Nocturia Causes, Diagnosis, and Management

Nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding (i.e. to urinate).” The term is derived from Latin nox, night, and Greek urine. Causes are varied and can be difficult to discern. Although not every patient needs treatment, most people seek treatment for severe nocturia, waking up to void more than 2–3 times per night. Although there is no cure for nocturia, many actions can manage the symptoms with some Home remedies and Siddha remedies of Swami Hardas Life System, invented by Dr. Swami Hardas.

What is Nocturia?

Nocturia is a condition that causes you to wake up during the night to urinate. This can be thought of as nocturnal urinary frequency — having to urinate more often at night. This condition becomes more common as people age and occurs in both men and women, sometimes for different reasons.

It can be common for most people to wake up once during the night to urinate, but urinating more frequently may be a sign of something else going on. Nocturia can be associated with daytime urinary frequency or occur by itself. It’s important to distinguish nocturia (urinating too frequently) from polyuria (urinating too much volume).

What are the symptoms of Nocturia?

Normally, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. People who have nocturia wake up more than once a night to urinate. This can cause disruptions in a normal sleep cycle.

Symptoms of nocturia can include:

• Waking up more than once a night to urinate.
• Urinating more volume (if polyuria is present).
• Fatigue, sleepiness — even after waking up. This occurs because frequent urination can interrupt your sleep cycle.

Nocturia Prevalence

Studies show that 5–15% of people who are 20–50 years old, 20–30% of people who are 50–70 years old, and 10–50% of people 70+ years old, urinate at least twice a night. Nocturia becomes more common with age. More than 50 percent of men and women over the age of 60 have been measured to have nocturia in many communities.

Even more over the age of 80 are shown to experience symptoms of nocturia nightly. Nocturia symptoms also often worsen with age. Although nocturia rates are about the same for both genders, data shows a higher prevalence in younger women than younger men and older men than older women.

Nocturia Impact

Research suggests that more than 60% of people are negatively affected by nocturia. Resulting insomnia and sleep deprivation can cause:

• Exhaustion,
• Changes in mood,
• Sleepiness,
• Impaired productivity,
• Fatigue,
• Increased risk of accidents, and
• Cognitive dysfunction.

Almost 25% of falls that older individuals experience happen during the night, of which 25% occur while waking up to void.

A quality-of-life test for people who experience nocturia was published in 2004. The pilot study was conducted only on men.

Nocturia Causes

Polyuria

Polyuria is excessive or an abnormally large production or passage of urine. Increased production and passage of urine may also be termed diuresis. Polyuria is usually viewed as a symptom or sign of another disorder (not a disease by itself), but it can be classed as a disorder, at least when its underlying causes are not clear.

Global polyuria

Global polyuria is the continuous overproduction of urine that is not only limited to sleep hours. Global polyuria occurs in response to increased fluid intake and is defined as urine outputs of greater than 40 mL/kg/24 hours. The common causes of global polyuria are primary thirst disorders such as diabetes mellitus and diabetes insipidus (DI). Urination imbalance may lead to polydipsia or excessive thirst to prevent circulatory collapse. Central diabetes insipidus is caused by low levels of Vasopressin (also called antidiuretic hormone (ADH), arginine vasopressin (AVP), or argipressin). 

Diagnosis of DI can be made by an overnight water deprivation test. This test requires the patient to eliminate fluid intake for a fixed period of time, usually around 8–12 hours. If the first-morning void is not highly concentrated, the patient is diagnosed with DI. Central DI usually can be treated with a synthetic replacement of ADH, called desmopressin. Desmopressin is taken to control thirst and frequent urination. Although there is no substitute for nephrogenic DI, it may be treated with careful regulation of fluid intake.

Nocturnal polyuria

Nocturnal polyuria is defined as an increase in urine production during the night but with a proportional decrease in daytime urine production that results in a normal 24-hour urine volume. With 24-hour urine production within normal limits, nocturnal polyuria can be translated as having a nocturnal polyuria index (NPi) greater than 35% of the normal 24-hour urine volume.

NPi is calculated simply by dividing NUV by the 24-hour urine volume. Similar to the inability to control urination, a disruption of arginine vasopressin (ADH) levels has been proposed for nocturia. Compared with normal patients, nocturia patients have a nocturnal decrease in ADH levels.

Other causes

Other causes of nocturnal polyuria include diseases such as:

• Congestive heart failure,
• Nephritic syndrome,
• Liver failure, and
• Lifestyle patterns such as excessive nighttime drinking.
• Sleep apnea increases obstructive airway resistance. Obstructive sleep apnea sufferers have been shown to increase renal sodium and water excretion which are mediated by elevated plasma atrial natriuretic hormone (ANH) levels. ANH is released by cardiac muscle cells in response to high blood volume. When activated, ANH releases water, subsequently increasing urine production.

