The nightly interruption of sleep by a violent urge to urinate
is the norm for many older people in Germany. At least one in ten people over 60 and more than 80 percent of those over 80 suffer from nocturia, or nocturnal urination.
What is nocturia?
Nocturia is the regular and sometimes multiple interruptions of nighttime sleep due to the urgent need to urinate. Nocturia is the regular and sometimes multiple interruption of nighttime sleep by the urgent need to urinate. Infrequent nocturnal urination, which may be triggered by excessive consumption of fluids immediately before going to bed, for example, does not fall under the term nocturia and is accordingly not defined as such.
Causes
The occurrence of nocturia can have many different causes. For example, benign prostatic hyperplasia (BPH), or enlargement of the prostate gland, is a common trigger, especially in older men. The pressure this exerts on the urinary tract can cause it to narrow below the bladder, severely restricting the unimpeded flow of urine. In women, on the other hand, pelvic floor weakness, triggered for example by a ruptured bladder (urethrocystocele) or a prolapsed uterus (uterine prolapse), can be a reason. Furthermore, tumors in the urinary bladder or bladder stones can also cause the condition. If urination is associated with pain, an infection of the lower urinary tract may also be present. Very often, a reduction in the capacity of the urinary bladder or a defective working of the muscles is also the trigger of nocturia. Numerous other diseases also lead to increased urine production and thus also to nocturia, such as diabetes, edema, chronic kidney failure, Parkinson’s disease or Alzheimer’s disease. In addition, the use of certain medications or increased alcohol or caffeine consumption can also lead to the occurrence of nocturia.
Diseases with this symptom
- Bladder stones
- Pelvic floor weakness
- Irritable bladder
- Sleep apnea
- Bladder cancer
- Urethrocystocele
- Chronic renal failure
- Heart failure
- Benign prostatic hyperplasia
- Uterine prolapse
- Parkinson’s disease
- Diabetes mellitus
Diagnosis and course
While nocturia in itself does not pose a serious threat to health, it can lead to very serious sequelae, as it severely disrupts and severely restricts an elementary component of human well-being – sleep. Indeed, a lack of sufficient sleep can lead to comparatively mild limitations, such as a general feeling of malaise, daytime sleepiness, or a reduction in mental performance, but which can significantly lower the quality of life. In addition, nocturia is also demonstrably responsible for more serious illnesses and ailments. For example, approximately 1.8 times as many elderly people with nocturia suffer a fracture of the neck of the femur than those who do not. Some symptoms of depression, as well as a negative effect on the immune as well as cardiovascular systems, can also be attributed to nocturia. However, as varied and difficult to fathom as the sequelae may be, nocturia is very clear and easy to diagnose:
Nighttime awakenings over a prolonged period of time, triggered by an urge to urinate, are very likely to be nocturia.
Complications
Nocturnal urination results in disruption of sleep. The time of regeneration needed by the organism is interrupted. During the day, fatigue occurs, which takes a chronic course if the condition persists for several weeks. Mood swings occur due to the fatigue. Attention and performance levels are lowered. Occupational problems are imminent or everyday life can no longer be managed as usual. Nocturnal urination can lead to impaired nighttime sleep for the partner. The partner also suffers from the consequences of fatigue. Conflicts and quarrels can be the result. Treatment often disregards the fact that nighttime urination is a natural process in old age.Sufferers are rarely made aware of this and experience a state of distress even though they don’t have to. Sleep changes in quality and quantity throughout life. Frequently, the administration of medication occurs, although it is indicated to seek a cognitive change. The medications provide suppression of urination. They have side effects that can lead to an altered emotional experience. Pressure in the abdomen may develop. Nighttime urination is associated with fear of bedwetting. An anxiety disorder may develop as a possible complication.
When should you see a doctor?
