Nocturia is a nocturnal urge to urinate. It is constantly or periodically observed in diseases of the kidneys and bladder, prostate adenoma, neurological pathologies, heart failure, and some endocrine diseases. It occurs episodically when the regime is violated. The cause of the symptom is established on the basis of complaints, examination results, laboratory and hardware techniques. Treatment includes antibacterial drugs, NSAIDs, and other medications. According to the indications, correction of endocrine disorders is carried out, surgical interventions are performed.
Why does nocturia occur
Physiological causes and effects of drugs
The cause of nocturnal urges in healthy people is most often the use of a large amount of liquid before bedtime. Due to the diuretic effect, nocturia can be provoked by strong tea, coffee and alcoholic beverages taken in the afternoon. Of the medications, the symptom is most often caused by diuretics. The disorder can also develop when taking calcium channel blockers and some other drugs.
Diseases of the urinary system
With cystitis, there is an increase in frequency and soreness of urination, a decrease in urine portions, pain, burning, pain over the pubis, a feeling of incomplete emptying of the detrusor. Cystitis in women is a widespread disease, is more often diagnosed at the reproductive age, can occur acutely or chronically, often develops during pregnancy. In men, pathology is diagnosed less often. Other diseases accompanied by nocturia include:
- Pyelonephritis. For an acute process, urination disorders are uncharacteristic. Patients with a chronic form complain of pollakiuria, nocturia, lower back pain, weakness, cephalgia, appetite disorders. The anamnesis reveals an episode of acute pyelonephritis with general hyperthermia, turbidity of urine and other typical symptoms.
- Glomerulonephritis. The acute form is manifested by oliguria, alternating with nocturia, micro- or macrohematuria, frequent urination, facial edema, increased blood pressure. Chronic glomerulonephritis occurs with periodic exacerbations that repeat the clinical picture of an acute episode.
- Interstitial nephritis. The disease manifests itself with significant hyperthermia, febrile syndrome, pronounced weakness, severe pain in the lumbar region, hematuria and a decrease in the amount of urine up to anuria, followed by the development of nocturia and pollakiuria. With a progressive course, the symptoms are erased.
- Nephrosclerosis. It is formed against the background of arterial hypertension, atherosclerosis of the renal arteries, venous congestion, diseases of the kidneys and lower urinary tract. At the initial stage, pronounced nocturia (more than 3 episodes per night), polyuria, constant pulling pains in the lumbar region, increased blood pressure are determined. Subsequently, edema joins, then the daily diuresis decreases.
Nocturia is an extremely common symptom in older men. In the absence of diseases, it is provoked by a decrease in the level of sex hormones, disorders of nervous regulation, violations of the circadian rhythm of ADH release. Often indicates the development of prostate adenoma. Along with nocturia, this pathology reveals imperative urges, increased frequency and difficulty urinating, urinary incontinence, sluggish jet, a feeling of incomplete emptying of the bladder.
A frequent neurological cause of nocturia is considered to be an overactive bladder that occurs with multiple sclerosis, alcoholic and diabetic polyneuropathy. At night, many patients visit the toilet more than 2 times. Frequent urination, imperative urges, urgent incontinence are noted. It is possible to develop nocturia and pollakiuria without incontinence.
Neurogenic bladder is formed against the background of strokes, encephalitis, complicated spinal fractures, cerebrospinal circulation disorders, polyradiculoneuritis, polyradiculopathies, abnormalities of the central nervous system. Nocturia is typical for the hyperactive variant of the syndrome, supplemented by urinary incontinence and imperative urges. There may be difficulties at the beginning of urination, the appearance of vegetative disorders before surgery.
Pronounced polyuria is characteristic of diabetes insipidus. The volume of daily urine reaches 4-10 liters or more, nocturia manifests itself by repeated rises during the night, combined with daytime increased urination. Polydipsia is also observed. Due to constant awakenings, sleep is disturbed, frequent trips to the toilet lead to nervous exhaustion and the emergence of neuroses. The disease often debuts acutely, less often develops gradually.
In the absence of treatment, diabetes mellitus manifests itself with constant thirst, polydipsia and polyuria, including nocturia. There is dryness and itching of the skin, pustular infections, cramps in the calf muscles, weakness, fatigue. With type 1 diabetes, the symptom is more pronounced, combined with weight loss. In patients with type 2 diabetes, skin infections predominate, obesity is often detected.
One of the signs of hyperthyroidism are disorders of water metabolism, including polyuria, nocturia and extreme thirst. These symptoms are combined with an acceleration of metabolism, an increase in appetite with weight loss. Unbalance, anxiety, increased excitability, cardiovascular and ophthalmological disorders are noted.
In chronic heart failure, nocturia is combined with a decrease in daily diuresis, supplemented by shortness of breath, attacks of suffocation, cough, cyanosis. Edema is detected, ascites develops over time. Pathology is formed against the background of coronary heart disease, cardiomyopathy, myocarditis, and other diseases. May complicate chronic intoxication.
Along with the listed diseases , nocturia accompanies the following pathological conditions:
- Venous lesion: advanced varicose veins, chronic venous insufficiency. The reason for night urination is the deposition of blood in the lower extremities against the background of daytime stay in an upright position and its subsequent redistribution.
