Nocturia

It is quite normal to wake once or twice during the night to pass water. If you have to do so more often than that it can become both annoying and tiring. The need to pass water
during the night very frequently is called nocturia .

Nocturia can happen because you are growing older. Or it may be because of a medical problem which requires treatment - so it is a good idea to report a frequent need to go to the toilet during the night to your doctor or to a continence nurse.

Why does nocturia affect older people more than others ?
There are several reasons for this. One simple reason is that as you get older your bladder is not able to hold as much urine as it used to. Another is that later in life you are more likely to suffer from other medical conditions which can affect the bladder.

There are several medical reasons which can cause nocturia and which are more common in older people :

Hormones - A hormone is produced at night whose job is to make your body retain fluid while you sleep rather than producing urine. As you get older less of this hormone is produced and so your bladder fills at a daytime rate, which means needing to pass water more frequently.

Circulation - The kidneys filter your blood as it passes through them and they collect waste products and excess fluids which your blood has brought from around your body. As the waste products and fluids are collected the kidneys make urine, which then passes to your bladder, where it is collected.

When you get a little older your heart and circulatory system can become less efficient, so that some fluids are left behind in the body s tissues - especially around the ankles because it is harder for the heart to lift fluids from there.

When you lie down at night it becomes easier for the circulatory system to work. The fluid is absorbed into your blood and delivered to the kidneys, which then send it to the bladder as urine. This means that your bladder fills as you sleep much more than it normally would.

Prostate - The prostate gland becomes enlarged in most men over a certain age. More than half of all men over the age of 60 and 80% of all men over 80 have enlarged prostate glands. (This is not the same as prostate cancer.)

When the prostate becomes enlarged it begins to squeeze the bladder outlet and when this happens you might find that you have difficulty passing water. Because your bladder has difficulty squeezing the urine out, it seldom empties completely. Since it is never completely empty it takes a much shorter time for it to fill up again, so that you will have to pass water more frequently.

Other causes of nocturia
Nocturia can also be caused by several medical conditions which have nothing to do with age :
It can be a result of a kidney or bladder condition - such as kidney stones, a urinary tract or bladder infection or an overactive bladder.

Pregnancy - a growing womb can put pressure on your bladder so that it can hold less.
A heart condition can result in a weakened circulatory system and could cause the same effect as described above.
Diabetes can lead to bladder problems such as nocturia.
Drugs - nocturia can be a of side effect of some drugs. Check with your doctor to see if any medicines you have been prescribed might be the cause of your nocturia - but do not stop taking any medicine unless advised to do so.
Constipation can cause the bowel to swell and put pressure on the bladder.
And, of course, excessive fluid intake can cause you to need to pass water at inconvenient times.

What can be done ?
Your doctor will check to see if your nocturia is caused by an underlying condition which needs to be treated.

Meanwhile, it makes sense to pay attention to the wider picture so that you give your bladder the best chance of working properly.

Fluid intake
It is important to drink enough each day. Generally, most people do not drink enough fluids. Try to drink about three pints of fluid each day. If you drink a lot less than this, then increase the amount you drink gradually. Some people experiencing bladder problems start to drink less, thinking that this will help. But if you do not drink enough, your urine will become more concentrated and this can cause irritations and infections - and make matters worse.

However, restricting how much you drink a few hours before bedtime can help to reduce the problem of nocturia.

Fizzy drinks, alcohol and the caffeine in tea and coffee can all irritate the bladder. It is better to drink plain water, fruit juices or cordials, decaffeinated coffee or herbal tea.

Diet
Try to eat a balanced diet. Eating some food that contains fibre every day will help to keep your bowels healthy. Foods like fruit and vegetables, baked beans, wholemeal bread and bran cereals are rich in fibre.

Helping your heart
Lying down for an hour or so in the afternoon can help if you have swollen ankles as a result of poor circulation. Your feet should be higher than your heart. In this way you can help the circulatory system to draw some of the excess fluid away, which can reduce problems at night.

Drugs
Drugs are available which can be used to treat nocturia and these can be discussed with your doctor. Do not take any medication without seeking medical advice.
Diuretics - these are drugs which promote the production of urine. Sometimes these can be used to help your body to rid itself of excess fluids before bedtime.
Anticholinergics - these are a group of drugs which relax your bladder so that it can hold more urine without wanting to empty.
Desmopressin - this drug reduces the amount of urine produced by your body at night.

Practical help
If you continue to need to pass water frequently during the night, perhaps you should make it easier for yourself to reach a toilet so that your sleep is interrupted as little as possible. You might consider placing a commode in your room or using a urinal which could be kept by your bed. You can ask your
nurse for advice about these.

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Troubled Nights