Condition: Nocturia
Brief Overview: According to UpToDate, Nocturia “is defined as waking to pass urine during the main sleep period. Nocturia is likely clinically meaningful if a patient voids two or more times nightly. Several medical conditions contribute to nocturia, including heart failure and other edematous states, sleep disorders, bladder and prostate conditions, and medication effects.”
Prevalence: According to UpToDate, “Approximately 50 percent of adults between the ages of 50 to 79 have nocturia.”
Etiology: According to UpToDate, “nocturia results from one of three mechanisms: low-volume bladder voiding, increased nighttime urine production, and sleep-related disorders.”
Risk Factors:
- Increasing age
- Male > female, after age 50 years old
- Diabetes
- CKD
- Peripheral edema, diuretics
- OSA, insomnia
- Increased fluid intake prior to bedtime
Commonly Associated Conditions:
- Diabetes
- HTN
- Heart disease, CHF
- OSA
- OAB
- BPH
Common Medications:
- Alpha-1 adrenergic antagonists (for males with additional BPH symptoms) – alfuzosin, silodosin, tamsulosin
- Topical vaginal estrogen therapy (for postmenopausal females)
- Beta-3 agonists - mirabegron (Myrbetriq), vibegron (Gemtesa)
- Antimuscarinics – oxybutynin, tolterodine
- Desmopressin – in patients <65 years old (avoid in patients 65 years old and older)
Common Labs, Imaging, and Tests:
- Postvoid residual testing (PVR) with bladder ultrasound
- Urinalysis, urine culture
- BMP, PSA (in males)
- Urine cytology, cystoscopy
Common Symptoms:
- Nighttime awakening to urinate
- Sleep disruption (which can lead to fatigue, daytime sleepiness)
Common Treatments:
- Medications (see above)
- Pelvic floor muscle exercises, Kegel exercises
- Manage any underlying conditions
- Reduce evening fluid intake
- Bladder training, timed voiding
- Sleep hygiene measures
Physical Findings:
- Often normal physical exam.
- May find peripheral edema (heart failure, venous insufficiency)
- May find enlarged prostate on DRE (in men with BPH)
- May find elevated blood pressure or signs of volume overload
- May find BMI elevation (sleep apnea risk)
Potential Complications and Contraindications:
- Sleep fragmentation, daytime fatigue, increased fall risk in older adults
- Nocturnal falls and injury (especially in seniors)
- UTIs and incontinence complications
- Quality of life decline, increased risk of depression, or caregiver burden
General Health and Lifestyle Guidance:
- Ask your healthcare provider if you should limit fluids for 2–4 hours before bedtime (especially caffeine and alcohol).
- Ask your healthcare provider if you should elevate legs in late afternoon or wear compression stockings if edema is present.
- Establish consistent sleep schedule and good sleep hygiene.
- If you take diuretics, discuss timing of that medication with your healthcare provider to help minimize nocturia.
- Encourage regular exercise and weight management to reduce sleep apnea risk, as indicated and approved by patient’s healthcare provider.
- Report worsening symptoms or new medical issues to your healthcare provider promptly.
Suggested Questions to Ask Patients:
- How many times per night do you typically wake to urinate?
- Does this impact your ability to sleep or function during the day?
- How much fluid do you drink in the evening?
- Are you taking any diuretics or bladder medications?
- Do you have leg swelling during the day?
- Have you been diagnosed with sleep apnea, heart failure, or diabetes?
- Have you had any falls or accidents when getting up at night?
Suggested Talking Points:
- Nocturia is common, especially as we age, but it can be improved with a combination of lifestyle changes and treatment.
- Identifying the cause — whether it’s excess nighttime urine production, bladder issues, or another condition — guides the best treatment.
- You may be able to work with your healthcare provider to reduce how many times you wake up at night, improving your sleep and quality of life.
- Some medications may help, and adjusting fluid intake and timing can make a big difference.
- If you have leg swelling, managing it earlier in the day can reduce nighttime urination.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/nocturia-in-adults-clinical-presentation-evaluation-and-management?search=chronic%20nocturia&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
- https://www.urologyhealth.org/urology-a-z/n/nocturia
- https://my.clevelandclinic.org/health/diseases/14510-nocturia