Nocturia Archives

Nocturia (nocturnal enuresis) is a medical term for excessive urination especially at night and during sleep. This is a medical condition and a symptom of any of the different types of urinary disorder.  This is a secondary bedwetting syndrome marked by involuntary loss of urine and is common in the elderly.

Bedwetting is prevalent in children from age 0 to about 4 years old. A child’s bladder reaches maturity by the time the toddler is potty trained, usually at age 5. Although every child’s bladder matures at different age, children generally stop bedwetting by the time they reach 6 years old. When a child suddenly starts bedwetting again after a long period of being dry then parents should start to worry.

What is nocturia? Secondary nocturia in children can be a symptom of a urinary tract infection, emotional stress, psychological trauma or juvenile Diabetes. The child at sleep fails to recognise the urge to void, hence urinating in bed. In adults, bedwetting is a sign of a urinary problem and anybody can suffer from any of the following types of incontinence:

  • Stress incontinence that affects more women due to injuries incurred during pregnancy and subsequent deliveries, marked by an uncontrollable loss of urine when coughing, laughing or straining. The pelvic floor muscles become weak due to the strain of carrying heavy weight babies, doing high impact sports or obesity
  • Urge incontinence in both male and female, which cause sudden involuntary passage of urine. The urge is uncontrollable and so intense that the person is likely to void before reaching a toilet. This condition is brought about by bladder nerve damage, injuries to the abdominal region, urinary system, uterus or prostate gland inflammation
  • Overflow incontinence affects men who have strictures or narrowing of the urinary tubes caused by scarring from previous surgeries. Blockage in the urinary tubes, urethra or the urethral sphincter by kidney stones passed from the kidneys cause difficulty in starting urination, weak stream during urination and incomplete voiding; urine retention is a common consequence. The bladder is always half-empty  and there is frequency in urination
  • Functional incontinence affects people who have lost their ability to recognise the need to void although their urinary system is fully functional. This is prevalent in bedridden people with spinal cord injuries, patients suffering from neurological disorders like Alzheimer’s and Parkinson’s disease, multiple sclerosis, cerebral palsy or dementia. There is total loss of cognizance of the urge therefore complete voiding happens when the bladder gets full

All these types of urinary incontinence share a common denominator, weak pelvic floor muscles. Therefore, strengthening this band of muscles is one of the primary interventions recommended by the health care provider along with the other treatments suited for the particular type of incontinence. Correlative to the Kegel exercises are the following intervention:

  • Diet modification and management focusing on the elimination of sodium and bad cholesterol in the diet and replacing it with high fibre and vitamin-enriched foods can help regulate the body’s normal metabolism. Coffee, soda and alcoholic beverages are bladder irritants and cause the formation of kidney stones
  • Drugs such as anti-cholinergics and anti-depressants are medications to calm the bladder muscles and reduce frequency of contraction.  Anti-diuretic hormone called Arginine vasopressin or AVP reduces the production of urine at night so that the bladder does not get full whilst asleep. These drugs are regulated and have side effects hence these should be administered under your doctor’s guidance
  • Sling procedures for women to support a prolapsed uterus that causes compression on the bladder. This procedure is done through laparoscopic method that is less invasive and recuperation period is fast and cure rate is high
  • Bladder neck suspension is another semi-invasive procedure aimed to support the neck of the bladder to improve the function of the urethral sphincter
  • An endoscopy of the male urinary tubes will show strictures due to scarring; laser surgery to scrape the scars will improve urine flow and stop retention

Focused treatment of the causative factors will eliminate most if not all of the prevailing symptoms. This method will also prevent trial and error treatment that often costs more with ineffective results. It is important to understand what is nocturia and its causes, symptoms and treatment by seeking professional help and following doctor’s orders.

Many studies have been made about man’s capability to sleep through the night without waking up and going to the toilet to urinate. Some people wake up once in the middle of the night with the urge to empty their bladder and to some people, waking up more than twice in the night to use the toilet is more than enough reason to be anxious.

