Nocturia

Nocturia describes waking at night to urinate. It is more common in older adults, but no population data define a normal range for any group; therefore the complaint implies a deviation from a perceived norm. Furthermore, the primary complaint often centers on the sleep disturbance rather than on urination. It may represent frequent nocturnal urination or excessive nocturnal urine production (nocturnal polyuria). Although often thought of as a prostatic symptom, it is common in both men and women. The many secondary causes in addition to local causes include prostatic hyperplasia and bladder dysfunction (Box 40-4). In patients with prominent lower urinary tract symptoms, the problem is compounded by urination difficulty. Furthermore, studies in older adults indicate that nocturia/LUTS increases risk of falling (Parsons, et al., 2009). Age-related variations in arginine vasopressin secretion may play a role in nocturnal polyuria (Weiss and Blaivas, 2000).

Treatment centers on the underlying cause, and a voiding diary may aid clinical decisions. Prostate hyperplasia or bladder dysfunction often receives first attention. Treating BPH may help, although BPH often does not result in true physical obstruction, and epidemiologic data have indicated that noc-turia is common in men without prostatic obstruction. Thus, family physicians should consider the contribution of nocturnal polyuria. For example, patients with chronic heart failure and leg edema may benefit from fluid restriction and napping with leg elevation during the day. Treating obstructive sleep apnea helps alleviate the increased urine production resulting from increased atrial natriuretic peptide production. Behavioral

Box 40-4 Causes of Nocturia

Alcohol consumption Anxiety

Benign prostatic hyperplasia Bladder outlet obstruction Caffeine Calculi

Chronic heart failure Cystitis

Detrusor instability Diabetes insipidus Diabetes mellitus Diuretics

Dysfunctional voiding Edema

Excessive nighttime fluid consumption

Myeloneuropathy

Nephrotic syndrome

Neurogenic bladder

Obstructive sleep apnea

Overactive bladder syndrome

Sleep disorders

Somatization

Stroke

Urologic cancer

From Weiss JP, Blaivas JG. Nocturia. J Urol 2000;163:5-12.

interventions include avoiding excess nighttime alcohol or fluid intake and afternoon napping. Adjusting diuretic doses so they are given earlier in the evening should negate medication effects during sleep (Weiss and Blaivas, 2000).

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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