From the Guidelines
Nocturia is commonly caused by nonurological medical conditions, including sleep disorders, cardiovascular disease, renal disease, endocrine disorders, and neurological conditions, as identified in the PLanning Appropriate Nocturia Evaluation and Treatment (PLANET) study 1, 2, 3. The most frequent causes of nocturia include:
- Excessive fluid intake before bedtime
- Urinary tract infections
- Enlarged prostate (BPH) in men
- Overactive bladder
- Diabetes
- Heart failure
- Sleep disorders like sleep apnea
- Certain medications such as diuretics Age-related changes also contribute to nocturia, as the body produces less antidiuretic hormone at night as we get older, leading to increased nighttime urine production 4. Treating nocturia depends on identifying the underlying cause, and management strategies include:
- Limiting fluid intake in the evening (especially caffeine and alcohol)
- Taking prescribed medications at appropriate times
- Treating underlying conditions
- Using medications like desmopressin for nocturnal polyuria or alpha-blockers for prostate issues
- Behavioral modifications like timed voiding and pelvic floor exercises for overactive bladder It is essential to determine the degree to which function is impaired and the negative impact on quality of life to make decisions about thresholds for treatment 4. If nocturia persists or is accompanied by other symptoms like pain, fever, or blood in urine, medical evaluation is necessary as it could indicate a more serious condition requiring specific treatment 5, 6.
From the Research
Causes of Nocturia
The causes of nocturia are multifactorial and can be attributed to various factors, including:
- Nocturnal polyuria (nocturnal urine overproduction) 7, 8, 9, 10
- Diminished nocturnal bladder capacity 7, 9
- Systemic medical diseases such as:
- Lower urinary tract pathology 7, 8, 9, 10
- Sleep disorders such as:
- Behavioral and environmental factors 7, 8, 9
- Medications 8
Pathophysiology
Nocturia can result from a fundamental mismatch between nocturnal urine production, storage capacity, and sleep architecture 8. The distinction between nocturnal polyuria and diminished nocturnal bladder capacity can be made by a simple arithmetic analysis of the 24-hour voiding diary 7. Understanding the manifold origins of nocturia is essential for rational treatment of specific contributing pathophysiologic factors 7.