Nocturia is an excessive urination at night. Also called nocturnal enuresis or bedwetting or urinary incontinence, a condition that is often a cause of embarrassment and anxiety for the person suffering from it and inconvenience and stress for the family who car for the affected person. It is involuntary and uncontrollable.

This condition is a normal occurrence for children from age 0 to 4 when their bladder is still immature and cannot hold urine for a long time. This stage is called primary bedwetting that goes away with time, usually when the child is already potty trained and their bladder muscles and nervous system have acquired some degree of maturity.

Secondary bedwetting on the other hand is when the child is bedwetting again after more than 6 months of being dry. This can be a symptom of an underlying medical problem like urinary infection, rare tumours in the urinary tract, bladder or urethral sphincter. Psychological trauma can also play a part in losing urinary continence.

In adults, Nocturia is more prevalent in older people and more common in men than in women. Age has nothing to do with this problem even though more elderly people are afflicted than the younger population. Although bedwetting seems to be a hereditary trait, there are reasons that may aggravate this condition including:

  • Enlarged prostate gland (benign prostatic hyperplasia) that may block the urethra or the urinary tracts
  • Spinal cord injuries that may render paralysis of the lower extremities
  • Dementia caused by Alzheimer’s disease, Parkinson’s disease, Multiple Sclerosis
  • Diabetes and other debilitating illness like arthritis
  • Post-operation recuperation period
  • Depleted supply of hormone that slows down urine production at night

This urinary incontinence may be a serious medical condition but it is not totally incurable. Treating nocturnal enuresis starts at finding the underlying cause and treating it. A professional health care provider (GP or Urologist) can determine the probable cause through a series of tests and checkups to rule out other complications.

Medication

Your doctor may prescribe certain drugs such as anti-depressants and anti-cholinergics to relax the bladder. Anti-inflammatory drugs help to ease the swelling of the prostate gland and medications to manage Diabetes and other medical problems.

Physical Therapy

Temporary paralysis can be helped with physical therapy with focus on the range of motion (ROM) exercises to rehabilitate atrophied muscles of the lower extremities. Exercise also helps ease the pain and stiffness of arthritic joints. Kegel exercises help in strengthening the pelvic floor muscles and improve muscle tone.

Psychological Counseling

This is an important and integral part of treatment for people suffering from incontinence. It is necessary to be aware that incontinence is not an isolated case, in fact it is a very common problem and many people are affected with it. Attending support group meetings help in restoring self-esteem and self-confidence.

Behavioural Modification

Bladder re-training is re-learning the toilet patterns one has learned during the toilet training in childhood. Using the toilet to void at regular intervals, voiding completely and not stopping in midstream, urinating when the urge gets urgent and observing proper hygiene after using the toilet are the patterns that the patient must learn again.

Proper Diet and Nutrition

Food and beverages play an important part in the occurrence of bedwetting. Caffeine and carbonated drinks stimulate the bladder causing frequent urination. Eating healthy and fibre-rich foods instead of processed and spicy foods that can aggravate the condition help maintain proper metabolism.

Semi-invasive Treatment

Injectable bulking agents are used to give the urethral sphincter more bulk and improve closure. The bladder is injected with certain drugs to temporarily paralyse the muscles and prevent overactive bladder. Laparoscopic sling procedures help women with prolapsed uterus to ease the compression on the bladder. Open surgery is a last option.

Incontinence Products

While undergoing treatments, using incontinence products such as incontinence pads, pants, bed pads, mattress protection covers and urine collectors help in managing nocturia. There is no need for drastic changes in your lifestyle. These products can help you lead a normal life and pursue your goals unhampered by incontinence.

Disclaimer: All material published on the Incontinence.co.uk web site is for informational purposes only. Readers are encouraged to confirm the information contained herein with other sources. The information is not intended to replace medical advice offered by your doctor or health professional. Readers should always discuss health matters and review the information carefully with their doctor or health care professional. Extended Disclaimer