Nycturia is urination at night, which can indicate negative processes in the body. The condition is considered pathological if a person systematically gets up at night to go to the toilet more than 2 times for a long time (days, weeks, etc.). It is a type of urination disorder and is more common in the male population.
Historical background
The problem of nocturnal urination began to be actively studied in the late 90s. Domestic urologists have identified two medical terms - "nocturia" and "nocturia". The meaning of these words is different. Nocturia refers to an empty bladder before bed. Because of this, there is a need to urinate at night. Nocturia is an increase in nocturnal diuresis during pathological processes in the body.
Physiology of correct urination
Normally, daily urine output implies a predominance of daytime diuresis (urine volume) over nighttime. The ratio is 3:1. During the day, a person consumes liquid, the volume of which shouldbe equal to the amount of urine excreted.
When is nocturnal diuresis predominant?
During the day, a person is in an upright position and the renal arteries are stretched, because they are part of the supporting system of the kidney. Nocturia is a compensatory mechanism for getting rid of excess fluid in the body. In various pathologies, the kidneys cannot adequately cope with the excretion of urine. The edematous syndrome develops. When a person takes a horizontal position, the degree of tension of the renal artery falls and the kidney is better supplied with blood. The filtration rate increases and urine is produced.
When does nocturia occur?
Pathology can occur at any age. Here are some reasons:
- Congenital malformation of the genitourinary system. For example, a small bladder.
- Pathology of the urinary tract - nephrosclerosis (wrinkled kidney), glomerulonephritis, chronic pyelonephritis, cystitis. In infectious and inflammatory processes, irritation of the receptors in the urinary tract and the urge to urinate occur. As the kidney parenchyma shrinks, the vasculature expands and increases daytime and nighttime diuresis.
- Diabetes. An increase in blood glucose levels is accompanied by polyuria (increased daily urine output) at any time of the day. Glucose is an osmotic diuretic because it attracts large amounts of urine to itself.
- diabetes insipidus. Occurs when there is a deficiency of antidiuretic hormone (vasopressin). Diuresis occurs at any time, and the body cannot replenish its water reserves. Dehydration develops.
- Prostate adenoma in men is a volumetric formation of the prostate gland, which compresses the urethra and disrupts the outflow of urine. It affects the male population over 50 years of age. A man experiences a constant urge to urinate, which is also observed at night.
- Cardiovascular and renal failure. There is a chronic circulatory disorder of the kidneys and other organs. And nocturia is an unfavorable sign in these pathologies, especially against the background of oliguria (small amount of urine) in the daytime. There is venous stasis of fluid with the formation of subcutaneous edema. With the development of pathology, edema can spread in body cavities (in the chest, in the abdominal cavity, in the skull).
- Cirrhosis of the liver. Arterial hypertension develops, and the pressure in the renal arteries increases, which is accompanied by increased filtration and urination.
- Pelvic floor muscle atrophy. It occurs more often in women. There is a prolapse of the pelvic organs, a violation of their correct location. At night, gravity does not act on the pelvic floor and the organs take a more advantageous position. The process of urination improves. Pathology is associated with a lack of estrogens, which affect the tone of muscles and connective tissue structures.
- Overactive bladder. In the muscle layer, the number of nerve impulses increases and there is a need to urinate. It is observed more often in people with neurological and mental disorders.
- Receptiondiuretics (diuretics).
- Age. There is a sclerosis of the kidney vessels, the level of ADH decreases. Elderly people experience nocturnal urge to urinate. In childhood, nocturia is normally observed up to 2 years. Babies older than this age may urinate involuntarily at night (enuresis) or be restless during sleep. Often nocturia in children is observed due to stressful situations.
Types of nocturia
- Physiological - observed when drinking fluids before bedtime. Tea, coffee and alcohol have a diuretic effect. It can occur during pregnancy, when the fetus squeezes the structures of the kidneys and urinary tract during the day. At night, the pressure is released and there is an increase in renal blood flow and urine filtration. Symptoms of nocturia disappear when the causative factor is eliminated.
- Pathological - develops during pathological processes in the body and is persistent. Requires appropriate treatment, without which the symptoms of nocturia will not disappear.
How does nocturia manifest itself?
The highest percentage of patients with nocturia complain that they do not get enough sleep due to night trips to the toilet. Symptoms of nocturia:
- Night urine output dominates daytime urine output.
- Restless sleep. A full bladder can cause disturbing dreams with a corresponding plot in search of a toilet. A person, knowing this, gets up at night.
- Decrease in performance the next day.
- Drowsiness, irritability, apathy,depression.
Nycturia is a common symptom of severe illness.
Diagnosis of nocturia
You can identify the problem in the early stages of the development of pathology. Diagnosis is as follows:
- Collection of relevant complaints from the patient (how many times he urinates during the day and at night).
- Finding out the process of development of nocturia, what it is connected with (taking drugs, drinking fluids before bedtime).
