Nocturia - Nighttime Voiding
Marja Sprock, M.D.
The definition of nocturia
is having to wake up at night once or more times to
To get up once at night
will become a normal occurrence for most people as they
age. However when nocturia presents more than twice
during the night, it will significantly impact on the
quality of life.
The first 3-4 hours of
sleep are the most restorative for physical functioning
and also to bolster the immune system. It is therefore
less damaging to have the first nocturia event happen a
little later in the night.
Though the symptom:
nocturia is easily described, the underlying reasons are
Simple obvious measures
are to change certain behaviors, eliminate excessive
fluid intake in the evening and reduce alcohol and
caffeine consumption shortly before going to bed.
can hear you say: "tried that, does not work”. Well you
may need a careful exam to start out with, to make sure
there is no prolapse of the bladder.
When a bladder descends/
falls down into the vagina during the day, it often
makes it difficult to empty and you may or may not feel
a pressure to empty. When at rest, in supine position,
the bladder moves back into the vagina and suddenly the
urine outflow is no longer obstructed. You can guess the
rest you will be up several times at night and empty
better at night than during the day.
Problems with heart and
kidneys can also lead to night time voiding. When a
heart has to work over time during the day to keep up
with you and is not healthy enough to supply all the
organs, it will not send much blood to the kidneys. At
night when the body is at rest, there will be blood left
over to be send to the kidneys, to make urine. Too bad
only that you will not feel rested in the am.
If none of the above is a
reason for your night time voiding escapades, before we
move on, make sure you do not have sleep apnea or other
factors like a restless partner who will wake you up and
make you decide it may be wiser to empty your bladder.
Nocturia as a complaint is not the same as being awake
at night and deciding to empty your bladder.
the volume of urine) and diuretic agents both can play a
role; one to retain fluid at night till better voiding
hours; the other to prevent water accumulation and empty
out before the sleeping hours. People who suffer from
swelling of the ankles know this very well; ankle
swelling/fluid accumulation increases during the day and
the ankles are skinniest in the morning. However you may
have been up several times to void of the fluid.
Also medications for
overactive bladder, anticholinergics can help some
people. These medications are widely advertised: "the
got to go medications" These medications are not a good
decision for people who often unconsciously do not
completely empty their bladder.
Patients with problems
emptying their bladder entirely may be helped by nerve
stimulation, elevating the bladder or both. Nerve
stimulation may also help some people with severe
When nocturia (nighttime
voiding) occurs more than twice
during the night, it will
significantly impact on the
quality of life.
Obviously we start with
the basics. Recently I saw Sarah, a young healthy 52
year old, who complaint of having to get up 5-6 times
per night. Sarah worked out, tried to eat healthy and
drank mostly water. After Sarah recorded a 24 hour diary
for me, it was clear why she had to get up 5-6 times at
night. Sarah’s daily urine output was more than 5
quarts, her intake was excessively high and this was in
her situation not due to a missing hormonal substance.
It was explained to Sarah that more water is not better
and in her situation was leading to health problems. It
took a while to convince her; since she thought she was
following a healthy lifestyle, however she cut her
intake by half and is sleeping through the night.
Margaret would get up 5
times at night and at age 82 that was not easy. Margaret
had difficulty to completely empty her bladder because
of the bladder coming down in the vagina during the day
and closing of the urethra. She was fitted with a
pessary, a little support shelf for the bladder, and is
as energetic as 10 years ago.
All nighttime voiding is
not the same, neither are the treatments. Diseases as
dementia also often have symptoms of nighttime dribbling
When nocturia suddenly
occurs, it may be a sign of a urinary tract infection.
Nocturia does not only
impact healthy sleep and rest, it is also potentially
dangerous when people trip in the dark and for instance
break a hip.
I always find it very
rewarding to see people back after a successful
treatment for nocturia or night time voiding. They are
"different” people. They feel better, have more energy
and look better. In other words if you suffer from
excessive night time voiding, get motivated to do some
about this, to improve your quality of life.
We do not offer
appointments in the middle of the night, but at numerous
very convenient hours.
Florida UroGynecology in Rockledge, keeps you dry,
also at night.
Call 321-806-3929 for an
appointment or leave a note