SPACE COAST MEDICINE SPOTLIGHT
The clinical name is nocturia, and it’s an inconvenience that may signal a chronic disease course. At Health First, we have the specialists ready to discuss any of them.
BREVARD COUNTY, FLORIDA – When we’re little, we complain at night that we’re thirsty, and mom or dad brings us a glass of water.
Later in life, the ghosts of glasses past haunt us, and we wake at night to urinate. Sometimes, a lot.
Nocturia is the clinical word for this, and while it’s an inconvenience – does it pose a problem?
“Many of my patients get up five times or more each night, which can interrupt brain restorative sleep,” says Dr. Jim Raders, a Urogynecologist at Health First.
The causes could be behavioral – we’re simply drinking liquids or eating too late at night. But nocturia may have root causes that should signal a trip to the doctor’s office.
“I ask my patients not just about the number of times they awaken, but we explore the circumstances as well,” Raders says.
“Many patients simply make too much urine at night, called nocturnal polyuria. Others have urgency, accidents on the way to the bathroom, even bedwetting. Often, part of the solution is reducing late-night drinking and eating. I discuss restricting the amount and certain types of fluid intake 3 to 4 hours before retiring.”
Overnight urination often yields small amounts. It can be associated with the sudden need to hurry to the toilet, with or without accidents.
“This is overactive bladder (OAB) or ‘urgency,’ as we call it. The cause is unknown in most cases and is related to premature contractions of the bladder muscle along with false messages that the bladder is full when it is not,” Raders says.
OAB affects as many as 1 in 7 Americans, women and men. There are a number of effective treatments, both pharmaceutical and behavioral.
Nocturia may be the result of bladder sensitivity – or it may be a person really has to pee! Why do some people produce a lot of urine at night? It may be fluid retention due to a high-sodium diet, or edema (swelling) of the legs or congestive heart failure.
When supine at night, the liquid elsewhere makes its way to the kidneys and bladder. Polyuria is a common symptom of diabetes, too.
Men are from Mars…
In men, nocturia is a very common symptom of benign prostate hyperplasia (BPH) and prostate cancer. The enlarged prostate puts pressure on the urethra and the bladder.
Fortunately, treatments for both BPH and prostate cancer have become very (advanced) and effective when implemented early.
Giving birth is a seismic factor in new nighttime inconveniences. Sometimes, habitually rising to feed or comfort a baby primes a person to wake often, even long after the wee one sleeps through the night.
But that goes only part of the way toward explaining why 2 in 3 women over 40 say they wake at night to urinate, and half say they do so two or more times each night.
“Both men and women have OAB, but women are at least three times more likely to leak with urgency than men” Dr. Raders says. “Nocturia can be dangerous. Women often fall hurrying to the bathroom in the dark, and there’s the potential to fracture a bone.”
What if the urge to pee overnight isn’t a fault of the urinary system at all? What if it’s a perfectly healthy response to a separate health issue entirely?
Sleep apnea is a serious disorder in which breathing is disrupted (airways become relaxed and narrowed or closed), cutting the necessary rhythm and timing of deep sleep and REM cycles. The body’s response to the disruption is to signal the need to release liquid, even if the bladder isn’t full.
A sleep apnea sufferer will awake and feel the need to urinate, unaware that choking and not the urge to pee is the real culprit.
Neurological disease courses can affect both bladder storage and sensitivity, and polyuria (often associated with diabetes). Nocturia can be a consequence of multiple sclerosis (MS), Parkinson’s disease, stroke or spinal cord injury.
In these cases, nocturia is not commonly the telltale symptom resulting in a neurological diagnosis. And nocturia may be addressed by behavioral and clinical therapies. n
To talk with a specialist about your nighttime bathroom breaks, visit HF.org/Urogynecology, or call 321.434.3131 to schedule an appointment.
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