- Determining the type of nocturia. Patients should keep a urinary diary for 5 days to understand if it is pathological or not.
- Detecting the presence of chronic diseases of the kidneys, cardiovascular and other systems.
- General examination of the patient.
To confirm the pathology, laboratory and instrumental diagnostics are required:
- General analysis of urine with the identification of its specific gravity, signs of inflammation, bacteria. At night, the density of urine should normally be higher. If you have diabetes, there will be sugar in your urine.
- Bacteriological culture of urine. To determine the flora that caused the inflammation. Sensitivity to antibiotics is also detected in order to select a drug with a narrow spectrum of action.
- Zimnitsky's test. Examine 8 portions of urine every 3 hours. The ratio of daytime and nighttime diuresis is determined and the specific gravity of each portion is examined. Nocturia is characterized by a decrease in the density of urine and the predominance of nocturnal diuresis. Thanks to this study, one can suspect kidney failure, diabetes insipidus,inflammatory kidney disease.
- Determination of the level of antidiuretic hormone (ADH). Its level is reduced in diabetes insipidus.
- Ultrasound of the bladder (allows you to determine the residual volume in the bladder), kidneys and abdominal organs.
- Examination of men - transrectal ultrasound and digital examination of the prostate through the rectum to detect adenoma. Symptoms and treatment of nocturia in men are determined by a urologist.
- What is nocturia in women? This is a decrease in the level of estrogen (determined by the laboratory). In this case, there is a drop in the muscle tone of the bladder, weakening of the muscles of the pelvic floor. urinary disorders develop. Symptoms and treatment of nocturia in women are determined by a gynecologist.
Treatment of nocturia
First of all, you need to identify the cause. Only a doctor can diagnose and treat nocturia.
General recommendations
They are aimed at eliminating the provoking factors for the development of nocturia. To reduce the discomfort of the disease, you need:
- Exclude liquids and foods with a diuretic effect (watermelon, melon) 3 hours before bedtime. It is better to limit the water load on the body after 6 pm.
- Avoid hypothermia.
- Do not take diuretics at night. Typically, these drugs are taken in the morning along with antihypertensives.
- Empty bladder before bed.
Etiotropic and pathogenetic treatment
- Taking antibiotics and herbal medicines("Canephron", "Uriflorin") for infectious and inflammatory diseases of the urinary system.
- Achieving diabetes compensation. Glucose is found in the urine at blood sugar levels above 10 mmol/l. It is necessary to consult an endocrinologist and correct treatment.
- ADH analogues for diabetes insipidus (replacement therapy).
- Prostate adenoma in men. Drug therapy is aimed at relaxing the smooth muscles of the bladder neck and prostate, as well as reducing the volume of the prostate. For this purpose, alpha-blockers and 5-alpha reductase inhibitors are used. The outflow of urine becomes better. Surgical treatment is to remove the prostate.
- Cardiologists and nephrologists deal with the treatment of cardiovascular and renal insufficiency. Struggling with arterial hypertension and edema.
- Cirrhosis of the liver is treated by internists or hepatologists. The goal is to control secondary arterial hypertension.
- Symptoms and treatment of nocturia in women is determined by a gynecologist. The therapy is aimed at eliminating hormonal disruptions, at strengthening the muscles of the perineum with the help of special gymnastics.
- An overactive bladder is treated with several groups of drugs. Selective antispasmodics ("Driptan") are used, which act purposefully on the muscle that contracts the bladder (detrusor). M-anticholinergics ("Spazmeks", "Detruzitol") reduce the contractile activity of the detrusor. Antidepressants ("Imipramine") also block m-cholinergic receptors, have a weaksedative effect. Used for enuresis in children older than 6 years. Botulinum toxin ("Botox", "Dysport") is injected into the bladder at 30 points in its cavity, leading to relaxation of the muscular wall of the bladder.
Prevention of nighttime urination
This type of pathology can be avoided if you take your he alth seriously and undergo a routine examination. Prevention measures include:
- Passing preventive medical examinations in order to identify pathological he alth deviations from the norm.
- Timely treatment of diseases that can cause nocturia.
- Observation by a specialized doctor who will help compensate for the course of a chronic disease (urologist, nephrologist, cardiologist, etc.).
- Proper nutrition to prevent atherosclerosis and cardiovascular pathologies. You need to eat more fiber, lean fish and meat, complex carbohydrates (cereals, pasta).
- Avoid hypothermia.
- Stress management. Urination disorders may be against the background of psycho-emotional problems.
- Regular exercise will help keep your pelvic floor muscles in good shape and improve your whole body.
Nycturia is not a harmless symptom, it is an indicator of a failure in the body. It is important to consult a doctor in time, who will prescribe the necessary types of diagnostics. The results of the study will allow timely prescribing of treatment and getting rid ofProblems. Often the body itself hints at various malfunctions in the body, which should not be overlooked. You need to monitor your condition.
