Nocturia

and Sabine Schrör, medical journalist

Dr. med. Fabian Sinowatz is a freelancer in the medical editorial team.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Nocturia is the nocturnal urge to urinate, when you have to go to the toilet twice or more at night. This can seriously disrupt night sleep and reduce the quality of life in the long term. Nocturia occurs mainly in the elderly and is often considered to be a harmless symptom of old age. However, it can also be a symptom of an illness and should therefore be clarified by a doctor. Read more about nocturia here.

Brief overview

• Definition: nocturnal urge to urinate that occurs more than twice a night. Mostly affects the elderly (men and women alike).
• Causes: e.g. heart failure, diabetes, impaired kidney function, sleep apnea, lack of antidiuretic hormone (ADH), certain medications (such as diuretics, some antidepressants and antibiotics), benign prostate enlargement, prostate cancer, overactive bladder, malfunction of the bladder muscle, lower urinary tract infections, reduced Bladder capacity.
• Diagnosis: based on medical history (anamnesis), physical examination, drinking and elimination diary, EKG and / or stress EKG, urine rapid test, ultrasound, rectal scanning of the prostate, blood test.
• Treatment: depending on the cause, e.g. heart failure: medication, healthy lifestyle, possibly pacemaker or heart transplant. For diabetes: drugs to lower blood sugar, healthy lifestyle. For urinary tract infections: mostly antibiotics. If the bladder is overactive or has reduced bladder capacity: bladder training. If the prostate is enlarged: surgery and / or medication.

Nocturia: definition

Many people have to go to the toilet at night - depending on how much they drink in the evening, this is quite normal. One speaks of nocturia only when someone is woken up from sleep twice or more regularly by the need to urinate at night, even though he or she has not drank too much in the evening.

A distinction is made between nocturia and enuresis - involuntary nocturnal wetting during sleep.

Who Does Nocturia Affect?

Nocturia is most common in the elderly. According to a Danish study, around 77 percent of all over-60s suffer from nocturia, with men and women equally affected.

Possible complications

Nocturia is usually much more than an unpleasant symptom of old age. Repeated urination at night makes restful sleep almost impossible. This has an impact on the health and quality of life of those affected: Many suffer from fatigue, headaches and difficulty concentrating during the day. Nocturia can even trigger or worsen depression.

In addition, going to the toilet at night - especially in the elderly - increases the risk of falling and getting broken bones (fractures) or worse injuries. Therefore, nocturia should always be clarified and treated by a doctor.

Nocturia: causes

Nocturia is not an independent disease, but a symptom that can occur in a wide variety of physical disorders.

Basically, there are two mechanisms that lead to excessive nocturnal urination: Either the body produces too much urine (polyuria) or the urinary tract does not function properly (urological cause).

Too much urine production (polyuria)

Polyuria can have several causes, for example:

• Heart failure: With heart failure, the heart can only pump to a limited extent. The body therefore stores water in the legs during the day (leg edema). At night when lying down, the fluid is flushed out again, which leads to an increased urge to urinate at night. Other symptoms of heart failure include decreased performance and shortness of breath.
• Diabetes (diabetes mellitus): Diabetics are often very thirsty (polydipsia) and therefore consume significantly more fluids than healthy people. As a result, your body also produces more urine.
• Impaired kidney function: If the kidney's tiny blood filters are damaged, albumin often accumulates in the urine (albuminuria). The protein binds water, which is why more urine is ultimately excreted.

• Obstructive Sleep Apnea Syndrome (OSAS): People with sleep apnea also often have an urge to urinate at night. Treating sleep apnea usually also reduces the number of visits to the toilet at night.

• ADH deficiency: Normally, the antidiuretic hormone (ADH) slows down the production of urine at night. However, if the body does not secrete enough ADH, too much urine will be produced during the night. Nighttime ADH production can be temporarily disrupted, especially with shift workers: After switching from night to day shift, nocturia can occur briefly.
• Medicines: Dehydrating, water tablets - the so-called diuretics - increase the production of urine. Therefore, these drugs should not be taken in the evening. Calcium antagonists (e.g. against high blood pressure), antidepressants of the SSRI class and antibiotics from the tetracycline group can also increase urine volume.

