From the Guidelines
Nocturia is primarily caused by nonurological mechanisms, including sleep disorders, cardiovascular conditions, renal disease, endocrine disorders, and neurological conditions, as identified in the PLANET study 1. The causes of nocturia can be complex and multifactorial, involving various medical conditions that affect salt and water handling or sleep quality.
- Sleep disorders such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) can contribute to nocturia 1.
- Cardiovascular conditions like hypertension and congestive heart failure (CHF) can also play a role in the development of nocturia 1.
- Renal disease, including chronic kidney disease (CKD), can lead to nocturia due to impaired urine concentrating mechanisms 1.
- Endocrine disorders such as diabetes mellitus, thyroid disease, and diabetes insipidus can also cause nocturia 1.
- Neurological conditions, including neurological disorders that affect bladder control, can also contribute to nocturia 1. The initial assessment and therapy of nocturia should consider the possibility of one or more medical conditions from these disease areas, and therapy of the medical condition may bring symptom relief of nocturia 1. Management strategies for nocturia include:
- Limiting fluid intake in the evening, especially caffeine and alcohol
- Taking prescribed medications like desmopressin for nocturnal polyuria, alpha-blockers for prostate issues, or anticholinergics for overactive bladder
- Elevating legs during the day to mobilize fluid for those with peripheral edema
- Addressing sleep disorders and optimizing treatment of conditions like diabetes and heart failure
- Patients should track their symptoms, including frequency and volume of urination, to help healthcare providers determine the most appropriate treatment approach 1. The evaluation of nocturia should include a review of the patient's past medical history, medications, and screening questions for identifying possible underlying medical conditions, as outlined in the PLANET study 1.
From the Research
Causes of Nocturia
The causes of nocturia are multifaceted and can be attributed to various factors, including:
- Poorly controlled diabetes 2
- Congestive heart failure 2
- Urinary dysfunction 2
- Obstructive sleep apnea (OSA) 2, 3, 4
- Sleep disorders, such as sleep apnea, snoring, or periodic leg movements in sleep 3
- Lower urinary tract symptoms, including nocturnal polyuria 5, 6
- Behavioral or environmental factors, such as excessive fluid intake before bedtime 6
- Pathologic conditions, including cardiovascular disease, diabetes mellitus, lower urinary tract obstruction, anxiety, or primary sleep disorders 6
- Diminished nocturnal or global bladder capacity 6
- Global 24-hour polyuria 6
Underlying Mechanisms
The underlying mechanisms of nocturia are complex and not fully understood, involving factors such as:
- Autonomic nervous system affects 4
- Oxidative stress and endothelial damage 4
- False signal of cardiac overload and response natriuresis 4
- Comorbidities, medication use, alcohol consumption, and lifestyle factors 4
Classification of Nocturia
Nocturia can be classified into different categories, including: