DR. CHAN SIEW HONG
Consultant Urologist in SGH and KPJ Kuching
If you find yourself waking up in the middle of the night and rushing to the bathroom, don’t worry – you’re not alone! The need to wake up and urinate at least once at night is called nocturia. This is a very common condition and its incidence increases with age. It is estimated that up to 60% of people above 70 wakes up at least twice each night to urinate. This increases up to 80% for people above 80 years old. While waking up once at night to urinate is generally not too bothersome, the need to wake up several times can affect a person’s quality of life and general wellbeing. Sleep disruption can cause daytime drowsiness, lower work productivity and increase the risk of falls. Longterm sleep deprivation can lead to depression, hypertension, obesity and glucose intolerance.
The causes of nocturia are many and often complex. Often, older men with nocturia are wrongly treated for enlarged prostate, which is why their symptoms of nocturia do not improve. The treating doctor (usually the urologist) needs to take a full medical history, physical examination and perform some tests to find out the underlying cause for the condition. It may be something as simple as underlying undiagnosed diabetes mellitus, which causes increased production of urine, or simply drinking too much fluid at night, to something serious such as prostate cancer. As part of the diagnostic workup, you will usually be asked to keep a ‘bladder diary’, which requires you to keep a record of how much you drink and urinate over a 24-hour period. This helps the urologist understand the severity of the symptoms and make the correct diagnosis and treatment decision.
The most common cause for nocturia in the elderly is nocturnal polyuria. This is a condition where a person has an altered day to night ratio of urine production. Nocturnal polyuria is diagnosed when more than a third of urine production occurs at night while the total 24hour urine production remains unchanged. A person may notice that he or she does not urinate as much during the day as usual but produces a lot of urine at night. Medical conditions such as heart failure and renal failure can contribute to the syndrome. However, the reason for nocturnal polyuria is still unknown (idiopathic), although current theories indicate it may be caused by hormonal changes associated with ageing.
Simple lifestyle modifications can improve nocturia. This includes drinking less in the evening and more during the daytime; it is recommended to drink at least 1.5L of water during the day as long as there is no heart or kidney failure. Avoid caffeine (coffee, tea, soft drinks), alcohol and smoking as well as having dinner too late at night. It is advisable to have dinner at least three hours before bedtime, and maintain a good, regular sleep routine.
Definite treatment of nocturia depends on the cause. If it is due to nocturnal polyuria, normally a simple modification to a person’s lifestyle is enough. Medication that reduces urine production at night may be started if conservative measures fail. If nocturia is a result of obstruction from an enlarged prostate or better known as BPH (benign prostatic enlargement), then medications for BPH will be needed. Occasionally, surgery is necessary to improve symptoms.
In conclusion, nocturia is a common condition, so don’t worry too much! However, if you are experiencing symptoms of significant nocturia (two or more/night) should seek medical evaluation. This bothersome condition can often be treated successfully with simple lifestyle modifications with or without medications and occasionally surgery.