Nocturia

When deep slumber at night is regularly disrupted by an urgent feeling of urination, it is a condition called nocturia. It is common in older adults, both men and women, usually in the age group of 55 and 84 years. Nocturia is different from enuresis or bed-wetting wherein the person does not wake up from sleep but involuntarily empties the bladder. Nocturia affected person experiences sleep loss due to an urgent need to urinate. Mild nocturia is characterized by a need to urinate two to three times and in severe cases it can be anywhere between five to six times on a particular night, occasionally or daily.

Nocturia types and causes

Besides the normal aging process, nocturia is also linked to other causes. In women, besides age, childbirth or pelvic organ prolapse and menopause are often contributing factors to nocturia.

Nocturnal Polyuria

There is an overproduction of urine at night. In a 24-hour cycle the urine volume may be greater than 40 ml/kg or if the volume of urine passed at night exceeds one-third of the total daily urine output. The main feature of nocturnal polyuria is that more urine is produced during sleep which in turn induces more nighttime urination.

All fluids or even certain foods like salads, vegetables, fruits, rice and pasta with high water content can cause nocturnal polyuria. Diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene and excessive Vitamin D medication can lead to frequent urination. Ankle swelling is another common cause of nocturnal polyuria. Congestive heart failure, venous stasis, hypoalbuminemia or excessive salt intake are other causes for fluid retention.

Polyuria

In adults, the normal urine production is 1 to 2 liters. Polyuria is characterized by urine output that exceeds 2500 ml/24 hours during the day as well as at night. Polyuria is common in people with diabetes mellitus and diabetes insipidus. Other conditions causing polyuria are Polycystic kidney disease, Sickle cell disease, Pyelonephritis, Amyloidosis, Sjogren syndrome and Myeloma. Vascular disease, restless leg syndrome, thyroid disorder and congestive heart failure are some causes for increased urinary output at night by the kidneys. Polydispisia or excessive thirst that compels drinking lots of water can cause polyuria. The thirst center or hypothalamus is affected due to anxiety, stress or psychiatric illness and leads to excessive thirst. Intravenous saline drip excessively administered can lead to polyuria. Hypercalcemia and hypokalemia lead to abnormal levels of electrolytes that can result in excessive urination.

Inadequate bladder storage

The urinary bladder has the capacity to hold as much as 600 ml of urine. But the desire to urinate is experienced when the level reaches about 150 ml. There are various reasons and conditions that lead to inadequate bladder storage. Bladder obstruction, bladder infection or recurrent urinary tract infection, bladder inflammation, pain in the bladder, bladder cancer can reduce bladder storage capacity. Stroke and Parkinson's disease can also lead to reduction in its storage capacity thus inducing an urgent need to empty the bladder.

Mixed Nocturia

A combination of nocturnal polyuria with reduced bladder capacity is termed as mixed nocturia.

Diagnosis of Nocturia

Basic diagnostic procedure is to record the frequency, volume and timing both daytime and nighttime for a minimum of 1-3 days. Certain diagnostic tests like urine analysis, urine culture or an ultrasound are done. Accordingly, the treatment procedure is determined. Treatment options include making dietary changes, behavioral changes with a combination of medications.

Renal Failure

Acute renal failure happens when the kidneys suddenly lose their ability to remove toxins from the urine. Typically the cause for a sudden kidney failure are acute tubular necrosis (ATN) and autoimmune kidney diseases. Other causes leading to kidney damage are acute pyelonephritis and septicemia. The symptoms indicating acute renal failure are changes in urination, lowered sensation in extremities and metallic taste in the mouth. Typical symptoms include nausea, blood in stools, swelling of feet and ankles, swelling of ankle or leg, fluid retention and fatigue. A person might also notice high blood pressure, nausea and reduced appetite. Change in mental alertness might be noticed.

A nephrologist will need to examine the patient and suggest further course of action. BUN test and blood tests for creatinine and potassium are done. Kidney ultrasound or MRI might be done to look for any stones, tumors or blockage. A person suffering acute kidney failure is hospitalized and the amount of liquid ingested in monitored. The diet has to be tailored to reduce proteins and salt. Diuretics might be prescribed for reducing fluid retention. In some cases, dialysis is done; especially when the potassium levels are abnormally high. The balance of body electrolytes is maintained.

Acute kidney failure is more common with older adults and those suffering kidney or liver disease, heart failure or diabetes. An abdominal surgery might also make you more susceptible to kidney failure. Severe dehydration, blood pressure medications and overuse of NSAIDs are other possible causes for renal failure. This condition can be life threatening if not treated in time. It can lead to chronic kidney failure or damage to the nervous system and the heart. The patient can develop very high blood pressure or loss of blood in the intestines leading to last-stage kidney disease. Treatment for kidney disease include antibiotics and iodine-based medications.