Nocturia

Classification according to ICD-10
R35	Polyuria - nocturia
ICD-10 online (WHO version 2019)

The nocturia (from ancient Greek νυκτουρία nykturía , German , nocturnal urination ' ) denotes the single or multiple interruption of nocturnal sleep due to urination. Those affected often get up several times at night to urinate. Nocturnal urination is thus the most common cause of nocturnal sleep interruption. The International Continence Society (ICS) classifies nocturia as a clinically significant problem, because both quality of life and performance of the patients are significantly reduced due to the interruptions in their sleep.

Epidemiology

The prevalence of nocturia is 12–14% and increases with age. In people over the age of 60, the prevalence is between 25 and 45%. Men and women are equally affected. In men between 70 and 79 years of age, the incidence of nocturia is 50%. An incidence of 40% is assumed for women over 40 years of age. There are currently 10 million people diagnosed with nocturia in the United States, and 1.5 million of them are receiving medical treatment for the condition. Worldwide, around a third of people over the age of 30 have to go to the toilet at least twice at night. Nocturia is the most common cause of night sleep disturbances.

Complications

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Different symptoms and complaints result from sleep disorders caused by nocturia: This leads to limitations in everyday performance, daytime sleepiness and a bad mood. Frequent infections caused by a weakened immune system can occur as a consequence of the sleep disorders, and psychological problems such as depressive symptoms can also arise.

For people over the age of 60, micturition at night can harbor another health risk: falls. Studies suggest that there is a significant association between nocturia and the risk of falling. The risk is directly related to the number of nocturnal visits to the toilet. The prevalence of falls caused by nocturia is currently estimated at 15%.

causes

Nocturia can occur in four different ways:

• Nocturnal polyuria: this produces excess urine during the night
• Global polyuria: overproduction of urine during the day and night
• Low bladder capacity at night: Less fluid absorption by the bladder during the night
• Mixed nocturia: combination of the first three types.

Depending on the type that occurs, the causes are also different: The triggers for nightly or global polyuria are predominantly the ingestion of excess fluids, especially caffeinated drinks or alcohol before bed, heart failure, sleep disorders such as sleep apnea, diabetes insipidus, gestational diabetes or the use of various medications the active ingredients cardiac glycosides , demeclocycline, lithium, methoxyflurane , phenytoin , propoxyphene, excessive vitamin D and diuretics . Another important cause of nocturia is nocturnal polyuria. This leads to an increased urge to urinate at night due to a lack of the antidiuretic hormone . The main causes of low bladder capacity at night are: bladder obstruction, bladder overactivity, urinary tract infection, cystitis, bladder tumor, interstitial cystitis, and pregnancy.

Disturbance of the bladder function

• Relative narrowing ( obstruction ) of the urinary tract downwards of the urinary bladder , in older men often due to benign enlargement of the prostate gland with considerable residual urine . The urge to urinate occurs particularly when lying down.
• Dysfunction / overactivity of the muscle system of the urinary bladder ( Musculus detrusor vesicae ) and / or residual urine
• Lower urinary tract infection
• Decreased functional urinary bladder capacity
• Bladder tumors
• Urinary bladder stones
• Pelvic floor weakness (e.g. due to a ruptured bladder or a prolapsed uterus )

Conditions with increased nocturnal urine production

• Diseases associated with edema , e.g. B. nephrotic syndrome or heart failure ; possible with right heart as well as left heart and global insufficiency (most common cause). With the body lying horizontally during sleep, the right heart no longer has to overcome the incline to the legs that exists during the day and again conveys more of the fluid stored during the day, so that edema of the legs is driven out more strongly at night.
• Obstructive Sleep Apnea Syndrome
• Autonomous neuropathy
• Chronic venous insufficiency
• Nocturnal polyuria syndrome , possibly caused by insufficient nighttime secretion of antidiuretic hormone (vasopressin).

In the course of a number of internal diseases, there is generally greater urine production ( polyuria ); this also leads to increased urine production at night, which can be interpreted as nocturia (even if the increased urine production is not specifically related to night):

• Diabetes mellitus or diabetes insipidus
• Chronic kidney failure
• Hypokalemia
• Hypercalcemia
• Neurodegenerative diseases such as Parkinson's disease or Alzheimer's disease
• Medication ( diuretics , calcium channel blockers , caffeine , alcohol, or selective serotonin reuptake inhibitors )
• Excessive fluid intake (polydipsia)

Medicines such as tolvaptan can also lead to increased nocturnal urine production as an undesirable side effect.

diagnosis

Clarification of the causes of nocturia should take place with the urologist, gynecologist or family doctor. The frequent nocturnal micturition can be due to a number of possible causes such as: B. hide a nocturnal polyuria, a heart failure or diabetes mellitus . As a first diagnostic step, the doctor will do a physical exam. The doctor will also ask for the medical history. This also includes the documentation of drinking and sleeping habits. This is done using a bladder diary, which is usually given and analyzed by a urologist. Patients are asked to write down in it over a period of around three days when and how much they drink during the day and when micturition occurs.

