Nocturia is a nocturnal urge to urinate. Constantly or periodically observed in diseases of the kidneys and bladder, prostate adenoma, neurological pathologies, heart failure, some endocrine diseases. Occasionally occurs with violations of the regime. The cause of the symptom is established on the basis of complaints, examination results, laboratory and hardware techniques. Treatment includes antibiotics, NSAIDs, and other medications. According to indications, endocrine disorders are corrected, surgical interventions are performed.
Why does nocturia occur?
Physiological causes and effects of drugs
The cause of nighttime urges in healthy people is most often the use of large amounts of fluid before bedtime. Because of the diuretic effect, nocturia can provoke strong tea, coffee and alcoholic drinks taken in the afternoon. Of the drugs, 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 and pain in urination, a decrease in portions of urine, cramps, burning, pain above the pubis, a feeling of incomplete detrusor emptying. Cystitis in women is a widespread disease, more often diagnosed in reproductive age, can be acute or chronic, and often develops during pregnancy. In men, pathology is diagnosed less frequently. Other illnesses associated with nocturia include:
- Pyelonephritis. For an acute process, urination disorders are uncharacteristic. Patients with the chronic form complain of pollakiuria, nocturia, back pain, weakness, cephalgia, and appetite disorders. The anamnesis reveals an episode of acute pyelonephritis with generalized hyperthermia, turbidity of urine and other typical symptoms.
- Glomerulonephritis. The acute form is manifested by oliguria, followed by nocturia, micro- or macrohematuria, frequent urination, swelling of the face, and increased blood pressure. Chronic glomerulonephritis occurs with periodic exacerbations, repeating the clinical picture of an acute episode.
- Interstitial nephritis. The disease manifests with significant hyperthermia, febrile syndrome, severe 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, severe nocturia (more than 3 episodes per night), polyuria, constant pulling pains in the lumbar region, and 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, and disturbances in the daily 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, a sluggish stream, a feeling of incomplete emptying of the bladder.
A common neurological cause of nocturia is 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, urgency, and urge incontinence are noted. It is possible to develop nocturia and pollakiuria without incontinence.
The neurogenic bladder is formed against the background of strokes, encephalitis, complicated spinal fractures, cerebrovascular accidents, polyradiculoneuritis, polyradiculopathies, and CNS developmental anomalies. Nocturia is typical of the hyperactive variant of the syndrome, accompanied by urinary incontinence and imperative urges. There may be difficulties at the beginning of urination, the appearance of autonomic disorders before micturition.
Pronounced polyuria is characteristic of diabetes insipidus. The volume of daily urine reaches 4-1 or more liters, nocturia is manifested by repeated rises during the night, combined with a daily increase in urination. Polydipsia is also seen. Due to constant awakenings, sleep is disturbed, frequent trips to the toilet lead to nervous exhaustion and the occurrence of neuroses. The disease often debuts acutely, rarely develops gradually.
If untreated, diabetes mellitus is manifested by constant thirst, polydipsia and polyuria, including nocturia. Dryness and itching of the skin, pustular infections, cramps in the calf muscles, weakness, fatigue are observed. In type 1 diabetes, the symptom is more pronounced, combined with weight loss. Skin infections predominate in patients with type 2 diabetes, and obesity is common.
One of the signs of hyperthyroidism is water metabolism disorders, including polyuria, nocturia, and intense thirst. These symptoms are combined with an acceleration of metabolism, an increase in appetite with weight loss. Unbalance, anxiety, irritability, cardiovascular and ophthalmic disorders are noted.
In chronic heart failure, nocturia is combined with a decrease in daily diuresis, supplemented by shortness of breath, asthma attacks, 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:
- Damage to the veins: advanced varicose veins, chronic venous insufficiency. The cause of nighttime 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 long course, the manifestation is aggravated due to the formation of myocardial dystrophy and heart failure.
- Failure of the pelvic muscles. Weakness of the pelvic floor muscles in women is a polyetiological condition that develops against the background of complicated childbirth, gynecological diseases. Nocturia can be combined with urinary incontinence.