Urological causes

Many older men develop benign enlargement of the prostate (benign prostatic hyperplasia). This is often associated with an urge to urinate at night. The enlarged prostate narrows the urethra so that the urinary bladder cannot be completely emptied when urinating - several hundred milliliters of residual urine remain in the urinary bladder every time you go to the toilet. So the bladder is filled again after a short time, which triggers a renewed urge to urinate.

In addition to benign enlargement of the prostate (prostate cancer), malignant enlargement of the prostate (prostate cancer) can also be responsible for the increased urge to urinate.

In women, on the other hand, there is usually an overactive bladder or a malfunction of the bladder muscle behind the nocturia. Those affected feel an excessive urge to urinate both during the day and at night.

Infections of the lower urinary tract such as a bladder infection can also lead to an increased urge to urinate. A severe burning sensation when urinating is another typical symptom of these disorders.

Rarely, reduced bladder capacity is the cause of nocturia. For example, bladder stones or a bladder tumor can reduce the capacity of the bladder.

Nocturia: diagnosis

If you have to urinate more than twice regularly at night, you should see a doctor. Because if sleep is interrupted several times, this has a negative effect on your quality of life over time. In addition, nocturia can be a symptom of serious medical conditions that require medical attention.

The first point of contact for nocturia is the family doctor, not the urologist. Because the increased nocturnal urination does not have to be based on a urological cause, but often has general medical causes.

When making a diagnosis, the doctor will first ask you questions about your complaints and your medical history in an initial consultation (anamnesis), for example:

• How long have you suffered from the urge to urinate at night?

• How often do you have to urinate at night?

• How much urine do you excrete every night you go to the toilet?

• Do you also have to urinate more during the day?

• Are you often very tired during the day? Has your partner observed nocturnal breathing pauses in you?

• Do you have other symptoms such as pain / burning when urinating, shortness of breath, daytime sleepiness, thirst, weight loss, etc.?

• What known pre-existing conditions do you have (e.g. diabetes, heart problems, sleep problems)?

• What medication are you currently taking?

Your doctor may ask you to keep a so-called "drinking and urination diary". In it you write down for at least two days what you drank, when, and how much urine you excreted and when. These accurate records will help the doctor make a diagnosis.

Depending on the suspected cause, your family doctor may refer you to a specialist (e.g. cardiologist, urologist, neurologist). However, the doctor often carries out certain examinations himself. The most common test methods to clarify nocturia include:

• general physical examinations: e.g. listening to the chest with a stethoscope (auscultation)
• EKG (recording of cardiac currents) and / or stress EKG on the bicycle ergometer if a heart disease is suspected as the cause of the nocturia

• Rapid urine test: blood in the urine may indicate a urinary tract infection, for example, and sugar in the urine may indicate diabetes

• Ultrasound (sonography) of the kidneys, bladder and prostate

• Rectal palpation of the prostate to examine the size and texture of the prostate

• Blood tests to identify general health disorders

Nocturia: treatment

Once the cause of the nocturia has been determined, the symptom can usually be significantly alleviated with a tailor-made treatment. The selection of the appropriate therapy depends on the underlying cause. Some examples:

• Heart failure: Sufferers are given appropriate medication such as ACE inhibitors or beta blockers. In more severe cases, a pacemaker or a donor heart can be implanted. In all cases, a healthy lifestyle is also advisable (healthy diet, appropriate amount of water to drink, no / little alcohol, regular exercise, etc.).

• Diabetes mellitus: The pathologically increased blood sugar level must be lowered with medication (with blood sugar-lowering tablets or insulin injections). In addition, a changed lifestyle (reduction of excess weight, adapted diet, lots of exercise, etc.) can have a positive effect on the course of diabetes.

• Infections of the lower urinary tract (cystitis, urethritis): They are usually treated with an antibiotic.

• Overactive bladder and reduced bladder capacity: Bladder training can help here. In doing so, those affected learn to suppress their urge to urinate and to delay going to the next toilet. As a result of training, the bladder gradually gets used to larger volumes again, which means that the urge to urinate begins later. For many sufferers, symptoms improve within two to three months with this therapy.

• enlarged prostate: sometimes it is surgically removed. In other cases, drug therapy is sufficient: so-called alpha blockers relax the muscles of the bladder, which makes urination easier overall.

As you can see, nocturia can be treated well. It is not a reason for false shame and belongs in medical hands as soon as possible. Always remember: Medical professionals are very familiar with almost all physical phenomena - so overcome unfounded shame and seek medical advice early on. Then you have excellent prospects of a life without nocturia.

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