With advancing age, people may find it increasingly difficult to fall asleep or have the mandated 7-8 hours of uninterrupted sleep every night. Especially, when the elderly wake up frequently during the night to pass urine more than once or twice, then it is defined as nocturia.
This condition becomes evident when elderly persons experience tiredness or excessive sleepiness during the daytime, to the extent that they are not able to complete their daily activities. Not just quality of sleep, this condition can lead to high blood pressure, heart condition and loss of energy with the risk of falls and injuries, say experts.
Elderly may also feel isolated socially and have depressive feelings because of the altered quality of life brought on by nocturia.
In a US-based study, 49.7 percent individuals aged between 65 and 85 years (both men and women), who were examined, were found to exhibit nocturia with the biggest risk factors for the condition being obesity, hypertension and diabetes mellitus.
What causes nocturia?
- Prostate enlargement (also known as Prostatic Benign Hyperplasia)
- Urinary tract infections
- Age-related problems such as decreased bladder capacity or hormonal changes
- Kidney conditions
- Use of diuretics closer to bedtime. Diuretics are pills that remove excess water and sodium from the body and are usually prescribed for high blood pressure.
- Too much water intake towards evening and bedtime.
The most common cause of nocturia is an enlarged prostate; other ailments such as urinary tract infections, high blood sugar levels and renal problems can also contribute to higher output of urine at night.
“In some people, nocturia may be accompanied by other symptoms such as urgency to pass urine and not being able to control urine flow. Because of health reasons, some elderly persons may drink large quantities of water after dinner, which will increase the urine output in the night leading to nocturia,” says Dr Avinash Ignatius, senior consultant nephrologist, transplant physician and Head of the department of Nephrology at Noble Hospital, Pune.
As people age, the kidney gets weaker and there are hormonal changes that affect urine output.
“In a young person, there is reduced production of urine in the night compared to daytime because of the function of a hormone called vasopressin. In older people, there may be decreased production of this hormone, resulting in increased frequency of night-time bathroom visits,” adds Dr Ignatius.
Underlying health conditions could lead to nocturia
Underlying disease can also increase urine output at night. In some elderly persons who have renal or cardiac problems, there is fluid accumulation in the lower limbs as they go about their activities in the daytime.
“In young people, the fluid is circulated and gets absorbed into the body but in older people, when they are in the sleeping posture at night, the accumulated fluid builds up and has to be removed from the body through urination,” explains Dr Govardhan Reddy, lead consultant, Urology and Uro Oncology, Aster CMI Hospital, Bengaluru.
How passing urine at night affects an individual?
When the quality of sleep is affected, there is a feeling of tiredness and not being adequately rested, which results in excessive daytime sleepiness. Sleep deprivation is associated with high blood pressure, fluctuation in blood sugar and higher risk of falls and injuries.
“In few cases, nocturia may lead to frequent need to urinate even at daytime; because of this the affected person may experience social isolation and go into depression. If the problem is severe, the person may have to use an adult diaper at night, which may impact them psychologically,” adds Dr Ignatius.
Doctors say the diagnosis of nocturia should start by collecting a thorough medical history and information of daily habits such as:
- How much urine does the person pass?
- How often does he/she get up at night?
- Do they have symptoms other than nocturia?
- Do they have difficulty passing urine or controlling urine flow, say, before reaching the bathroom?
Treatment
The primary aim of treating nocturia is to ensure that patients get good quality sleep for at least 4-5 hours, so they can function normally.
“We need to check if they are drinking too much water at night. Tests and investigations must be done to rule out prostate malignancy, kidney or cardiac problems, diabetes mellitus and so on. Most ailments can be treated with medications and by making some lifestyle changes,” says Dr Reddy.
For some patients with severe nocturia, a medication called desmopressin may be prescribed to decrease urine output. But this is done with caution as the medicine can bring down sodium levels in the body, adds Dr Reddy.
Takeaways
- Nocturia is a condition where an individual wakes up during their sleep frequently to pass urine. This condition of waking up more than 2-3 times could lead to serious health conditions in the elderly.
- There are various age-related causes for this condition and seeking immediate medical advice and following certain lifestyle changes can help one overcome the condition.
