Nocturia (waking up at night to urinate) affects individuals across all age groups and genders.
This issue, referred to as “nocturia,” can affect individuals of all ages but becomes more common in people past age 60. It also has been associated with a variety of diseases, including diabetes, heart disease, and high blood pressure.
It should be noted that all of us, even healthy adults, have increased urine production at night due to various factors including return of fluid trapped in legs to the blood circulation and decreased production of a brain hormone called ADH which normally suppresses urine production during the daytime. Patients with diabetes, heart failure, lower extremity swelling, etc. have even more urine production at night.
It is considered normal to have 0-1 night time awakening to urinate. More than 2-3 times can very bothersome and a sign of an underlying issue such as overactive bladder or enlarged prostate gland not allowing easy bladder emptying. This has to be differentiated from other issues such as poor sleep quality (age, depression, etc) that result in frequent sleep interruptions or awakenings during the night, which are not due to the sensation of a full bladder with the urge to urinate per se.
Can You Address Nocturia on Your Own?
Nocturia is a chronic condition and usually associated with other problems, but there are many ways to control this problem on your own, such as:
- Manage your caffeine consumption. Coffee, tea, and other caffeinated drinks stimulate the bladder and also increase your urine volume. The first step in decreasing nocturia and even urinary incontinence (leakage of urine) is to decrease fluid intake before bedtime also avoiding caffeinated beverages (including decaf, which still has a small amount of caffeine).
- Avoid fluid intake few hours before bedtime. By minimizing the fluid intake in the hours prior to your sleep, you can slow down the production of urine at night (which is already more than daytime as mentioned above) and minimize the risk of incontinence.
- Keep your legs elevated during the day. Oftentimes, keeping the legs elevated throughout the day is a great way to stimulate the flow of fluid throughout the body, so it will accumulate in the legs and produce more urine at night when this fluid goes back into the circulation. You also may want to pick up a pair of compression stockings. They have been shown to help improve blood flow and reduce the risk of circulation problems.
- Avoid smoking cigarettes and consuming alcohol. Smoking cigarettes increases the risk of bladder cancer that may present with urgency and sometimes incontinence, while alcohol consumption is a known bladder irritant and diuretic (i.e. increases urine production). If you can stop smoking and consuming alcohol, you could lower your risk of incontinence.
- Address related medical issues. Optimizing the treatment for any medical condition such as diabetes or congestive heart failure can help control your nocturia and other urinary symptoms in many cases.
Of course, there may be urinary incontinence cases where urologic assistance is necessary. With the help of the right urologist, a patient can identify the underlying causes of urinary incontinence and develop a personalized treatment plan to address a particular problem.
How Does a Urologist Treat Urinary Incontinence?
The causes of nocturia and nighttime urinary incontinence may vary. Some of the common causes associated with incontinence include:
- Infection
- Inflammation
- Anatomic variations that occur due to childbirth or surgery
- Neuromuscular dysfunction due to diabetes, stroke, spinal cord injury, or other underlying diseases
- Enlarged prostate
A urologist understands that every patient is different, and as such, takes a comprehensive approach to diagnose urinary issues. First, a urologist evaluates a patient’s medical history and conducts a medical examination. He or she also will learn about a patient’s urinary symptoms. In many instances, a urologist will request a “voiding diary” from a patient as well; this diary is simply a log of intake/output of fluids and helps a urologist evaluate the extent of urinary symptoms, volumes, and context in which they take place.
Next, a urologist conducts diagnostic studies to assess the underlying causes of urinary problems. These studies may include:
- Pelvic Ultrasound: Provides images used to analyze organs and structures within the pelvis including bladder and prostate (males) or uterus (females).
- Post Void Residual (PVR) Exam: Measures the amount of urine left in the bladder after a patient uses the restroom to “empty” the bladder via a quick scan by a hand-held device.
- Cystoscopy: Enables a urologist to visualize and examine the lining of the bladder and urethra (tube that carries urine out of the body) by passing a small endoscopic camera inside the urinary tract.
- Urodynamic Evaluations: Test the ability of the bladder, sphincters, and urethra in terms of urine storage and release, including sensations, contractions, urine flow and pressures, etc.
The aforementioned studies enable a urologist to understand the relationships between the urinary bladder and surrounding tissues. Perhaps most important, they help the urologist provide proper urinary incontinence diagnosis and treatment.
Common Nocturia Treatment Options
There is no one-size-fits-all approach to address nighttime urination and other voiding issues, and treatment depends on the underlying cause, degree of bother to patient, and severity of symptoms. Sometimes, a urologist will prescribe medications to help a patient manage urinary symptoms. A urologist weighs the benefits of a medication versus the potential risks or side effects associated with it before prescribing any medication to a patient. After careful consideration, a urologist may prescribe a medication to a patient and schedule a follow-up appointment with him or her to ensure optimal results.
Pelvic Floor Rehabilitation Therapy
For some patients, pelvic floor rehabilitation therapy may prove to be an ideal way to address urinary urgency and incontinence. Pelvic floor rehabilitation therapy involves regular sessions with doctors and therapists, and to date, has delivered proven results to many urinary incontinence patients. Generally, patients are taught floor rehabilitation exercises that can be performed at home, and a urologist will monitor a patient’s progress over time. A patient also may use floor rehabilitation therapy in combination with various dietary and lifestyle changes.
Peripheral Nerve Stimulation
Moreover, Peripheral Nerve Stimulation is a specialized third-line treatment option for overactive bladder. It helps patients manage irritative urinary symptoms (e.g. frequency, urgency, nocturia) and often provides relief to patients who have struggled to achieve their desired results with other incontinence therapies. Very good success rates and virtually no serious side effects make this a great choice for many patients.
Minimally Invasive Surgery
Minimally invasive surgical options are available to treat urinary issues too, obviously depending on the underlying issue. These include pelvic and urethral support procedures can be customized to a patient’s needs (usually females with incontinence or males who have had their prostate removed for cancer and leak urine as a result). For example, transvaginal and trans-obturator slings may be implanted into women, or male sling options or an artificial urinary sphincter may be implanted into men. Endoscopic injections also help curb urinary leakage. And in some cases, sacral neuromodulation or nerve stimulator implants are used to electrically stimulate the bladder nerve roots and improve voiding or stop leakage. Also one of the most common issues is benign prostate enlargement or BPH, which is managed with many procedures including transurethral resection (TURP, shaving out the obstructing prostate tissue inside the urinary channel with electrical cautery), and REZUM (injecting water vapor into the obstructing prostate tissue in the urethra to make it shrink thus opening the channel better) are prime examples among many other available options.
Choose Comprehensive Urology for Urinary Incontinence Treatment
At Comprehensive Urology, our team works with each patient to create a custom urinary incontinence treatment plan. To find out more about how our team can help you address your urinary incontinence symptoms, give us a call today at (310) 499-2756, and you can set up an appointment with one of our friendly doctors.
Sources:
https://www.mayoclinic.org/tests-procedures/cystoscopy/about/pac-20393694
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