Bladder storage

Normal human bladder storage capacity varies from person to person and is considered 400 – 600 mL. A bladder storage disorder is any factor that increases the frequency of small volume voids. These factors are usually related to lower urinary tract symptoms that affect the capacity of the bladder.

According to the above criteria, some patients with nocturia have neither global nor nocturnal polyuria. Such patients most likely have a bladder storage disorder that impacts their nighttime voiding or a sleep disorder. Nocturnal bladder capacity (NBC) is defined as the largest voided volume during the sleep period.

Decreased bladder storage

Decreased NBC can be traced to a decreased maximum voided volume or decreased bladder storage. Decreased NBC can be related to other disorders such as:

• Benign prostatic hyperplasia (BPH), also known as prostate enlargement,
• Neurogenic bladder dysfunction,
• Learned voiding dysfunction,
• Anxiety disorders,
• Urinary tract infection, and
• Certain pharmacological agents.

Mixed Nocturia cause

A significant number of nocturia cases occur from a combination of causes. Mixed nocturia is more common than many realize and is a combination of nocturnal polyuria and decreased nocturnal bladder capacity. In a study of 194 nocturia patients:

• 7% were determined to solely have nocturnal polyuria,
• 57% solely had decreased NBC, and
• 36% had a mixed cause of the two.

Multifactor-caused nocturia is often unrelated to an underlying urological condition. Mixed nocturia is diagnosed through the maintenance and analysis of the bladder diaries of the patient. Assessment of cause contributions is done through formulas.

Nocturia Diagnosis

Nocturia diagnosis requires knowing the patient’s nocturnal urine volume (NUV). The ICS defines NUV as “the total volume of urine passed between the time the individual goes to bed with the intention of sleeping and the time of waking with the intention of rising.” Thus, NUV excludes the last void before going to bed but includes the first-morning void if the urge to urinate woke the patient. The amount of sleep a patient gets, and the amount they intend to get, are also considered in a diagnosis.

As with any patient, a detailed history of the problem is required to establish what is normal for that patient. The principal diagnostic tool for nocturia is the voiding bladder diary. Based on information recorded in the diary, a physician can classify the patient as having global polyuria, nocturnal polyuria, or bladder storage problems. A voiding bladder diary should record:

• Number of voids,
• Timing of voids,
• Volume voided, and
• Volume and time of fluid intake.

Patients should include the first morning void in the NUV. However, the first-morning void is not included in the number of nightly voids.

Nocturia Management

Lifestyle changes

Although there is no cure for nocturia, many actions can manage the symptoms:

• Prohibiting caffeine and alcohol intake. Both are diuretics.
• Beverage consumption regulation. In regard to nocturia, this specifically means avoiding consuming fluids for three or more hours before bedtime so giving the bladder less fluid to store overnight. This especially helps people with urgency incontinence. 
• Compression stockings may be worn throughout the day to prevent fluid from accumulating in the legs unless heart failure or another contraindication is present.
• Drugs that increase the passing of urine can help decrease the third spacing of fluid, but they could also increase nocturia.

Medications for Nocturia

• ADH replacements such as Desmopressin and Vasopressin.
• Selective Alpha-1 blockers are the most commonly used medicine to treat BPH. Alpha-1 blockers are the first-line treatment for the symptoms of BPH in men. Doxazosin, terazosin, alfuzosin, and tamsulosin have all been well established in treatment to reduce lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia. They are all believed to be similarly effective for this purpose.
• First-generation alpha-1 blockers, like prazosin, are not recommended to treat lower urinary tract symptoms because of their blood-pressure-lowering effect. Later-generation drugs in this class are used for this purpose.
• In some cases, alpha-1 blockers have been used in combined therapy with 5-alpha reductase blockers. Dutasteride and tamsulosin are on the market as combined therapy and results have shown that they improve symptoms significantly versus monotherapy.
• If urinary tract infection is causative, it can be treated with urinary antimicrobials.
• Antimuscarinic agents such as oxybutynin, tolterodine, and solifenacin are especially used in patients who suffer from nocturia due to an overactive bladder and urgency incontinence because they help bladder contractility.

Nocturia Surgery

If the cause of nocturia is related to benign prostatic hyperplasia or an overactive bladder, surgical actions may be sought out.

• Surgery for benign prostatic hyperplasia includes increasingly popular and minimally invasive laser surgery.
• Surgical correction of the pelvic organ prolapse.
• Sacral nerve stimulation.
• Bladder augmentation.
• Detrusor muscle myectomy.

