From the Guidelines
Nocturia in females can be caused by various nonurological mechanisms, including sleep disorders, cardiovascular conditions, renal disease, endocrine disorders, and neurological conditions, as identified in the PLANET study 1.
Causes of Nocturia
The causes of nocturia can be categorized into several areas, including:
- Sleep medicine: insomnia, periodic limb movements of sleep, parasomnias, and obstructive sleep apnoea
- Cardiovascular: hypertension and congestive heart failure
- Renal: chronic kidney disease
- Endocrine: diabetes mellitus, thyroid disease, pregnancy/menopause, and diabetes insipidus
- Neurology: conditions that affect the brain and nervous system
Evaluation and Treatment
The evaluation of nocturia should consider the possibility of one or more medical conditions from these disease areas, and therapy should be tailored to the underlying cause 1. The initial assessment should include:
- Establishing the impact of nocturia on the patient's quality of life
- Review of past medical history and medications
- Screening questions for identifying possible SCREeN conditions
- Gross examination and baseline investigations, such as a 72-h bladder diary and blood tests
Management
Treatment of the underlying medical condition is crucial in managing nocturia, and in some cases, therapy of the medical condition can lessen the severity of nocturia 1. However, in many cases, there is a conflict between managing the medical condition and the nocturia symptom, and the medical condition generally takes priority on safety grounds. Medication adjustment and lifestyle modifications, such as limiting evening fluids, may also be necessary to manage nocturia. It is essential to discuss with the patient the priority given to overall health and the limitations of treatment, so they do not develop unrealistic expectations of nocturia improvement 1.
From the Research
Causes of Nocturia in Females
- Nocturia is defined as the urge to urinate at night when the micturition was directly preceded and followed by sleep 2
- The main risk factors for the occurrence of nocturia include lower urinary tract symptoms, underlying illnesses, urogenital disorders, previous surgeries, and medications administered 2
- In females, nocturia can be caused by various factors, including diurnal polyuria, nocturnal polyuria, and bladder storage problems 3
- A clear understanding of the underlying pathophysiology of nocturia is necessary to address symptoms and co-morbid conditions 3
Diagnostic Evaluation
- Diagnostic evaluation of nocturia in females includes a detailed patient's history, physical examination, laboratory tests, and a voiding bladder diary 2, 3
- A gynecological examination with pelvic organ prolapse assessment is recommended as part of the physical examination 2
Treatment Options
- Treatment of nocturia in females can begin with modifying dietary habits, including compliance with the fluid regimen, avoiding alcohol, coffee, and tea, and moderate physical exercise 2
- Pharmacological treatment of nocturia caused by nocturnal polyuria is based on the use of desmopressin, with a daily single dose of 25 µg for women 2, 4
- Desmopressin has been shown to be effective in reducing the number of nocturia episodes and improving the overall quality of life and sleep 2, 5, 4