Nocturia - Nighttime Voiding
By Marja Sprock, M.D.

The definition of nocturia is having to wake up at night once or more times to void.

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 not.

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.

I 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.

Anti-diuretic (diminishing 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 overactive bladder

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 and incontinence.

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.

Remember: Central Florida UroGynecology in Rockledge, keeps you dry, also at night.

Call 321-806-3929 for an appointment or leave a note here.