effective approach to managing nocturia is a shared decision-making process between the physician and patient, taking into account the individual's unique needs and circumstances, as emphasized in the study 1.
From the Research
Nocturia and Age
- Nocturia is defined as the urge to urinate at night when the micturition was directly preceded and followed by sleep 2.
- It is a frequent condition among older adults and entails detrimental effects with regard to sleeping, sexual activity, comfort, depression, mental function, and vitality 3.
- The risk of nocturia increases with age due to various factors, including changes in bladder function, hormonal changes, and the presence of underlying medical conditions such as benign prostatic hyperplasia (BPH) 4, 5, 6.
Underlying Causes of Nocturia
- Nocturnal polyuria, which is an abnormally large volume of urine during sleep associated with a decreased daytime urine production, is a common cause of nocturia in older adults 3, 4, 5, 6.
- Global polyuria, defined as a urinary rate ≥ 125 ml/h (3000 ml/day), can also contribute to nocturia 3.
- Other factors, such as lower urinary tract symptoms (LUTS), urogenital disorders, and certain medications, can also play a role in the development of nocturia 2, 4, 5, 6.
Treatment of Nocturia
- Desmopressin, a synthetic hormone that helps regulate urine production, is an effective treatment for nocturia caused by nocturnal polyuria 2, 4, 5, 6.
- Low-dose oral desmopressin has been shown to decrease nocturnal urine output and the number of nocturia episodes, and improve the overall quality of life and sleep in patients with nocturia 4, 5, 6.
- Lifestyle modifications, such as modifying dietary habits and avoiding alcohol, coffee, and tea, can also help alleviate nocturia symptoms 2.