Home remedies for Nocturia

The urge to frequently pee can occur to any one of us regardless of our age and gender. However, it is much more common in elderly and middle-aged individuals, men with an enlarged prostate, and pregnant women. Frequent urination can be managed over time by treating the underlying cause. You can use natural ingredients to overcome this symptom as well. A few home remedies using natural ingredients are as follows:

Pomegranate Paste

Pomegranate skin has the ability to destroy microorganisms. It is especially effective against a bacteria called E.coli, which is mainly responsible for urinary tract infections (due to which frequent urination might occur).

To use pomegranate as a remedy, you have to peel the fruit pomegranate and save its skin. Then you have to grind the skin to form a paste. Add a few spoons of water to this paste and consume it on a daily basis to reap its benefits.

Fenugreek Seeds

In a study, it was found that fenugreek can be used to decrease blood sugar levels and improve the quality of life. This activity is due to the presence of specific bioactive compounds (alkaloids, steroids, and trigonelline).

It also acts as an antioxidant and reduces oxidative stress in the body, which is a cause of diabetes and frequent urination. You can make use of fenugreek seeds by simply consuming a little amount of them daily, either in the form of powder or by merely swallowing the seeds.

Amla

Amla is rich in vitamin C and is effective in controlling blood sugar and hence, frequent urination. It is especially beneficial for the urinary system as it promotes the elimination of urine but does not overly stimulate urine flow.

You can use amla as a home remedy for frequent urination by simply preparing its juice. This juice of amla can be consumed either directly or by adding honey to enhance its taste. Drinking this juice on alternate days might be beneficial to control frequent urination.

Tulsi

Tulsi is effective against various bacteria, fungi, and viruses. In Ayurveda, it is used to manage multiple infections, like urinary tract infections (a common cause of frequent urination).

You can crush a few leaves of tulsi and eat them with a little bit of honey. You can also use tulsi leaves to make a decoction by boiling them in a little bit of water. Then, drink this decoction to gain the benefits of tulsi.

Cumin

Cumin is an aromatic plant. It is used for adding flavor to dishes and has medicinal value also. It has activity against various bacterial infections. One research found that the essential oil of cumin has activity against a bacteria that is popular for causing urinary tract infections.

It also stated that cumin could be used alone or with other microbe-destroying agents to manage bacterial infections. Thus, it might help in relieving frequent urination caused due to urinary tract infections. You can use cumin to remedy frequent urination by boiling it in water and drinking the water.

Cranberry Juice

It is hypothesized that cranberries can be effective in treating urinary tract infections. It may be due to its activity against the bacteria E.coli, known for its notorious nature of causing urinary tract infections. Cranberries might act against this bacteria by not allowing it to attach to the urinary tract walls.

You can consume cranberry in the form of juice that is available commercially, or you can make juice and drink it. To make the juice, soak the dried cranberry in water for some time, then blend it in a blender to make a juice.

Horse Gram

Horse gram has many traditional uses. It has been used for a long time in traditional folk medicine. It has various bioactive compounds, which it is found to help manage a variety of diseases, including urinary disorders. It is effective against E.coli, among many other bacteria.

Therefore, it might help deal with frequent urination caused due to urinary tract infections. You can take a few spoons of horse gram, add it to a hot pan, and roast it. This roasted horse gram can be eaten directly or made into a powder, mixed with water, and consumed. Regular use might show you the beneficial effects.

Kegel Exercises

Kegel exercises help in strengthening the muscles of the pelvic region. They are also helpful in strengthening the urinary bladder. Therefore, they can be beneficial for frequent urination, which might occur due to weakened muscles of the urinary system. The following are the steps of the exercises:

• You can sit or lie down after emptying your bladder.
• First, you have to tighten your pelvic floor muscles and hold on for three to five seconds.
• Then count for three to five seconds and relax your muscles.
• You have to repeat this ten times, three times a day. i.e. in the morning, afternoon and night.

Siddha remedies for Nocturia

A daily routine

 

Which Siddha remedies can help treat Nocturia? In general, a daily routine for nocturia may look like this: Follow the instructions of your Doctor; Consume the Sattvic diet; Perform breathing exercises regularly; Perform walking exercises; Apply free touch therapy (UAM) a minimum 3 times a day, as explained above; Perform Swayamsiddha Agnihotra or Agnihotra daily, either self or the caretaker can perform; and in case, if someone wishes to learn advanced methods of Swami Hardas Life System, undergo unique training.

Reference: https://en.wikipedia.org/wiki/Nocturia