Nocturnal Polyuria

Nocturia is a condition that causes you to wake up at night to urinate. In cases of nocturnal polyuria, up to ⅓ of urine output happens overnight.

Nocturia/Nocturnal Polyuria Symptoms, Causes, Treatments

Nocturia is a condition that causes you to wake up at night to urinate. In cases of nocturnal polyuria, up to ⅓ of urine output happens overnight. Nocturia may be caused by an overactive bladder, sleep apnea, or other factors like lifestyle and health conditions. Treating nocturia symptoms typically involves restricting fluid intake and the use of certain medications that reduce the symptoms of frequent urination at night. Nocturnal polyuria can have many causes including obstructive sleep apnea or excessive fluid intake in the 4-6 hours before bedtime. In some cases, it can be the symptom of a more serious medical condition, such as an enlarged prostate or even congestive heart failure.

Symptoms of Nocturia

The most easily recognizable symptom of nocturia is waking at night to go to the bathroom.

A healthy body should be able to achieve 6-8 hours of uninterrupted sleep each night. When this doesn’t happen, our quality of life decreases, even if there are no pervasive medical problems present.

Some symptoms of nocturia include:

Waking up more than one time a night to urinate
Urinating more volume (this occurs when polyuria is present)
Feeling sleepy or fatigued when you wake up in the morning

Nocturia is common in both men and women, particularly older adults.

Recent studies indicate 69% of men and 76% of women over 40 get up to go to the bathroom at least one time during the night. Approximately a third of adults over age 30 make 2 or more trips to the toilet overnight.

Causes of Nocturia

What causes excessive urination at night? Excessive urination at night, called nocturia, can be caused by lifestyle habits as well as health conditions. It’s also possible to have multiple underlying causes for a case of nocturia.

Here are the 3 most common categories that nocturia can fall into, based on the cause.

Nocturnal Polyuria

Like global polyuria, nocturnal polyuria involves a significantly increased urine output. However, nocturnal polyuria occurs overnight, during sleeping hours.

What causes nocturnal polyuria? Nocturnal polyuria can be caused by diseases including sleep apnea, congestive heart failure, and side effects of some medications.

How many times is normal to urinate at night? It is common to urinate once per night, particularly as we age. However, 2 or more times of getting up to use the restroom may indicate nocturnal polyuria.

The most common risk factors for nocturnal polyuria are:

Sleep apnea or other sleep disorders. Sleep apnea disrupts your brain from working well. Usually, your body should be able to halt the voiding stimulus during sleep naturally. Jolting awake from snoring or choking may cause you to go to the bathroom out of habit, rather than necessity. Sleep deprivation can also have other serious consequences.
Edema. Once called dropsy, edema is swelling caused by fluid retention that often occurs in the feet, legs, and ankles. Wearing compression stockings may help alleviate symptoms.
High blood pressure or congestive heart failure. In hypertension, more blood flows through the body’s filters, creating more urine. Taking a diuretic for elevated blood pressure will also cause frequent urination.
Disruption of normal vasopressin secretion. In older patients, vasopressin (antidiuretic hormone) levels can run low, increasing nighttime urine output.
Some medications or vitamins. Medicines like diuretics for elevated blood pressure (or water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, or even excessive vitamin D can affect frequent urination.
Overactive bladder (OAB). Overactive bladder is a condition in which the bladder squeezes urine out at the wrong time. Symptoms include: need to urinate more than 8 times a day, and more than 2 at night, and sudden, strong urges to urinate immediately. Although it’s possible to have nocturia and OAB simultaneously, they are not the same condition.

Polyuria

People with polyuria urinate >3,000 ml in 24 hours. This excessive urination is usually due to too much water filtered by the kidneys. Diuresis, or extra urine produced by the kidneys, can come from several factors.

Increased urination in the day and night is known as global polyuria. Typical causes of too much urine around the clock may be:

High fluid intake. The fluid you consume in the last 4-6 hours before you go to bed plays a significant part in how your body reacts during the night. Especially when coupled with a reduced bladder capacity, overactivity of the bladder is likely.
Diabetes type 1 and type 2. The name diabetes mellitus originates from the Greek, meaning “to pass through.” This can describe the copious urination and bladder overactivity that can occur.
Diabetes insipidus. Nocturnal polyuria can stem from diabetes insipidus — a rare condition causing the kidneys to produce large amounts of urine.

All of these issues can be diagnosed and addressed by your physician in the treatment plan you create.

Nocturnal Urinary Frequency

Certain medical conditions increase the likelihood of developing nocturia, becoming underlying causes of a much more obvious problem. For many people with nocturia, it is triggered by other conditions that cause difficulty filling the bladder.

The most likely causes of nocturia are:

Obstructive sleep apnea. Here it is again — OSA can cause issues with filling the bladder.
Vaginal or pelvic prolapse. Vaginal prolapse is a common condition where the bladder, uterus, and or bowel protrudes into the vagina.
Urinary tract infections. Because estrogen levels drop dramatically during menopause, muscular pressure around your urethra may increase. Changes in hormone levels may also increase the risk of urinary tract infections (UTIs) during this time.
Enlarged prostate from benign prostatic hyperplasia. Symptoms of BPH prostate enlargement are moderate to severe in one-third of males between 50-60 years old, rising to about 50% by age 80. Symptoms include a frequent or urgent need to urinate, especially at night.

