Treatment

Many people who suffer from nocturia do not seek help, wrongly accepting it as a natural process of ageing. If you suffer from nocturia or regularly wake up one or more times a night to urinate, you should discuss this with your doctor.

Different medicinal options exist to alleviate and even treat nocturia. These may be used alone or combined with behavioral therapy. Doctors will devise appropriate treatment plan based on the diagnosis.

Behavioral Therapy

  • Restriction on fluid intake
  • Elevation of legs to avoid leg/ankle swelling
  • Wear compression stockings to help reduce fluid retention and swelling (edema)

Pharmalogical Therapy

Nocturnal Polyuria

Nocturnal polyuria is a condition of increased urine production during sleep caused by a decrease release of antidiuretic hormone (vasopressin) from the brain, so even by limiting drinking before bedtime, the problem could still be there, you will still experience the need of urination at night . The best treatment for nocturnal polyuria is by medication like desmopressin, an antidiuretic hormone replacement therapy. Desmopressin helps to lower the volume of urine produced and making the urine more concentrated, therefore symptoms are relieved. Efficacy of desmopressin has been proven by several controlled clinical trials which reported that people receiving desmopressin achieved more than 5 hours of undisturbed, good quality sleep per night than those who did not

Desmopressin : also known as DDAVP, is licensed and approved for the treatment of nocturia by the International Consultation on Incontinence (ICI). It functions like the natural ADH (vasopressin) that causes kidneys to produce less urine. It is well tolerated by many people, those who take it no longer need to wake up to urinate and sleep peacefully through out the night. Desmopressin, is given as an oral pill, has been proven to be effective in treating nocturia in patients with diabetes insipidus, autonomic dysfunction and Parkinson’s disease. However, older people need to be careful about the amount consumed as very high dosage of Desmopressin can result in high blood pressure.

Imipramine : is mainly used in the treatment of depression (an antidepressant medicine) but also exerts some effects in urination control while its exact mechanism is not known. Extreme caution is needed when using Imipramine because of its severe side effects of reducing blood pressure and increasing suicidal tendency. Other common but less severe side effects include sleep disturbance, loss of appetite, gastrointestinal symptoms and in some cases personality changes.

Furosemide: is a diuretic (medicine that increases urination) used in the treatment of congestive heart failure and edema, It can increase day time output of urination by blocking ion flow in kidneys allowing better control of urine production.

Bumetanide : is a diuretic to treat heart failure. It is used in high doses when furosemide fails to show effectiveness in symptom control. It helps an individual to regulate urine production before sleep to reduce the need to wake up and void.

Reduced bladder storage

People with reduced bladder storage generally also have problems with their urinary system, such as bladder outlet obstruction, nocturnal detrusor instability, neurogenic bladder, cystitis, bladder cancer, prostate cancer and bladder stone. Therefore, the best treatment is to focus on targeting these underlying causes.

Anticholinergic Medications : These prescription medications are effective for treating nocturia caused by bladder dysfunction such as detrusor overactivity. The main side effects are dry mouth, dizziness, and blurred vision.

  1. Oxybutynin: - anticholinergic medicine that relaxes the detrusor muscle of the bladder. It reduces wet nights in those with nocturnal enuresis and can be combined with bladder volume training.
  2. Tolterodine: - antimuscarinic antagonist that is available in both short-and long-term acting dosages and has similar actions as like oxybutynin.
  3. Solifenacin - a new anticholinergic that is a more selective antimuscarinic agent with fewer anticholinergic side-effects.

You must consult a healthcare professional if you are considering taking the above mentioned medications.

Benign Prostatic Hyperplasia Medications : BPH refers to the increase in size of the prostate in middle-aged men, which can cause bladder storage symptoms (urinary frequency, urgency) and nocturia (urination at night) These prescription medications are effective for treating nocturia caused by BPH.

Treatment of BPH include alpha blockers (α1-adrenergic receptor antagonist) that relaxes the smooth muscles in the bladder neck and prostate, hence reducing the blockage of urine flow, making it easier for a person to urinate. 5α-reductase inhibitors prevent the prostate from further swelling, when used in conjunction with alpha blockers could alleviate symptoms of nocturia.

  1. Doxazosin: - an alpha-1 adrengeric receptor blocker with a diuretic property. However, caution is needed when taking Doxazosin because it can increase you risk for cardiovascular disease and congestive heart failure.
  2. Alfuzosin - an alpha-1 receptor antagonist that relaxes the smooth muscles in the prostate and the bladder neck. People with severe renal insufficiency should Alfuzosin with extra caution.
  3. Terazosin hydrochloride - an alpha-1 adrengeric receptor blocker that used to increase urinary flow without affecting bladder contractility.

You must consult a healthcare professional if you are considering taking the above mentioned medications.

Combination

In some cases, a person can have both problems of nocturnal polyuria and reduced bladder storage. For this type of nocturia, doctors will need to find out the main causes for your condition and subsequently device a treatment plan that combines various medications and therapies that is best suited for your needs.

Nocturia can be bothersome and affects sleep which translates to poor day time performance thus it is advisable to report to your doctor if you think you are a sufferer of this condition. Sometimes the cause is easily treated, but if left untreated the condition may indicate significant health risks .

You may follow this link for a list of doctors who can help in Hong Kong.

    Reference

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