Nocturia In Women Research Articles

Nocturia in women

Nocturia, the complaint of waking at night to void, is a bothersome condition known to affect Quality of Life. In addition sleep deprivation is also known to affect daytime functioning and productivity. Whilst recently recognised as a discrete clinical entity nocturia is also a symptom of those women complaining of Overactive Bladder (OAB) syndrome. The causes of nocturia are multifactorial although in clinical practice nocturia is generally associated with either increased nocturnal urine production, problems related to bladder storage or sleep pattern abnormalities. When evaluating women complaining of nocturia a urinary diary and clinical examination is integral to making the diagnosis prior to commencing treatment. Having excluded and treated any underlying cause behavioural modification, such as moderation of fluid intake or timing of taking anti-diuretic medication, should be considered first line therapy. Should this conservative approach fail then treatment with antimuscarinic agents or desmopressin, a nona-peptide analogue of anti-diuretic hormone (ADH) is often helpful.

Nocturia in Women

Nocturia, one of the most bothersome of all urological symptoms, has previously been both poorly classified and understood. Multiple factors may result in nocturia, among which are pathological conditions such as cardiovascular disease, diabetes mellitus, lower urinary tract obstruction, anxiety or primary sleep disorders, and behavioral and environmental factors. Nocturia may be attributed to nocturnal polyuria (nocturnal urine overproduction), diminished nocturnal bladder capacity, polyuria or a combination of the three. These conditions can be distinguished by a simple arithmetic analysis of the patients 24-h voiding diary. After reviewing the current state of knowledge, a scheme for rational diagnosis and care of patients suffering from loss of sleep due to nocturnal micturition is presented in this article.

Degree of Bother Caused by Nocturia in Women

No AccessJournal of UrologyUrological Survey: Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology1 May 2005Degree of Bother Caused by Nocturia in Women Alan J. WeinM.D. Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)60673-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Degree of Bother Caused by Nocturia in Women." The Journal of Urology, 173(5), p. 1664 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 173Issue 5May 2005Page: 1664 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement PDF DownloadLoading ...

The 24-h frequency-volume chart in adults reporting no voiding complaints: defining reference values and analysing variables.

To determine the variables (e.g. voiding frequency, voided volumes, urine production) and their mutual relationships and differences between age groups and genders, using a frequency-volume chart (FVC) in an adult population (representing all age groups) who denied having any voiding complaints. In all, 1152 men and women aged > 20 years completed a 24-h FVC; registration started with the first voided volume in the morning and concluded with the first voided volume the next morning. The time of voiding and volume were both recorded, and bedtime hours noted. Each participant claimed to have no voiding complaints. The statistical analysis was aimed at discerning the relationships between the FVC variables, gender and age. There was a linear increase in mean 24-h voiding frequency and nocturia in men, from 6.0 and 0.5 in the third decade to 8.5 and 1.6 in those aged > 70 years. Contrary to men, in women the mean 24-h frequency declined slightly in the older decades; it increased from 6.9 in the third to 8.2 in the sixth, declining to 7.8 in those aged > 70 years. Nocturia in women increased linearly, although slower than in men, from 0.7 in the third decade to 1.4 in those aged > 70 years. The mean volume/void decreased significantly in both genders, from 313 to 209 mL in men, and from 274 to 240 mL in women. The mean 24-h volume was 1718 and 1762 mL in men and women, respectively. For both genders there was a strong linear association between 24-h urine production and voided volumes. The volume/void and maximum voided volume decreased significantly with age in both sexes, but more prominently in men. As a result, in men the frequency increased with age, probably reflecting subclinical changes associated with the development of prostatic enlargement. In contrast to men the frequency in women increased initially and decreased in the older groups. A higher 24-h urine production was associated with a higher mean volume/void.

Nocturia and complementary indices: determination and quantification of the cause of nocturia by frequency-volume charts in women with lower urinary tract symptoms.

