The other day, a friend’s parents were complaining that they don’t sleep well. Added to the fact that they are older, they wake up many times to go to the bathroom, and in the morning they wake up quite tired.
These complaints are more common than we think and have a name: adult nocturia. According to the International Continence Society, it is exactly defined as the need to wake up to urinate at least twice a night.
This problem, which affects sleep and quality of life, is more common as we age. It is estimated that three out of five people over the age of 70 suffer from it, although it can also occur at younger ages. And it affects men and women equally.
A wide range of causes
Two causes can give rise to nocturia: decreased bladder capacity and/or increased urine production, known as polyuria.
In the first case, we are talking about an organ with a capacity of between 300-600 ml, which in turn can be reduced by two factors:
* A anatomical alteration. In men, it is most commonly due to benign prostatic hypertrophy, and in women, to obesity and pelvic organ prolapse.
* functional problems such as overactive bladder syndrome, cystitis, infections…
As far as polyuria is concerned, nocturnal urine production usually decreases due to the action of antidiuretic hormone, but as we get older, the release of this substance is reduced at night.
This is one of the main causes, although various diseases can also precipitate it –diabetes, edematous states caused by venous insufficiency or heart failure, arterial hypertension…–, increased fluid intake in the evening and caffeine consumption, alcohol or tobacco.
In addition, there are medications whose side effects can increase urine production or alter bladder function. The most common are:
* diuretics: Used to treat fluid retention and lower blood pressure.
* Anticholinergics: Often used to treat overactive bladder syndrome. They can interfere with the nerve signals that control this organ and cause an increase in urinary frequency, including nocturia.
* Medications for high blood pressuresuch as calcium channel blockers and angiotensin-converting enzyme inhibitors.
* some antidepressantssuch as selective serotonin reuptake inhibitors, which block the action of antidiuretic hormone.
* lithiuma drug used to treat bipolar disorder.
It is important to note that not everyone who takes these medications will experience nocturia as a side effect.
If someone suspects that they have this effect or is concerned about said symptom, it is important that they speak with their doctor or doctor, so that they can provide alternatives or adjust the treatment.
Five measures to tackle it
The management of nocturia should be considered individually, since many factors influence it. Here are some elementary tips.
1. Lifestyle changes: reduce fluid intake 4-6 hours before bedtime, avoid alcohol and caffeine at night, quit smoking and lose weight if overweight. It is also advisable to urinate before going to bed and do pelvic floor exercises. And if you suffer from fluid retention in your legs, it is a good idea to raise them a few hours before nightfall.
2. If the night is caused by an ailment, such as diabetes or heart disease, treating it properly can reduce symptoms. It is important to continue monitoring with primary care health professionals.
3. Modify drug treatment schedules, diuretics and angiotensin converting enzyme inhibitors. Health professionals should be consulted first so that treatment can be adjusted to minimize side effects.
4. The pelvic floor treatment and bladder training with physical therapists can be helpful in teaching better urination control.
5. Sometimes, after an individual assessment, the doctor can prescribe medicines to treat nocturnal polyuria: diuretics (administered mid-afternoon), antidiuretic hormone analogues, and tricyclic antidepressants, which increase the production of said hormone.
In summary, although nocturia is very common in older people, it does not stop affecting sleep and, consequently, rest and quality of life.
It is advisable to consult with the Primary Care professionals, who will make an individualized assessment, taking into account everything from lifestyle habits to the review of medications and other pathologies.
*Ana Isabel Cobo Cuenca She is a tenured professor at the University of Castilla la Macha (UCLM). IMCU Group, University of Castilla-La Mancha. Antonio Sampietro Crespo He is a specialist in Urology, Health Service of Castilla-La Mancha. This article was published on The Conversation and reproduced here under the creative commons license. Click here to read the original version.
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