Differential Diagnosis for a 75-year-old Lady with Nocturia
Single most likely diagnosis
- Nocturnal Polyuria: This condition is characterized by the production of an excessive amount of urine at night, leading to frequent awakenings to void. It is a common cause of nocturia in the elderly, often due to age-related changes in the body's ability to concentrate urine, mobility issues, or global polyuria.
Other Likely diagnoses
- Overactive Bladder: Although the patient reports no urinary problems during the day, overactive bladder could still contribute to nocturia, especially if the bladder is not fully emptying during the day, leading to more frequent voiding at night.
- Benign Prostatic Hyperplasia (BPH) in Men is analogous to Pelvic Organ Prolapse or Uterine Fibroids in Women: While BPH is more common in men, conditions like pelvic organ prolapse or uterine fibroids in women can cause urinary retention, leading to dribbling and frequent urination, especially at night.
- Sleep Disorders: Sleep disorders such as sleep apnea can increase the production of urine at night, leading to nocturia.
- Medication Side Effects: Certain medications, such as diuretics, can increase urine production, leading to nocturia.
Do Not Miss diagnoses
- Diabetes Mellitus: Uncontrolled diabetes can lead to polyuria, causing frequent urination both day and night. It's crucial to rule out diabetes due to its significant impact on health.
- Congestive Heart Failure: CHF can cause nocturia due to increased fluid redistribution and increased renal perfusion at night, leading to increased urine production.
- Renal Failure: Chronic kidney disease can lead to a decrease in the kidney's ability to concentrate urine, resulting in polyuria and nocturia.
- Sleep Apnea: Although mentioned earlier, sleep apnea is also a "do not miss" diagnosis due to its association with significant cardiovascular and other health risks.
Rare diagnoses
- Multiple Sclerosis or Other Neurological Disorders: Certain neurological conditions can affect bladder control, leading to urinary frequency, urgency, and incontinence, including at night.
- Bladder Cancer: Although rare, bladder cancer can cause irritative voiding symptoms, including frequency and nocturia.
- Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which can lead to frequent and urgent need to urinate, including at night.