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.