Nocturia resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Common Causes

• Hormonal imbalance which may leads to:
  • Global polyuria
  • Nocturnal polyuria
• Vesical problems which includes bladder storage disorders:
  • Benign prostatic hyperplasia (BPH)
  • Neurogenic bladder dysfunction
  • Learned voiding dysfunction
  • Anxiety disorders

Diagnosis

Urinary frequency volume chart

Reduced urinary frequency

{{{24hr Polydipsia}}}

{{{ 24HR Urine volume }}}

{{{ Nocturnal urine volume }}}

May have reduced bladder capacity

{{{ Increased fluid intake }}}

{{{ Global polyuria }}}

{{{Nocturnal polyuria }}}

Check for primary or secondary bladder disorders which include: Post void residual volume Urinalysis Uroflowmetry Urodynamic studies Bladder biopsies

{{{ Check for: Diabetes Insipidus Diabetes Mellitus Amount of fluid intake Type of fluid intake }}}

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Treatment

Shown below is an algorithm summarizing the treatment of Nocturia according the the [...] guidelines.

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Start with Conservative Treatment: - First, educate the patient about the nature of his disease by drawing flowcharts or simple diagrams. - Restrict fluid intake at night. - avoid sugary food and coffee before bedtime -Manage use of diuretics -If previous illness leads to nocturia, then treating that illness will surely help. It's important to treat diabetes, an enlarged prostate (BPH), congestive heart failure, obstructive sleep apnea (OSA), and/or high blood pressure. Changing the timing and dose of prescribed medication may also help sometimes. Always look into the patient's previous records. -Scheduled voiding at timed intervals, varying from 15 min to 1 h, based on the patient’s own frequency or incontinence intervals - Make a record of their voiding during day and night. -Do pelvic muscle strengthening exercises (contracting pelvic floor muscles) to suppress urgency. -Elastic compression stockings prevent fluid build-up. So the use of compression stockings can be helpful. -Increase compliance determines the success of treatment,

Successful

Failed

-Follow-up visits are scheduled every 1 to 2 weeks if the patient's condition is stable and he is responding to conservative therapy

At some point Patients stops responding to behavioral modifications

-Continue conservative treatments till it works

If lifestyle changes alone don't help with your nocturia, some medicines may help.

-Start Medical Intervention. -If patient experience bed-wetting, he can keep himself and his bed dry by using different products For example, waterproof mattress covers, absorbent briefs and skincare products.

Medicines to help the kidneys produce less urine. For example, Desmopressin, Anticholinergic medicines to treat bladder muscle problems. for example: Darifenacin, Oxybutynin, Tolterodine. a-Adrenergic agonists: Increases urethral closure pressure. it includes Ephedrine and Pseudoephedrine. Antispasmodic like Baclofen Botulinum toxin Tricyclic antidepressant: Imipramine, Amitriptyline Diuretic medicines to regulate urine production and high blood pressure. For example, Bumetanide, Furosemide

Some patients who are refractory to behavioral and pharmacologic therapies respond to FES. Functional electrical stimulation (FES) increasing pelvic floor muscle and urethral striated muscle contractility.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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