Prostate hypertrophy and frequent urination without early treatment can be dangerous in the middle and late stages
Many people suffer from frequent nighttime waking to the toilet, often cited as the cause of disrupted sleep, and although often thought to be a problem for older people, it affects all ages. Frequent waking up to the toilet may lead to sleep deprivation, excessive daytime sleepiness, and an increased risk of falls. Each of the problems that cause nocturia can be caused by a variety of underlying health problems.
What is nocturia?
A person has nocturia if they get up to urinate one or more times a night, and by this standard nocturia is common. However, many people may not think waking up to the toilet is a problem, but when waking up two or more times, even a sleep disorder that makes it difficult to fall asleep. Nocturia is different from bedwetting. Nocturia is waking up and realizing the need to urinate. Bedwetting usually occurs involuntarily and without the feeling that the bladder is full of urine.
How common is nocturia?
Both men and women are common, with research finding that 69% of men and 76% of women over 40 get up to go to the bathroom at least once a night, and 30% of adults over 30 go to the bathroom twice or more a night. Nocturia becomes more common with age, especially in older men, with 50% of people in their 70s having to wake up at least twice a night to urinate. Nocturia also usually occurs during pregnancy, but usually improves three months after delivery.
Does frequent urination disrupt sleep?
Nocturia is one of the most common causes of sleep disruption, according to a survey conducted by the National Sleep Foundation. Sleep deprivation and insomnia are often cited as the cause, especially in the elderly. More than 40% of people have difficulty getting up quickly in the morning, which means less sleep time, scattered sleep, and poor sleep quality. Nocturia is often associated with excessive daytime sleepiness, which can lead to impaired physical function, emotional irritability, and an increased risk of accidents.
The uria and isomnia-1 (Table 2) study showed that patients with nocturia had higher insomnia problems with difficulty falling asleep and waking up prematurely.
Other health problems associated with nocturia?
Frequent nocturia at night is not only sleep deprivation, but for older adults, nocturia can increase the risk of falls, especially when they rush to the toilet. Research shows that for people who go to the bathroom two or more times at night, the risk of falls and fractures increases by 50% or more. Nocturia reduces quality of life, and negative mental health conditions include depression. In addition, the statistical mortality rate is also higher.
The real nocturia has stricter definitions and requirements. The first is to wake up because of the strong urge to urinate to interrupt the original sleep, and such a situation is at least 2 times a night. Because under normal circumstances, during sleep, following the biological clock, the human body will produce an antidiuretic hormone in the brain, which acts on the kidneys, reducing the production of urine and not affecting sleep.
That is to say, because of insomnia and insomnia, it does not count if you have the urge to urinate for a period of time. The rate of urine production will be faster when you are awake all the time. In addition, you will not be in a sleep state, and your bladder will feel the feeling of storing urine. Still sensitive, and with nothing else to do, it is natural to urinate for a while. But some patients can’t tell the difference, so clarifying the causal relationship is also part of the differential diagnosis.
Trouble with nocturia
It is necessary to get up and urinate more frequently at night, and the resulting problems include the most direct impact on sleep quality, work performance during the day, and long-term depression. The elderly who need to urinate frequently at night are more likely to fall because of multiple medical conditions or drug use (such as anemia, hypotension, use of sleeping pills, etc.) accident.
Causes of nocturia
Urine is produced by the kidneys and stored in the bladder through the ureter. When a certain amount is reached, it causes a feeling of urine and prompts to urinate. As mentioned above, under normal circumstances, during sleep, urine theory will decrease, so if more urine is produced during sleep, the storage space of the bladder will become smaller, and the threshold for urination will become lower, which may cause nocturia. situation.
In addition, although poor sleep leads to frequent use of the bathroom, it is not included in the definition of nocturia, but because the patient may not be able to distinguish whether it is a chicken-and-egg problem, it also needs to be included in the differential diagnosis.
