You are here
Patients’ Lived Experiences of Nocturia: A Qualitative Study of the Evening, the Night, and the Next Day
Andrew Trigg, Fredrik L. Andersson, Natalie V. J. Aldhouse, Donald L. Bliwise, Helen Kitchen
Commentary by Philip Van Kerrebroeck:
In this study, the authors explored the experiences of patients with symptomatic nocturia from a qualitative perspective. Especially the daytime difficulties faced by patients were explorted, as well as any similarities or differences according to age and social roles. A total of 20 US patients with nocturia due to nocturnal polyuria were interviewed, and purposive sampling was employed to ensure demographic diversity. The ages of participants ranged from 39 to 80, of which 40% were retired. The patient experience of nocturia changed according to the time of day, with three distinct phases: evening, night and the next day. In the evening, patients described coping behaviours in an attempt to reduce night-time voids. Their adapted behaviour was both the result of physician advice (limiting fluid intake, feet elevation) and self-directed strategies (limiting evening food consumption and staying up later to postpone disruption). During the night, patients spoke of the defining nocturia symptom preventing them from reaching a “deep sleep”. Much focus was given to the irritation as a result of this. The focus of this research was to document detailed accounts of ‘the next day’. Obviously the lack of sleep caused tiredness the next day. However, it is the detailed accounts of this and associated impacts that are of importance. Tiredness compounded mood changes, poor concentration and reductions in patients’ ability to drive and carry out key family roles. For the non-retired patients, reduced work productivity due to nocturia was an important part of their experience in this study. A valuable finding of this study was the apparent differences in experience according to age and employment status, where younger, employed participants reported daytime burden more frequently than older, retired participants.
Whilst prior studies have quantified the association between nocturia and its wider impacts, this study is a welcome addition to the body of literature due to its added depth of exploration, and presentation through the patient’s own words. Keeping this perspective in mind offers a more holistic view of the condition, and is helpful to communicate the impact of nocturia to a wider audience.
Nocturia, waking to urinate two or more times during the night, is a chronic condition associated with significant patient burden due to sleep disruption. This study aimed to explore the lived experiences of patients with nocturia in terms of the disruption to their lives during the night and day.
Adult patients in the US diagnosed with nocturia were recruited for face-to-face qualitative interviews. Thematic analysis of patients' narratives, taking a phenomenological interpretative approach, summarised their experiences throughout the night and day, including any apparent contrasts between patients.
Twenty patients (10 male, 10 female) aged between 39 and 80 years, averaging three night-time voids, were interviewed. Analysis revealed that nocturia has a substantial impact on sleep quality and quantity, with the frequency of night-time voids a key driver of this. In addition to night-time phenomena, patients faced various difficulties the next day, including day-time tiredness, lack of energy and concerns related to emotional wellbeing, social functioning and cognitive functioning. All of these limited patients' capacity to work, perform daily activities or fulfil role responsibilities. Patients' lifestyles influenced experience, where younger patients in employment more readily emphasised the day-time physical and psychosocial burdens. Patients employed coping behaviours in an attempt to lessen the severity of nocturia and its impact, which were both physician-led and self-taught.
While the symptom of nocturia only occurs during the night, the impact is longer lasting, affecting functioning and wellbeing throughout the following day. Patients' circumstances can affect the extent of their burden; recognising this can improve effective delivery of patient-centred care.