- Apnea syndrome. Inadequate sleep contributes to frequent awakenings and night trips to the toilet. Neurophysiological disorders and dysfunctions of the heart play a significant role.
Diagnostic measures are carried out by a urologist. According to the indications, patients 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, for women - 4 days.
To exclude gynecological pathologies, women are examined on a chair. Men undergo a digital examination of the prostate through the rectum. As part of the additional examination, the following procedures are carried out:
- Ultrasound of the urinary system. Ultrasound of the bladder is performed to detect signs of inflammation, exclude residual urine, stones, neoplasms. On ultrasound of the kidneys, structural changes are visualized; to assess the condition of the vessels, the study is supplemented by ultrasound or duplex scanning.
- Sonography of other organs. If a pathology of the prostate gland is suspected, ultrasound of the prostate 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 in the development of the kidneys, nocturia of neurological origin, survey urography and excretory urography are informative. According to the indications, ascending pyelography, conventional and voiding urethrocystography are performed.
- Endoscopic methods. Cystoscopy allows you to determine the morphological form of chronic cystitis, to exclude other pathologies. With nephrosclerosis, malformations, some other kidney damage, nephroscopy may be required. Biopsy may be taken during endoscopic procedures.
- Urodynamic studies. With prostate adenoma, cystitis, neurogenic disorders, uroflowmetry, profilometry of intraurethral pressure, cystometry and a comprehensive urodynamic study may be indicated.
- Urinalysis. In the general analysis, signs of inflammation are revealed, with the help of a three-cup test, the localization of the inflammatory process is determined. To assess the concentration ability of the kidneys, a Zimnitsky test is performed. To establish the nature of the microflora, sowing on nutrient media is performed. Neoplasia and changes in tissue structure are detected by cytological or histological examination.
- Other analyses. In inflammatory diseases in the general blood test, leukocytosis, an increase in ESR are noted. In diabetes mellitus, the determination of blood glucose is indicated, in thyrotoxicosis, a test for thyroid hormones. With adenoma, the PSA level is evaluated to rule out prostate cancer.
Patients with pathologies of the kidneys and heart 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.
- Medicines for inflammation. With cystitis, uroseptics and combined herbal remedies are effective. Pyelonephritis may require detoxification, means to strengthen the immune system. With glomerulonephritis, hormones are included in the treatment regimen. NSAIDs are used to reduce the severity of inflammation and pain.
- Medicines for non-inflammatory processes. Patients with adenoma are prescribed alpha-blockers and alpha-reductase inhibitors. With an overactive detrusor, anticholinergic drugs, selective beta-3 adrenoceptor agonists, are used. In case of heart disease, cardiac glycosides, nitrates, vasodilators, anticoagulants, beta-blockers are recommended.
- Correction of hormonal disorders. Patients with diabetes insipidus are prescribed a synthetic analogue of ADH, antidiuretic hormone secretion stimulants. In type 1 diabetes, insulin is used, and type 2 diabetes is treated with hypoglycemic agents. In thyrotoxicosis, thyreostatics are effective.
Local treatment may include intravesical instillations, physiotherapy: inductothermy, UHF, ultrasound, laser therapy, etc. For neurogenic disorders and weakness of the pelvic floor muscles, special exercise therapy complexes and electrical stimulation are recommended. Sometimes behavioral therapy is indicated, which involves controlling 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 stones, excision of tumors, stenting of the ureters, reconstructive operations.
- Prostate adenoma: transurethral resection, laser vaporization, laser enucleation, adenomectomy, if radical intervention is not possible, installation of a urethral stent or cystostomy.
- Neurogenic nocturia: injection of botulinum toxin, sacral neuromodulation, augmentation cystoplasty, pudendal and sacral neurotomy, funnel resection of the bladder neck, epicystostomy, pyelostomy.
- Hyperthyroidism: hemithyroidectomy, resection of a lobe of the thyroid gland, subtotal resection of the thyroid gland, robot-assisted interventions of various sizes, radioiodine therapy.