Nocturia Overview:

Nocturia is a condition in which you wake up during the night because you have to urinate. This condition becomes more common as people age and occurs in both men and women for different reasons.  Nocturia is defined as getting up more than two times during the night feeling the need to urinate.

Bladder dysfunction occurs in at least 80 percent of people with MS during the course of the disease.  Severe nocturia is considered as waking up 5-8 times feeling the need to urinate.  Many multiple sclerosis patients experiencing nocturia awaken feeling the need to urinate yet when they attempt to do so very little urine stream comes forth.  Patients who experience nocturia also often experience daytime urination urgency which is often called overactive bladder (OAB), spastic bladder or flaccid (hypotonic) neurogenic.

Nocturia can be difficult to diagnose the cause of as other conditions such as disorders of the urinary tract, diabetes, kidney disease or damage, cervical compression, fluid processing imbalance for example can result in nocturia.

Urination, occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. The neural circuitry that controls this process is complex and highly distributed. The process involves pathways at many levels of the brain, the spinal cord and the peripheral nervous system and is mediated by multiple neurotransmitters.

Multiple sclerosis patients experience damage to the Central Nervous System (CNS) resulting in signal loss through nerve cells as a individual’s immune system attacks the nerves (neurons).  Since the process of urination in men and women is complex and distributed what areas of the CNS are damaged affect differing areas of control over urination such as daytime or nighttime urgency.

Nocturia Symptoms:

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.

  • You produce a great deal of urine (more than 2 liters) a day (polyuria)
  • Your body produces a large volume of urine while you sleep (nocturnal polyuria)
  • You produce more urine at night than your bladder is able to hold (low nocturnal bladder capacity). This causes you to wake up at night because you need to empty your bladder.
  • A combination of nocturnal polyuria and low nocturnal bladder capacity (mixed nocturia)
  • Poor sleep: Some people who have poor sleep and awaken frequently will go to the bathroom whenever they awaken. Typically in these cases, it is not the need to void that awakens them.
  • Awakening with a need to urinate yet when trying having a low output of urine.

Causes Of Nocturia:

  • Infection or enlargement of the prostate
  • Bladder prolapse
  • Sleep apnea may result in awakening and thus a need to urinate. When the apnea is addressed the nocturia may subside.
  • Overactive bladder (OAB) syndrome
  • Tumors of the bladder, prostate, or pelvic area
  • Diabetes
  • High blood pressure
  • Heart disease
  • Congestive heart failure
  • Vascular disease
  • Anxiety
  • Kidney infection
  • Edema, or swelling, of the lower legs
  • Neurological disorders, such as multiple sclerosis (MS), Parkinson’s disease, or spinal cord compression
  • Urinary tract infection (UTI)

Lifestyle Issues That May Contribute to Nocturia:

  • Behavioral patterns. This is something you have conditioned your body to do as a routine
  • Diuretic medications
  • Caffeine
  • Alcohol
  • Excessive fluids before bedtime
  • Fluid redistribution

Diagnosing Nocturia:

Diagnosing the cause of nocturia can be difficult. Your doctor will need to ask a variety of questions. It can be useful to maintain a diary for a few days, recording what you drink and how much, along with how often you find the need to urinate.

Questions your doctor may ask you include:

  • When did nocturia start?
  • How many times a night do you have to urinate?
  • Are you producing less urine than you did before?
  • Do you have accidents or have you wet the bed?
  • Does anything make the problem worse?
  • Do you have any other symptoms?
  • What medications are you taking?
  • Do you have a family history of bladder problems or diabetes?
  • A discussion of your medical history

You may also undergo testing such as:

  • Blood sugar test (to check for diabetes)
  • Blood urea test
  • Urine culture
  • Fluid deprivation test
  • Imaging tests, such as ultrasounds

Nocturia Treatment:

Medications:

  • Anticholinergic medications: reduce symptoms of overactive bladder
  • Bumetanide (Bumex®), Furosemide (Lasix®): diuretics that assist in regulating urine production
  • Desmopressin (DDAVP®): helps the kidneys produce less urine

Interventions:

  • Restrict fluids in the evening (especially coffee, caffeinated beverages, and alcohol).
  • Time intake of diuretics (take mid- to late afternoon, six hours before bedtime).
  • Take afternoon naps.
  • Elevate the legs (helps prevent fluid accumulation).
  • Wear compression stockings (helps prevent fluid accumulation).

Determine if there is anything else that is disturbing your sleep, other MS symptoms such as spasms, anxiety, depression or neuropathic pain may disturb your sleep and you are more likely to need to urinate if you are awake. Side effects of certain medications can also increase urinary frequency. Talk to your health professionals about managing these symptoms and the possibility of substituting any medications which may be causing your nocturia.

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