From the Guidelines
Nocturia is commonly 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, insomnia, and restless legs syndrome can increase the likelihood of nocturia.
- Cardiovascular conditions like hypertension and congestive heart failure can also contribute to nocturia.
- Renal disease, including chronic kidney disease, can affect the kidneys' ability to concentrate urine, leading to nocturia.
- Endocrine disorders such as diabetes mellitus and thyroid disease can also play a role in the development of nocturia.
- Neurological conditions like multiple sclerosis and Parkinson's disease can affect bladder control and lead to nocturia.
To manage nocturia, it is essential to identify and address the underlying medical condition, as treatment of the condition may improve or resolve the nocturia symptoms 1.
- Initial evaluation should include a review of the patient's medical history, medications, and lifestyle factors, as well as screening questions to identify possible underlying conditions.
- Baseline investigations such as a 72-hour bladder diary, blood tests, and urine dipstick analysis can help identify the underlying cause of nocturia.
- Treatment of the underlying condition, such as continuous positive airway pressure (CPAP) for obstructive sleep apnea or medication adjustment for diabetes, may improve or resolve the nocturia symptoms.
Addressing the root cause of nocturia is essential for effective management of this disruptive condition, and treatment should prioritize the underlying medical condition over the nocturia symptom, if necessary, to ensure the patient's overall health and safety 1.
From the Research
Causes of Nocturia
Nocturia can be caused by various factors, including:
- Intake factors, such as increased fluid intake 2
- Urological factors, such as benign prostatic hyperplasia (BPH) 3
- Nephrological factors, such as chronic kidney disease 4
- Hormonal factors, such as low nocturnal serum concentration of the antidiuretic hormone 3
- Sleep factors, such as sleep disorders 5
- Cardiovascular factors, such as hypertension and congestive heart failure 4
Pathophysiology of Nocturia
The pathophysiology of nocturia is complex and can involve:
- Nocturnal polyuria (NP), characterized by overproduction of urine at night 2, 3, 4
- Diminished nocturnal bladder capacity 2, 6
- Global polyuria 2
- Sleep disorders, such as primary sleep disorders or sleep disorders secondary to other medical conditions 5
Associated Medical Conditions
Nocturia can be associated with various medical conditions, including: