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Questions & Answers about Nocturia

Our team of experts answer all your Nocturia related questions

The term “Nocturia” defines the need to wake at night from sleep to void. Nocturia is likely clinically meaningful if a patient voids two or more times nightly. It is the most distressing symptom in men with benign prostatic hyperplasia and it is the lower urinary tract symptom most strongly associated with poor quality of life.

Nocturia is a leading cause of sleep disturbance, and is associated with increased rates of depression, lower self-rated physical and mental health, congestive heart failure and increased all cause mortality. Did you know that nocturnal polyuria is an important component of nocturia?


Expert Answers

What is Nocturia?

What is Nocturia?

Nocturia is defined by the International Continence Society (ICS) as the complaint that the individual has to wake at night one or more times to void. Each void is preceded and followed by sleep1.
 

1. Van Kerrebroeck et al. Neurourol Urodyn 2002;21:179–183

How common is nocturia and who gets it

How common is nocturia and who gets it

A meta-analysis of 43 studies shows that Nocturia is present in a significant proportion of all populations studied, and across nationalities, gender and age groups.1

 

Although Nocturia increases with age, a substantial proportion of younger adults are also affected. Nocturia is generally found to be equally common in men and women. However, some studies show that younger women are more likely to be affected than men.

 

The prevalence of Nocturia (≥1 and ≥2 nocturnal voids) is summarised by age and gender below.

 

Age range Nocturnal voids Prevalence
    Men (%) Women (%)
20-40 years ≥1 11–35.2

20.4–43.9

  ≥2 2–16.6 4.4–18
70–80 years ≥1 68.9–93 74.1–77.1
  ≥2 29–59.3 28.3–61.5


1. Bosch & Weiss. J Urol 2010;184: 440-446

What causes nocturia?

What causes nocturia?

 The most common cause of Nocturia is Nocturnal Polyuria (NP), i.e. an overproduction of urine at night. Other major causes include bladder storage problems, global polyuria or a mixture. Conditions underlyingnocturia and NP are outlined in several recent reviews.1, 2, 3 Clinicians should be alert to the fact that this overproduction of urine at night may be a key contributory factor in their patients, even those with an OAB or BPO diagnosis. NP can be identified easily with the routine use of frequency-volume charts, which also provide a reasonable indication of the patient functional bladder capacity.

 

1. Bosch & Weiss. J Urol 2010;184: 440-446.

2. Weiss et al. J Urol 2011; 186:1358–1363

3. Weiss et al. Neurourol and urodyn 2012; DOI 10.1002/nau.22219

What is nocturnal polyuria?

What is nocturnal polyuria?

Nocturnal polyuria (NP) is the over-production of urine at night. In subjects aged ≥65 years, NP is present when >33% of the 24-hour urine volume is voided at night (including first morning void). In subjects aged <65 NP is present when >20% of total urine is voided at night1


1. van Kerrebroeck P et al. Neurourol Urodyn 2002;21:179-183

How prevalent is nocturnal polyuria in nocturia?

How prevalent is nocturnal polyuria in nocturia?

Recent data indicate that NP is highly prevalent among patients presenting for treatment of nocturia2. In the primarily European NOCTUPUS trials the prevalence of NP among these patients was estimated to be between 64% and 76%; in studies conducted in North America it was estimated to be between 57–88%.


2. Weiss JP et al. J Urol 2011; 186:1358–1363

Who gets nocturnal polyuria?

Who gets nocturnal polyuria?

Prevalence increases with age (Figure 1) and is high in men and women with nocturia regardless of whether voiding disorders (eg benign prostatic hyperplasia [BPH] or overactive bladder [OAB]) are present or not (Figure 2). In fact, ‘is NP present in most patients with nocturia regardless of gender, age, ethnicity, country and concomitant BPH/OAB treatment’2.


2. Weiss JP et al. J Urol 2011; 186:1358–1363

What are the consequences of nocturia?

What are the consequences of nocturia?

 Nocturia is the leading cause of sleep disturbance and is an independent predictor of poor sleep1, 2, 3. Poor sleep is associated with poor physical and mental health and impaired performance at work4. A recent review summarises the effect of nocturia on sleep.5

1. Middelkoop et al. J Gerontol A Biol Sci Med Sci 1996;51:M108–M115

2. Ohayon. J Psychiatr Res2008; 43:48–54

3. Bliwise et al. Sleep Med 2009;10:540–548

4. Kobelt et al. BJU Int  2003;91:190–195

5. Ancoli-Israel et al. Sleep Med Rev 2011;15:91-97

 

 Nocturia is associated with several negative outcomes, including (but not limited to): falls and fractures, depression, cardiovascular disease, and increased mortality risk. 6, 7, 8, 9

6. Nakagawa et al. J Urol 2010;184:1413–1418

7. Kupelian et al. Eur Urol 2012;61:78–84

8. Lightner et al. BJU Int 2012; DOI:10.1111/j.1464-410X.2011.10806.x

9. Kupelian et al. J Urol 2011;185:571–577

How should nocturia be evaluated?

How should nocturia be evaluated?

A key instrument in the evaluation of Nocturia and differential diagnosis among the underlying causes is the frequency volume chart (FVC), in which patients record the volume and timing of daytime and nighttime voids for 1-3 days.1, 2, 3 Based upon analysis of the 24-hr FVC, the patient may be categorized as having any of the following: (1) nocturnal polyuria; (2) low bladder capacity (nocturnal and/or 24 hr); (3) mixed (a combination of NP and low global or nocturnal bladder capacity (NBC)); and (4) global polyuria. 

 

1. Bosch & Weiss. J Urol 2010;184: 440-446.

2. Weiss et al. BJU Int 2011;108: 6–21

3. Van Kerrebroeck et al. Int J Clin Pract 2010;64:807–816

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Lecture from the ICS

6th - 9th October 2015

ICS 2015: Nocturia Plenary Satellite Symposium, Montreal, Canada

Program Chair: Philip E. V. Kerrebroeck

Featured Editorial

Defining Nocturnal Polyuria
By Prof. Philip van Kerrebroeck

Best read article

  • Nocturia in older men

    Boris van Doorn, J.L.H. Ruud Bosch

    Maturitas, Volume 71, Issue 1, 2012, pages 8 - 12

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Book on Nocturia!

Nocturia: Causes, Consequences and Clinical Approaches Is the first volume exclusively on the topic of nocturia and is designed to be a comprehensive treatise on the subject.