Urine production
Situations where more urine is still produced during sleep, including drinking too much water or diuretic beverages such as coffee and wine a few hours before bedtime, but most of the patients who seek medical attention due to nocturia have already adjusted themselves and dare not Drink too much water before bed. Common causes include poorly controlled diabetes, high blood sugar, low or poor response to hormones (antidiuretic hormone), and edema and excess water in the body.
When the blood sugar is too high, the kidneys cannot recycle too much sugar, and the excess sugar will be excreted from the kidneys along with water, resulting in the so-called solute diuresis. And some diseases can cause the hormone (antidiuretic hormone) to secrete too little or not respond well, so that even with a small amount of water, there is still a lot of urine excretion, usually > 3000 cc a day
When the body has edema (such as poor heart function or extremely poor kidney function or a lot of proteinuria), there is too much water in the interstitial space. When lying down at night, the water will return to the blood vessels and the heart, and then hit the kidneys. , instead producing a lot of urine at night. In addition, in patients with chronic kidney disease, due to the poor response of the kidneys to antidiuretic hormones, the effect of excessive urine production at night may also be amplified.
Therefore, nocturia may often be a sign of changes and aggravation of some chronic diseases (diabetes, heart disease, kidney disease, etc.).
Cause of nocturia?
Excessive urine production at night: Excessive urine production at night is known as nocturnal polyuria, the cause of 88% of nocturia. Certain types of excess urine are produced during the day and at night, a condition called full-day polyuria, and is often associated with excess fluid intake, diabetes, and kidney function problems. Substances such as diuretics, alcohol, and caffeine can also cause increased urine production. The amount of urine produced only at night increases when fluid intake increases at night. Medical problems such as peripheral edema, swelling of the legs, or fluid buildup can increase the risk of nocturnal polyuria. Some studies have shown that older adults have abnormal circadian rhythms, resulting in a higher proportion of nocturnal urine production,
Decreased bladder capacity and increased urinary frequency: One of the most common causes of urinary tract infections (UTIs), abnormal bladder capacity. May also occur in patients with enlarged prostate, benign prostatic hyperplasia (BPH), and overactive bladder. A strong urge to urinate, inflammation of the urethra, and bladder stones are all risk factors for decreased bladder capacity and increased urinary frequency, which some people experience throughout the day and others mainly at night.
Sleep Disorders: Although nocturia can disrupt sleep, sleep problems are also a major contributor to nocturia, the most obvious example being obstructive sleep apnea (OSA), which causes repeated nocturnal cessation of breathing, and is associated with nocturia in 50% of patients with OSA, which repeatedly decreases Respiratory airflow and oxygen concentration during sleep are factors that increase urine. On top of that, people with OSA often experience disrupted sleep and notice the need to urinate. Studies have shown that light sleep may increase nocturia, which is reduced in older adults during periods of deep sleep, which means they are more likely to be aroused and, once awake, may notice the urge to urinate, leading to nocturia.
Has a significant impact on health and is associated with other diseases
1. Treatment of the underlying disease causing nocturia, many patients have undergone drug therapy or drug adjustment, and have greatly improved.
2. Reduce fluid intake at night, especially before bed.
3. Avoid alcohol and caffeine in the afternoon and evening.
3. Raise your legs an hour before going to bed to reduce the absorption of peripheral edema into urine.
4. Good sleep hygiene, including bedroom environment and sleep habits.
5. Maintain a consistent sleep schedule, including waking up at the same time on weekdays and weekends.
6. Learn relaxation techniques to fall asleep easily after going to bed and going to the toilet.
According to the definition of the International Association for the Prevention and Treatment of Urinary Incontinence, as long as you get up at night to urinate more than two times (including two times), and go back to sleep after each urination, it may be “nocturia”. Dr. Qian Zuming further explained that if the total amount of urine at night is greater than 1/3 of the urine output of the whole day, it belongs to “nocturnal polyuria” in nocturia. Nocturia is more common in people over 40 years old. Men, especially with age, have a higher prevalence. According to the latest population estimates, there are more than 4.5 million people over the age of 40 in Taiwan who suffer from nocturnal polyuria (Note 1 and Note 2). It affects the size decision in daily life; and nocturia is also one of the symptoms of many other diseases, which must be taken seriously and sought medical attention immediately.
