The other day, a friend’s parents were complaining that they don’t sleep well. In addition to the fact that they are older, they wake up many times to go to the bathroom, and in the morning they wake up quite tired.
These complaints are more common than we think and have a name: adult nocturia. According to the International Continence Society, it is defined exactly as the need to wake up to urinate at least twice a night.
This problem, which affects sleep and quality of life, becomes more common as we age. It is estimated that three out of five people over the age of 70 suffer from it, although it can also occur at younger ages. And it affects men and women equally.
A wide range of causes
Two causes can give rise to nocturia: decreased bladder capacity and/or increased urine production, known as polyuria.
In the first case, we are talking about an organ with a capacity of between 300-600 ml, which can be reduced in turn by two factors:
An anatomical alteration. In men, this is most commonly due to benign prostatic hypertrophy, and in women, to obesity and pelvic organ prolapse.
Functional problems such as overactive bladder syndrome, cystitis, infections…
As far as polyuria is concerned, nocturnal urine production usually decreases due to the action of the antidiuretic hormone, but as we get older, the release of this substance is reduced at night.
This is one of the main causes, although it can also be precipitated by various diseases – diabetes, edematous states caused by venous insufficiency or heart failure, arterial hypertension, etc. -, increased fluid intake in the evening, and the consumption of caffeine, alcohol or tobacco.
In addition, there are medications whose side effects can increase urine production or alter bladder function. The most common are:
Diuretics: used to treat fluid retention and reduce blood pressure.
Anticholinergics are often used to treat overactive bladder syndrome. They can interfere with the nerve signals that control this organ and cause increased urinary frequency, including nocturia.
Medications for high blood pressure, such as calcium channel blockers and angiotensin-converting enzyme inhibitors.
Some antidepressants, such as selective serotonin reuptake inhibitors, which block the action of antidiuretic hormone.
Lithium, a drug used to treat bipolar disorder.
It is important to note that not everyone taking these medications will experience nocturia as a side effect.
If anyone suspects that they have this effect or are concerned about such a symptom, it is important to talk to their doctor or physician, so that alternatives can be provided or treatment can be adjusted.
Five measures to tackle it
The management of nocturia must be approached on an individual basis, as many factors are involved. Here are some basic tips.
- Lifestyle changes: reduce fluid intake 4-6 hours before bedtime, avoid alcohol and caffeine at night, stop smoking and lose weight if overweight. It is also advisable to urinate before bedtime and do pelvic floor exercises. And if you suffer from fluid retention in your legs, it is advisable to elevate them a few hours before nightfall.
2. If nocturia is caused by a medical condition, such as diabetes or heart disease, treating it properly can reduce symptoms. It is important to follow up with primary care health professionals.
3. Modify schedules of pharmacological treatments, diuretics and angiotensin-converting enzyme inhibitors. Health professionals should be consulted first so that they can adjust treatment and minimize side effects.
4. Pelvic floor treatment and bladder training with physical therapists may be helpful in teaching better control of urination.
5. Sometimes, after an individual assessment, the physician may prescribe medications to treat nocturnal polyuria: diuretics (administered in mid-afternoon), antidiuretic hormone analogs and tricyclic antidepressants, which increase the production of antidiuretic hormone.
In summary, although nocturia is very common in the elderly, it does affect sleep and, consequently, rest and quality of life.
It is advisable to consult with primary care professionals, who will make an individualized assessment, taking into account everything from lifestyle habits to the review of medications and other pathologies.