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Introduction to Nocturia

Nocturia is a bothersome and highly prevalent condition defined by the International Continence Society as the need to wake one or more times nightly to void with each void preceded and followed by sleep. [1]

 

Studies of the relationship between QOL and nocturia suggest that the condition becomes clinically significant when 2 or more voids nightly are experienced. Among LUTS, nocturia is consistently reported to be one of the most bothersome symptoms by men as well as women and significantly compromises sleep and overall QoL. [2]

Negative sequelae of nocturia are various and include sleep fragmentations, mood disturbance, reduced productivity at work, poorer overall health, and increased falls and fractures. It appears to be associated with increased mortality. [3] Several reports of nocturia prevalence exist in the literature. [4] It has been reported that up to 1 in 5 or 6 younger people consistently wake to void at least twice each night on average. Voiding at least once nightly tended to be reported more frequently in younger women than in younger men (20.4% to 43.9% and 11% to 35.2%, respectively), but was equally common or more so in men in older age groups. The majority of older men and women experience at least 1 void per night and on average up to two thirds experience 2 or more voids per night. Overall, severity continues to increase with age. [4] 

Traditionally, nocturia is regarded as a symptom of benign prostatic hyperplasia and/or overactive bladder syndrome, but multiple factors may cause it, such as behavioral or environmental factors and other pathologic conditions, including cardiovascular disease, diabetes mellitus, diabetes insipidus, anxiety and depression  or primary sleep disorders, and sleep apnea.[5] 

Indeed, the condition is still not well understood in clinical practice, leading to partial or inaccurate diagnosis and in many cases inadequate treatment.

Common urological causes of nocturia are classified into 4 broad categories, (Table 1), including[1,6]:

1) 24-hour polyuria (excessive urine production during the day and night),
2) bladder storage problems (i.e. OAB or BPH),
3) nocturnal polyuria (NP-nightly urine overproduction)
4) mixed etiology (eg OAB and NP).

Nocturnal polyuria,  defined as age dependent nocturnal urine volume greater than 20% to 33% of 24-hour urine volume, has an extremely high prevalence of up to 82.9% in patients with nocturia and it is the single most common cause of the condition at urology clinics. [7] 

Frequency-volume charts are recommended for routine use in clinical practice, to determine whether nocturia is a result of excessive urine production at night, or of small voided volumes due to bladder problems, or a combination of these factors. 
For treatment, lifestyle adjustments are often helpful. Medical therapy with 5-alpha reductase inhibitors, alpha-blockers, a combination of the two, or anti-muscarinics, has a limited effect in many patients because nocturnal polyuria has been found to be present in the majority of cases.[7,8] Desmopressin, a synthetic analogue of the antidiuretic hormone, should be considered in patients with nocturia where nocturnal polyuria is present.

Table 1.

Potential Factors Underlying Nocturia

From Bosch JL and Weiss JP: The prevalence and causes of nocturia. J Urol 2010; 184: 440-6.

REFERENCES

[1] van Kerrebroeck P, Abrams P, Chaikin D et al. The standardization of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurol UroL Urodyn 2002; 21: 179-83.

[2] van Dijk MM, Wijkstra H, Debruyne FM et al: The role of nocturia in the quality of life of men with lower urinary tract symptoms. BJU Int 2010; 105: 1141.

[3] Asplund R:  Nocturia in relation to sleep, health, and medical treatment in the elderly. BJU Int 96: 15-21.

[4] Bosch JL and Weiss JP: The prevalence and causes of nocturia. J Urol 2010; 184: 440-6.

[5] Bliwise DL, Foley DJ, Vitiello MV et al. Nocturia and disturbed sleep in the elderly. Sleep Med 2008; 10:540-8

[6] Weiss JP, Weinberg AC and Blaivas JG: New aspects of the classification of nocturia. Curr Urol Rep 2008; 9: 362-7.

[7] Weiss JP, van Kerrebroeck PE, Klein BM, Nørgaard JP. Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia. J Urol. 2011; 186:1358-63.

[8] Brubaker L and FitzGerald MP: Nocturnal polyuria and nocturia relief in patients treated with solifenacin for overactive bladder symptoms. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 737-41.

[9] van Doorn B, Bosch JL. Nocturia in older men. Maturitas. 2012; 71:8-12.

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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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The journal articles, videos and statements published on the resource centre have been selected independently and without influence from Elsevier, European Urology Editors or the sponsor and do not necessarily reflect their opinions or views.

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.