The main cause of nocturnal polyuria is related to brain function and living habits!
Different from other common lower urinary tract diseases caused by the condition of the urinary organs, the main cause of nocturnal polyuria is actually caused by insufficient secretion of antidiuretic hormone from the pituitary gland. Just like the machine needs to sleep, the human body also needs to sleep. In order to allow the body to rest fully, the pituitary gland secretes antidiuretic hormone, which concentrates the urine and reduces the production of urine at night. The reason for the abnormal secretion of antidiuretic hormone is that the function of the pituitary gland gradually degenerates with age, the head has trauma, and the tumor grows. Modern people live under great pressure, and they are in a state of tension and tension for a long time, which makes the body unable to sleep. As a result, the pituitary gland cannot release vasopressin normally. Dr. Qian Zuming explained that in addition to adjusting living habits and properly reducing stress, oral supplementation of antidiuretic hormone drugs can reduce the number of times sleep is interrupted by nocturia and improve overall sleep quality.
Treat “abnormal” as “normal”!Leading to the delay of medical treatment for nocturia in modern people
According to Dr. Qian Zuming’s outpatient experience, among the patients diagnosed with nocturia, only less than 40% of the patients came to the doctor because of nocturia symptoms, and only half of the patients who came to the doctor knew that their condition could be treated by drugs or other methods. improve. People generally believe that getting up and going to the toilet multiple times at night is a manifestation of normal aging, and it is not known that it is a disease that must be treated and can be treated. Especially men over the age of 50 are the most obvious. They often think that it is a shame to go to the doctor because of urinary problems. The above reasons lead to delayed medical treatment for men with nocturia in Taiwan, leading to more serious problems.
A 50-year-old male patient got up and urinated 10 times a night. At first, he started to exercise in the gym because of his aging. Finally, because his body could not bear the intensity of heavy training, he had a hernia and had to undergo surgery. After the operation, he started taking synthetic antidiuretic hormone drugs under the diagnosis of the doctor, but he did not dare to take the drug after a week, because he did not need to get up to urinate at night after taking the drug, which made him suspect that his kidneys were out. question. Many cases of nocturia being treated as “abnormal manifestations” emerged one after another in Dr. Qian Zuming’s clinical experience, which made him shake his head and shout, modern people should no longer regard abnormal nocturia as a normal physiological condition.
There are ways to master the “two, three and four” of nocturia to improve treatment
Due to the low awareness of nocturia, the public can make good use of the formula of “nocturia two, three and four”, and observe by themselves that if you get up to urinate more than 2 times at night, and the urine volume exceeds 1/3 of the whole day’s urine volume, it may be nighttime. Polyuria has a prevalence rate of 40% (Note 3) in adults over the age of 40. The probability is very high. It is recommended to go to the outpatient clinic as soon as possible to prescribe the right medicine, which should not be ignored.
References:
1. Meta-analysis of epidemiology studies, by number of nocturia episodes per night. Reproduced with permission from Bosch JL, Weiss JP.7
2. Eun Kyung Park, MD1, *, Jung Hyun Park, MD1, *, Jee Hyun Kim, MD, PhD1, 2, Jung Im Choi, BS1, 3, Kyounghye Kim, MS4, 5, Hyeseung Lee, BS4, Hana Yoon, MD, PhD6, Hyang Woon Lee, MD, PhD1, 3, Relationships between Nocturia, Obstructive Sleep Apnea, and Quality of Sleep. Sleep Medicine Research (SMR) 2015; 6(1): 28-34.
3. Eric Suni.Nocturia or Frequent Urination at Night.https://www.sleepfoundation.org/articles/nocturia-or-frequent-urination-night
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