Unlock the key to nocturia with good communication

Embarrassed, exhausted, irritable, frustrated. Too often, many older patients I see in my practice can be described by these words.   

Unfortunately, most have suffered in silence for many years. In their view, symptoms related to lower urinary tract conditions are a natural part of aging, not worthy of treatment or mentioning to their healthcare provider.¹

But they’re wrong. The conditions that account for the highly bothersome urinary symptoms are quite treatable. For example, nocturia – nighttime urination – affects an astonishing number of Americans – as many as 40 million^2,3. Yet far too few patients know that it often can be addressed. Frequent awakening at night to urinate is a symptom seen in men who may have benign prostatic hyperplasia and in both men and women who experience overactive bladder.

The dilemma for clinicians is helping patients with urinary symptoms who suffer in silence. In my experience, the key is to educate and provide treatment options. If a symptom such as nocturia is bothersome, then it’s worthy of discussion.

I also suggest that patients prepare for the appointment. I advise them to bring to their appointment a written set of questions so they can feel fully prepared and confident that they won’t forget to ask anything. 

As part of their “homework,” I also recommend that they keep a record or “diary” of their daily consumption of food and drink and day and nighttime voiding frequency. This is particularly important for patients who suffer from nocturia, who wake up two or more times at night to void. Sometimes these patients need nothing more than simple behavior changes, such as drinking less alcohol or caffeine in the evening hours. In other cases, the issue may be chronic conditions such as diabetes or nocturnal polyuria, which is when the kidneys overproduce urine at night⁴. A urinary diary can help healthcare providers like me make a quick assessment of condition and treatment options.

Healthcare providers also should recognize this: Patients may notice the effect of frequent nighttime urination on their sleep habits immediately but may be entirely unaware of its potential effect on their short- and long-term health. Those short-term consequences include:

• Increased falls and fractures:  With every additional trip to the bathroom, an increased fall risk exists – 2.2 times higher with patients suffering from nocturia.⁵
• Daytime dysfunction: Due to lack of sleep during the night, daytime consequences include an increased risk of accidents⁵, reduced concentration and cognitive function and fatigue.⁷ 

All of these symptoms, when left unattended and untreated, can build to greater cause for concern, including an increased risk of susceptibility to cardiovascular diseases, type-2 diabetes and depression.⁷

Not to mention, the additional falls resulting from frequent nighttime urination create an annual direct cost of $1.5 billion^5,8while nocturia-related sick leave and loss of productivity cost $61 billion^5,8 annually throughout the United States.

The numbers on the prevalence of nocturia alone indicate that all healthcare providers have patients affected by this condition. We also know that what may be a mere nuisance for some may be a serious detriment to quality of life for others.

To find that key, we need first to create awareness. We need to educate our patients and residents about the conditions that give rise to these symptoms and about the fact that they often can be treated. Nocturia, in particular, needs to be identified and addressed in all patients and residents, especially those with chronic medical problems and those at risk for developing associated problems.

Nocturia can be treated both with behavioral interventions and drug therapy. Healthcare providers need to ensure that patients and residents are aware of these treatments and receive timely interventions.

[1] Newman, D.K. (2009). Talking to patients about bladder control problems. [Review] Nurse Practitioner, 34(12),33-45.

2 Fitzgerald MP, Litman HJ, Lin CL, Mckinlay JB; BACH Survey Investigators. The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol. 2007;177(4):1385-1389.

3 Population distribution by age. Kaiser Family Foundation website. https://www.kff.org/other/state-indicator/distribution-by-age. Accessed December 16, 2017.

4 Weiss JP. Nocturia: focus on etiology and consequences. Rev Urol. 2012;14(3-4):48-55.

5 Cleveland Clinic Report. http://www.mdedge.com/sites/default/files/issues/articles/media_f478b8d_757.pdf

6 Asplund, R. Nocturia: consequences for sleep and daytime activities and associated risks. 2005;3 Iss. 6 (24-32)

7 Kupelian V, Wei JT, O’Leary MP, Norgaard JP, Rosen RC, McKinlay JB. Nocturia and quality of life: results from the Boston Area Community Health Survey. Eur Urol. 2012;61(1):78-84.

8  Holm-Larsen T. The economic impact of nocturia. Neurourol Urodyn. 2014 Apr; 33 Suppl 1:S10-4. doi: 10.1002/nau.22593