- Pernicious anemia. The symptom occurs against the background of a decrease in blood pressure and impaired renal blood flow. With a prolonged course, the manifestation is aggravated due to the formation of myocardiodystrophy and heart failure.
- Failure of the pelvic muscles. Weakness of the pelvic floor muscles in women is a polyethological condition, develops against the background of complicated childbirth, gynecological diseases. Nocturia can be combined with urinary incontinence.
- Apnea syndrome. The inferiority of sleep contributes to frequent awakenings and night trips to the toilet. Neurophysiological disorders and cardiac dysfunction play a significant role.
Diagnostic measures are carried out by a urologist. According to the indications of patients, they are referred to a neurologist, endocrinologist, cardiologist, and other specialists. During the survey, the doctor determines when the symptom appeared, what other manifestations it was accompanied by, how the clinical picture changed over time. To clarify the severity of nocturia, men are offered to fill out a urination diary for 3 days, women – 4 days.
To exclude gynecological pathologies, women are examined on a chair. Men undergo a finger examination of the prostate through the rectum. As part of an additional examination, such procedures are carried out as:
- Ultrasound of the urinary system. Ultrasound of the bladder is performed to detect signs of inflammation, exclude residual urine, stones, neoplasms. Structural changes are visualized on ultrasound of the kidneys, to assess the condition of the vessels, the study is supplemented by ultrasound or duplex scanning.
- Sonography of other organs. If a prostate pathology is suspected, a prostate ultrasound is prescribed. With hyperthyroidism, ultrasound of the thyroid gland is performed, with cardiac pathologies – echocardiography, with gynecological diseases – ultrasound of the pelvic organs.
- Radiography. In diseases and anomalies of kidney development, nocturia of neurological genesis, overview urography and excretory urography are informative. According to the indications, ascending pyelography, conventional and mictional urethrocystography are performed.
- Endoscopic methods. Cystoscopy allows you to determine the morphological form of chronic cystitis, exclude other pathologies. Nephrosclerosis, malformations, and some other kidney lesions may require nephroscopy. Biopsy sampling is possible during endoscopic procedures.
- Urodynamic studies. With prostate adenoma, cystitis, neurogenic disorders, uroflowmetry, intraurethral pressure profilometry, cystometry and a comprehensive urodynamic study can be shown.
- Urine tests. In the general analysis, signs of inflammation are detected, and the localization of the inflammatory process is determined using a three-glass sample. To assess the concentration capacity of the kidneys, a Zimnitsky test is carried out. To establish the nature of the microflora, sowing is performed on nutrient media. Neoplasia and changes in the structure of tissues are detected by cytological or histological examination.
- Other tests. In inflammatory diseases, leukocytosis and increased ESR are noted in the general blood test. In diabetes mellitus, blood glucose determination is indicated, in thyrotoxicosis – a test for thyroid hormones. With adenoma, the PSA level is evaluated to exclude prostate cancer.
Patients with kidney and heart pathologies need a special diet. For the treatment of diseases accompanied by nocturia, the following are used:
- Antibacterial agents. They are the basis of drug therapy for cystitis, pyelonephritis, glomerulonephritis. They are used in the development of infectious complications against the background of prostate adenoma and neurological disorders. At the initial stage, broad-spectrum antibiotics are prescribed, after receiving the results of sowing, the drugs are replaced taking into account the sensitivity of the pathogen.
- Medications for inflammation. Uroseptics and combined phytopreparations are effective for cystitis. With pyelonephritis, detoxification and means to strengthen the immune system may be required. In glomerulonephritis, hormones are included in the treatment regimen. NSAIDs are used to reduce the severity of inflammation and pain.
- Medications for non-inflammatory processes. Patients with adenoma are prescribed alpha-blockers and alpha-reductase inhibitors. In hyperactive detrusor, anticholinergic drugs, selective beta-3 adrenergic receptor agonists are used. Cardiac glycosides, nitrates, vasodilators, anticoagulants, beta-blockers are recommended for heart diseases.
- Correction of hormonal disorders. Patients with diabetes insipidus are prescribed a synthetic analogue of ADH, stimulators of antidiuretic hormone secretion. In type 1 diabetes, insulin is used, type 2 – hypoglycemic agents. Thyrostatics are effective in thyrotoxicosis.
Local treatment may include intravesical instillations, physiotherapy: inductothermy, UHF, ultrasound, laser therapy, etc. In case of neurogenic disorders and weakness of the pelvic floor musculature, special complexes of physical therapy, electrostimulation are recommended. Sometimes behavioral therapy is indicated, which provides for monitoring the amount and time of fluid intake, drawing up a plan for urination.
The tactics of surgical treatment is determined by the cause of nocturia:
- Kidney diseases: restoration of urine outflow by nephropexy, removal of concretions, excision of tumors, ureteral stenting, reconstructive operations.
- Prostate adenoma: transurethral resection, laser vaporization, laser enucleation, adenomectomy, if radical intervention is impossible – installation of a urethral stent or cystostomy.
- Neurogenic nocturia: botulinum toxin administration, sacral neuromodulation, augmentation cystoplasty, pudendal and sacral neurotomy, funnel-shaped resection of the bladder neck, epicystostomy, pyelostomy.
- Hyperthyroidism: hemithyroidectomy, resection of the thyroid lobe, subtotal resection of the thyroid gland, robot-assisted interventions of various volumes, radioiodotherapy.