In this way, it can be determined whether the cause is urological or other. Depending on the suspected cause, the patient is referred to the respective specialist (cardiologist, endocrinologist, urologist), who can conduct further specific diagnostic tests.

therapy

Therapy for nocturia depends on its cause. Non-drug treatment options include, for example, bladder training or a change in drinking behavior. In the evening, attention is paid to reducing fluid intake. Drug therapy includes, for example, alpha blockers, alpha-5 reductase inhibitors or desmopressin .

See also

• Pollakiuria
• Anuria
• Cardiac asthma

literature

• Dean A. Kujubu, Sherif R. Aboseif: An overview of nocturia and the syndrome of nocturnal polyuria in the elderly . In: Nature Clinical Practice Nephrology . tape 4 , no. 8 , August 2008, ISSN  1745-8331 , p. 426-435 , doi : 10.1038 / ncpneph0856 , PMID 18578009 (English).

Individual evidence

1. ↑ nocturia symptom defined by ICS. The International Continence Society, accessed August 6, 2019 . 
2. ^ Ohayon MM: Nocturnal awakenings and comorbid disorders in the American general population. In: Florian Holsboer (Ed.): Journal of Psychiatric Research . tape 43 , no. 1 . Elsevier, 2008, doi : 10.1016 / j.jpsychires.2008.02.001 .
3. ^ Coyne KS et al .: The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA. In: British Association of Urological Surgeons (Ed.): BJU International . tape 92 , no. 9 . Wiley-Blackwell-Verlag, 2003, p. 948-54 , PMID 14632853 .
4. ↑ Tikkinen KA et al .: Is nocturia Equally common among men and women? A population based study in Finland. In: American Urological Association (Ed.): Journal of Urology . tape 175 , no. 2 . Elsevier-Verlag, 2006, p. 596-600 , doi : 10.1016 / S0022-5347 (05) 00245-4 .
5. ^ Akashi S., Tomita K .: The impact of a history of childhood nocturnal enuresis on adult nocturia and urgency. In: Karolinska Institute (ed.): Acta Paediatrica . tape 103 , no. 9 , 2014, p. e410-5 , doi : 10.1111 / apa.12694 .
6. ↑ Stephen W. Leslie et al .: Nocturia. In: National Center for Biotechnology Information. May 2019, accessed on August 6, 2019 . 
7. ↑ Drangsholt S. et al .: Diagnosis and management of nocturia in current clinical practice: who are nocturia patients, and how do we treat them? In: Urological Research Society (Ed.): World Journal of Urology . tape 37 , no. 7 . Springer-Verlag, 2019, p. 1389-1394 , doi : 10.1007 / s00345-018-2511-4 .
8. ↑ Akhavizadegan H. et al .: A comprehensive review of adult enuresis. In: Urol Assoc J. 2018.
9. ↑ NOCTURIA RELATED TO SLEEP DISORDERS. International Continence Society, accessed August 6, 2019 . 
10. ^ So Young Kim et al .: Nocturia Is Associated with Slipping and Falling . In: Public Library of Science (Ed.): PLOS ONE . tape 12 , no. January 1 , 2017, doi : 10.1371 / journal.pone.0169690 .
11. ^ Camille P. Vaughan: The Association of Nocturia with Incident Falls in an Elderly Community-Dwelling Cohort. In: John Wiley & Sons (Eds.): International Journal of Clinical Practice . tape 64 , no. 5 , 2011, p. 577-583 , doi : 10.1111 / j.1742-1241.2009.02326.x .
12. ↑ Types and causes of nocturia. October 25, 2018, accessed November 9, 2018 . 
13. ↑ E. Wolfgang Kühn, Gerd Walz : Therapy of the autosomal dominant polycystic kidney disease. In: Deutsches Ärzteblatt. Volume 112, Issue 51-52, from December 21, 2015
14. ↑ ^{a b} S. Gravas et al .: Management of Non-neurogenic Male LUTS. European Association of Urology, accessed August 6, 2019 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !