Nocturia – need to look beyond prostate in men

Frequent night time urination, otherwise known as nocturia, is extremely common in men, especially elderly. At a time, nealy 60-70% of men older than 60 years of age wake up once or more in night for passing urine. In men older than 80 years, almost each and every man gets up in night to pass urine. In young adults, it is relatively less comapred to elderly, but found in both sexes equally in the range of 10-20%.BPH (Enlarged prostate) Symptoms

There are various causes of passing urine at night. There is no single well defined reason for nocturia. Person having polyuria, behavioural issues with fluid intake called polydipsia in which a person consumes lot of liquids, diabetes mellitus, sleep disorder, heart failure, poor bladder emptying,  overactive bladder and many other reasons are behind this problem. Often persons having dependent lower limb edema suffer from this problem of frequent night time voiding. Besides this, frequently, the enlarged prostate has been associated with this problem though the real association between this remains unclear.NOCTURIA- is it sign of prostate disease in men ?

Read how nocturia is different from nocturnal enuresis or bedwetting  Nocturnal Enuresis (Bedwetting)

The effects of this problem are multifactorial on the person. There is lack of sleep leading to day time fatigue and less productivity, increased risk of falls and fractures in elderly while getting up in night for washroom, increased risk of cardiac morbidity and mortality etc. Majority of these persons produce more urine in night compared to daytime and may feel exhausted.

When such problem gets bothersome to a person, they usually seek urologist opinion. In men, evaluation is often done to look for bladder emptying, prostate enlargement and other parameters.Prostate enlargement diagnosis In females, since there is no prostate organ, evaluation is usually is restricted to bladder emptying. In both sexes, bladder diary where complete record of fluid intake and urine output is made is very helpful in the treatment. It has been seen that the majority of these patients have medical reasons for his or her problem and prostate which often implicated for this problem in men, contributes very less. So the only treatment of prostate may not completely resolves this problem in men.

Treatment often get initiated after initial evaluation to look out for various causes of nocturia. Patients with increased urine production may limit their fluid intake after evening to decrease number of nocturia episodes. 15-20 minutes of walk before going to bed helps reducing waking up at night for urine. Persons with peripheral edema need to wear stocking and keep limbs elevated while seated. Nocturia due to  obstructive sleep apnea get best benefitted with CPAP therapy. Patients with enlarged prostate and poor bladder emptying may be started medical therapy for prostate along with other behavioural therapies for fluid management. 5 tips for healthy prostateThe real cause of small frequent night voiding due to small bladder capacity is extremely rare and may need Surgical therapy.