We evaluated differences between women with lower urinary tract symptoms (LUTS) with and without nocturia in terms of voiding habits, urine production and voided volumes in order to determine and quantify the cause of nocturia by using frequency-volume (FV) charts. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score assessment, received a thorough explanation from the study coordinators, and were requested to complete a 3-day FV chart. Of the 123 women enrolled, 106 (86.2%) 20-83 years old (median age 55.0) completed the study. Nocturnal urine volume was higher in nocturics than in non-nocturics, but this was not statistically significant. Total daytime voided volume was lower in nocturics than in non-nocturics ( P=0.030) but with no detectable difference in total voided volume. To identify possible risk factors, we examined age and night time parameters including the nocturnal bladder capacity index (NBCI), nocturnal polyuria index (NPI) and nocturia index (NI) by univariate logistic analysis. When nocturia was defined as voiding at least twice per night, age and NI were found to be associated with it by univariate analysis. These two variables were further analyzed using a multivariate logistic model to determine their association with nocturia. In the multivariate analysis, a positive association was observed between age and nocturia. Patients 50 years or older had a 3.9-fold higher risk [odds ratio (OR) 3.86; 95% confidence interval (CI) 1.60-9.31; P=0.003] of voiding at least twice per night than those younger than 50 years. In the same model, patients with NI greater than 1.5 had a 4.5-fold higher risk of voiding at least twice per night (OR 4.59; 95% CI 1.80-11.17; P=0.001). FV charts are valuable for determining the cause of nocturia in women with LUTS. Our findings suggest that age and the NI may be important variables in the evaluation of nocturia in women with LUTS.

Degree of bother caused by nocturia in women.

The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.

Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women

Objective The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women. Study design Women aged 18 years or older with nocturia (≥2 voids per night with a nocturia index score >1) received desmopressin (0.1 mg, 0.2 mg, or 0.4 mg) during a 3-week dose-titration period. After a 1-week washout period, patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks. Results In double-blind phase, 144 patients were randomly assigned to groups (desmopressin, n = 72; placebo, n = 72). For desmopressin, 33 (46%) patients had a 50% or greater reduction in nocturnal voids against baseline levels compared with 5 (7%) patients receiving placebo ( P<.0001). The mean number of nocturnal voids, duration of sleep until the first nocturnal void, nocturnal diuresis, and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo ( P<.0001). In the dose-titration phase headache (22%), nausea (8%), and hyponatremia (6%) were reported. Two deaths occurred, although neither could be directly associated with the study drug. Conclusion Oral desmopressin is an effective and well-tolerated treatment for nocturia in women.

Nocturia in women

Frequent episodes of nocturnal voiding disturb the sleep and well-being of women. The prevalence of nocturia is more common in parous women and shows a linear increase with age, occurring in more than 50% of women ≥80 years old. Nocturia has a multifactorial origin that develops through a pathophysiologic mechanism of nocturnal polyuria or low functional bladder capacity or through a combination of both. Nocturia is also one of the most bothersome lower urinary tract symptoms and has a significant impact on quality of life. However, most women accept symptoms of nocturia as part of the aging process and few seek medical help. Treatments for nocturia (behavior modification and pharmacologic treatment) are effective in many cases, although it is important to tailor treatment to the underlying pathophysiology. This review discusses the impact of nocturia on women and reviews the current situation regarding the definition, prevalence, diagnosis, and treatment of this condition in this patient population. (Am J Obstet Gynecol 2001;185:514-21.)

Fluid balance therapy of nocturia in women.

Nocturia is a common and troublesome symptom in otherwise healthy elderly men and women. Nocturnal polyuria (an excessive nighttime urine output) has been documented to be a common finding in healthy men with lower urinary tract symptoms. It is also a presenting feature of various medical conditions, such as renal failure, hypercalcemia and diabetes. Fluid balance therapy is an option in those whose nocturia is secondary to nocturnal polyuria. If a reduction in fluid intake fails to reduce nocturnal frequency a variety of drug treatments may be beneficial. Several studies have confirmed the efficacy of intranasal DDAVP, a synthetic analog of antidiuretic hormone, in both healthy patients and those with neuropathic bladders, although fluid overload and hyponatremia are potential side effects. Other drug treatments include early evening diuretics, such as frusemide or bumetanide. More recently imipramine has shown therapeutic benefit in young adults with enuresis, and might prove to be useful in the elderly with nocturnal polyuria.

The use of desmopressin (DDAVP) for nocturia in women with multiple sclerosis.

Sixteen women with multiple sclerosis who complained of nocturia completed a double-blind cross-over trial of Desmopressin (DDAVP) and placebo. Nocturia was reduced from a mean of 2.55 voids to 2.01 with placebo and to 1.28 with Desmopressin (p less than 0.01, for the difference between placebo and Desmopressin). Side effects were minor, and equally distributed between treatment and placebo.