Nocturia is not a condition to put off addressing, particularly as we age. Sleep disruption or deprivation can result in an avalanche of problems.

Other Possible Causes

There are a few other underlying issues to consider in cases of urination at night. These range across a broad scope of lifestyle and medical considerations, like:

Pregnancy
Use of alcohol and caffeine in the evenings
Menopause
A habit of urinating at night

The reasons for nocturia and nocturnal polyuria are varied, which means that your clear next step is speaking to a healthcare professional.

Diagnosis of Nocturia

Because there are so many possible causes, a nocturia diagnosis may be difficult to pin down. Your healthcare provider will ask several questions related to lower urinary tract symptoms and recommend some tests.

You’ll be asked to keep a voiding diary, also called a bladder diary, for a few days. A voiding diary requires recording what you drink, how much you drink, times of day, and how often you have to urinate. It may also be helpful to look at your sleep patterns before your visit.

Questions Your Doctor May Ask

When did the symptoms start?
How many times per night do you wake to urinate?
Do you have accidents (wet the bed)?
Are you producing less urine than before?
Does anything make the problem worse?
What medications are you taking (diuretics, excessive calcium supplement)?
Do you have a family history of bladder problems or diabetes?

These will help your healthcare provider find the common cause of your nocturnal urine production.

Tests

After a medical history and physical exam, there may be a few tests in store. These are designed to measure the amount of urine left in the bladder, urinary frequency, urine flow rate, and bladder pressures, testing your urodynamics.

You’ll likely be asked to take a combination of some of these tests:

Blood tests for diabetes
Blood work for counts and blood chemistry
Urologic tests, such as urinalysis or urine culture
Fluid deprivation
Imaging, such as ultrasound or CT scan
Urological tests, like cystoscopy

From here, your doctor or dentist can determine the best treatment options for any bladder dysfunction.

How Does the Urinary Tract Work?

The urinary tract is the organs in your body that control the production and excretion of urine. Adult kidneys usually make between 1 ½ and 2 quarts of urine each day. Urine travels from the kidneys to the bladder through the adjoining tubes (ureters). The bladder takes cues from the brain to control proper urinary function. Lower pelvic muscles hold the bladder in place. The more muscular end of the bladder will stay closed to store the urine. When the brain sends the signal, bladder muscles contract, pushing urine out through the urethra and out of the body as the sphincter muscles open and release the bladder.

Treatment of Nocturia

The best treatment for nocturia depends on the underlying cause.

Several treatment options can be used for less urine production overnight, depending on the root cause of nocturia. Common treatment options for nocturia include:

Medications to decrease urine volume and prevalence, including solifenacin, desmopressin, solifenacin, desmopressin, and fesoterodine. These blockers assist in reducing urine volume and prevalence.
Timing changes. Altering the timing of taking meds that may increase urination can treat some cases of nocturia polyuria.
Antimuscarinic drugs. These medications increase bladder capacity and address urinary incontinence.
Behavioral therapies and exercises may be used to train and strengthen the bladder and control the urge to urinate.
Certain medical procedures, like bladder injections, nerve stimulation, and surgery, may treat OAB or nocturia.

In many cases, nocturia is a symptom of obstructive sleep apnea. In cases like these, a biological dentist can assist in a treatment plan with devices like the DNA appliance, Continuous Positive Air Pressure (CPAP) machines, and even surgery.

Rejuvenation Dentistry empowers our patients to take control of their whole-person health, including their sleeping habits that may cause nocturia.

Prevention of Nocturia

Simple modifications can decrease your nightly urine output, or prevent nocturnal polyuria from getting worse. For prevention and management of nocturia, try:

Reducing liquid intake 4-6 hours before bed, avoiding caffeine and alcohol.
Staying away from bladder irritants — chocolate, spicy or acidic foods, and artificial sweeteners.
Beginning kegel exercises and pelvic floor physiotherapy.
Talking to your dentist or health care professional immediately if you’re noticing symptoms of sleep apnea.
Napping to compensate for poor sleep and disrupted circadian rhythms.

Practicing these simple steps now can protect your nocturnal bladder capacity in the future.

Visit Us At Rejuvenation Dentistry

So, why is a dentist offering information about urination? It’s a fair question.

A significant trigger of nocturia is OSA, obstructive sleep apnea. We specialize in treating this issue from root to symptom.

Rejuvenation Dentistry’s biologic approach to sleep apnea can improve not only your quality of sleep but also your quality of life. Our dentistry practice looks beyond the mouth to whole-body health.

Schedule a consultation today to find out if your nocturnal polyuria can be transformed by dental work. Dr. Gerry Curatola is a renowned biologic restorative dentist with more than 40 years of clinical practice experience.

He studied neuroscience at Colgate University and attended dental school at the New York University (NYU) College of Dentistry where he now serves as Adjunct Clinical Associate Professor in the Department of Cariology and Comprehensive Care.

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