What is the need to urinate at night (nocturia)?
Urging to urinate at night (Nocturia) is waking up one or more times during the night due to the need to urinate. Waking up and going to the toilet due to pain, insomnia, noise and some mental problems are not included in this scope. Again, going to the toilet first thing in the morning is not nocturia. Normally, urine production decreases by half due to the hormone called ADH, which is secreted at the base of the brain while sleeping at night, and normally there is no need to get up to urinate during 6-8 hours of sleep. With aging, waking up once a night can be considered normal, but more than once and while sleeping at night, which was not the case before. Feeling the need to go to the toilet is not normal and is a medical condition that needs to be examined, especially if it is accompanied by other complaints. Besides, of course, the bladder is a social organ and we cannot accept this as pathological in a person who has acquired the habit of getting up to go to the toilet at night throughout his life. If the need to urinate at night affects your quality of daily life and If it disturbs your comfort, it is worth examining. The greater the need to urinate at night, the more it interrupts your sleep and will make you more tired during the day, affecting your ability to concentrate on your work, daily activities and social life. In addition, the need to urinate while sleeping during the day is included in the same scope for people who work night shifts and sleep during the day. Urination at night can be seen in both women and men, and its frequency increases with age. It is mostly seen in women under the age of 30 and men over the age of 50. It is seen at a similar rate in both men and women over the age of 60.
Causes and types of the need to urinate at night
There are many reasons for the need to urinate at night, depending on the type.
Excess urine production (Polyuria): Polyuria patients produce more than 3 Liters of urine in 24 hours. This is usually caused by too much water being filtered by the kidneys. Excessive fluid intake occurs in some conditions that cause excessive urine production, such as Type 1, 2 Diabetes or primary polydipsia (Diabetes insipidus - Pseudodiabetes), which causes a feeling of dry mouth and causes you to drink a lot of water, and gestational diabetes.
Excessive urine production at night (Nocturnal polyuria): Nocturnal polyuria is also only There is high volume urine production at night. However, urine volumes during the day are normal or even decreased. This is usually caused by fluid retention in the feet or legs due to edema during the day. When you lie down to sleep, when the negative effects of gravity disappear, the fluid in the edema areas returns to your veins and is filtered by your kidneys, causing excessive urine production.
Causes causing edema and excess fluid accumulation:
● Heart failure.
● Chronic renal failure
● Lower extremity edema (swelling of the legs).
● Sleep disorders such as obstructive sleep apnea (breathing is interrupted or stops many times during sleep).
● Some medications, including diuretics-diuretics, cardiac glycosides, demeclocycline, lithium, methoxyfluorane, phenytoin, propoxyphene, and excess vitamin D.
● Drinking lots of liquids before bed, especially coffee, caffeinated drinks or alcohol.
● Eating a meal high in salt.
● Decreased production of ADH-Vasopressin hormone
Night urinary frequency (True Nocturia): Although night urine production is normal, it refers to the need to get up to urinate at night. . In fact, the total amount of urine produced is not high. This is usually because the bladder does not empty completely (so it fills faster) or because the bladder does not fill completely before you develop the urge to urinate (low bladder volume). This may also occur due to difficulty sleeping, but is not included in nocturia.
Reasons for not being able to empty your bladder completely:
● Bladder outlet obstruction
● Prostate enlargement
● Prostate Cancer
● Congenital bladder outlet stenosis and urinary tract stenosis
Reasons for the bladder's inability to store urine completely may include:
● Bladder overactivity (bladder spasms).
● Bladder infection or recurrent urinary tract infection.
● Bladder inflammation (swelling).
● Interstitial cystitis-painful bladder syndrome.
● Bladder cancer.
Need to urinate at night - Nocturia diagnosis
The diagnosis of nocturia is relatively simple, but understanding the underlying causes is quite complex. Therefore, nocturia can also be a symptom of other potentially serious medical conditions. First, the doctor will learn your medical history and perform a physical examination. You should also record any medications you take, urinary tract infections, and related symptoms. Your physician will review the diary to determine possible causes and treatment for the need to urinate at night.
Your physician may ask you the following questions:
● When did this condition start?
● How many times do you urinate every night?
● How much volume do you pee when you urinate at night?
● Has there been a change in the rate and volume of urination (increase or decrease)?
● How much caffeine-coffee do you drink daily?
● Is urination during the night keeping you from getting enough sleep?
● Do you drink alcoholic beverages? How often and how much?
● Has your diet changed recently?
● He/she asks for your bladder-voiding diary and may request a urinalysis for infection.
Physical examination:
● Bladder distension (if your bladder does not empty completely, it may be tense and distended),
● Swelling in the ankles and legs (known as peripheral edema).
● Skin damage in your genital area (a sign of urinary incontinence)
● Discharge from the urethra (a sign of infection)
● Abnormalities in the genital area, prostate exam in men or pelvic exam in women may perform blood pressure measurements and examinations for heart, lung, or neurological conditions.
Treatment of night urination - Nocturia
Some recommendations can be made for the treatment of night urination need, the basic treatment is aimed at treating the underlying cause. Apart from this, symptomatic- Supportive treatments may be recommended. Treatment methods include medication and some surgical methods.
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