Nighttime urination is a normal occurrence if the person has drunk a lot the night before. The kidneys also work at night, but only on economy mode. A visit to the doctor is not necessary. However, the urge to urinate at night reduces the quality of sleep. If someone of advanced age has to go to the bathroom several times during the night without having taken in significant amounts of fluid before going to bed, visits to the doctor are advisable. Nocturia exists when urination occurs at night without apparent cause. The lack of sleep when getting up several times can make the affected person very tired. He may suffer from lack of concentration, depression or feelings of exhaustion. If there is suffering because of nocturnal urination, a visit to the doctor is definitely necessary. Nocturnal urination can lead to falls and dizziness in elderly people. Since heart failure with water retention in the body may exist as a cause of the need to urinate at night, nocturnal toilet trips without reason often require treatment in the elderly. Diabetes mellitus can also lead to increased urination. Therefore, regular visits to the doctor for diagnosis and monitoring of diabetes are advisable. In particular, the kidneys need to be monitored for increased urine production. If diuretics, calcium antagonists, certain antibiotics, or antidepressants cause frequent nighttime urination, the treating physician may be able to change the medication. Since many diseases result in increased urine production, clarifications are useful.
Treatment and therapy
Of course, successful treatment of nocturia requires first and foremost a thorough investigation of the cause by the urologist, since the triggering factors must be precisely identified before they can be removed and treated. If a bladder stone or tumor is present, for example, it must be removed. An infection of the lower urinary tract can be treated, for example, by taking antibiotics. Nowadays, an enlargement of the prostate can be corrected by means of a minor operation. If the intake of medication or increased alcohol or caffeine consumption is the identified culprit, the intake must either be reduced, discontinued or, in the case of medication, a substitute preparation must be found to successfully combat nocturia.
Outlook and prognosis
Prolonged, untreated nocturia can have a lasting impact on the quality of life of those affected. This includes increased fatigue during the day as well as concentration problems and headaches. Occupational difficulties are not infrequently the result. In older people, the effects can be even more serious. Not only does interrupted sleep reduce performance, it can also lead to falls and bone fractures. In general, the daily routine can no longer be organized in the usual way. If the patient is treated with medication, the prospects of at least suppressing nocturnal urination are good. However, it should also be taken into account that other diseases can be behind nocturia. These include, above all, diabetes, elevated blood pressure and cardiac insufficiency, which definitely require treatment. Treatment of these underlying diseases usually reduces or eliminates nocturia. If not treated, nocturia can significantly reduce the health and life expectancy of those affected. Other measures to combat overactive bladder include bladder training. This involves suppressing the urge to urinate for a period of time to get the bladder used to filling more. The times between toilet visits are thus constantly increased. An improvement in the symptoms of nocturia can thus be achieved after only a few months.
Prevention
Prevention does not protect against many triggers of nocturia, such as the tumors or serious diseases.Against some, such as infections, on the other hand, it is. For example, you should always wear warm clothing and eat a healthy diet to prevent an infection and thus also any nocturia. After a certain age, nocturia is the rule rather than the exception. You can protect yourself from some triggers, but unfortunately not from most. Nevertheless, there is a suitable and often promising treatment method for many of the causes.
What you can do yourself
It seems paradoxical: when urinating at night, it is extremely significant to consume sufficient fluids. However, care should be taken to supply the drinks early. On the other hand, the body starts metabolizing as well as excreting fluids at night. Young people are just as likely to wake up at night if they drink late at night. Those who suffer from nocturnal urination should limit their caffeine consumption. Caffeine has a driving effect and promotes nocturnal urination. Another measure against nocturnal urination is to exercise the bladder. The exercise is simple: as soon as the urge to urinate becomes apparent, those affected should not go to the toilet immediately. It makes sense to wait a few minutes first. In this way, the bladder gets used to filling up more and the urge to urinate sets in later. Those who take tablets that help to reduce weight should better refrain from taking them. They have a diuretic effect in order to eliminate the fluids quickly so that no metabolism takes place. Those who nevertheless wish to continue taking these medications should do so only in the morning. If all the tips remain unsuccessful, a medical professional should clarify the nighttime urination. Nocturnal urge to urinate indicates numerous diseases.
