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Excessive nighttime urinary frequency (nocturia) is a common and bothersome symptom, especially in older men and women. The presence of the condition in itself does not necessarily mean that there is a problem or that it requires treatment. In men over the age of 60, the symptom is often related to an enlarged prostate, and an overactive bladder in both sexes. However, excessive nighttime frequency sometimes may indicate serious medical conditions such as diabetes, heart disease or excessive fluid retention.
Nocturia can result from excessive urine excretion by the kidneys at night due to conditions such as congestive heart failure or diabetes. Several medications such as diuretics, antidepressants, some blood pressure medications and decongestants can also cause nighttime urinary frequency or sleep disruption. Elimination of excessive water out of the system in patients with conditions such as congestive heart failure by using timed diuretics can help treat nocturia.
Men with prostatic obstruction often have improvement in their nighttime urinary frequency with medical or surgical treatment of their prostate. However, even patients who have successful relief of prostatic obstruction may have persistent nocturia. This is especially true for the older patient. Such patients may find relief from the use of medications for an overactive bladder.
In summary, not all patients with nocturia or increased nighttime urinary frequency require any treatment. Many patients will find improvement by restricting fluid intake before bedtime and appropriate treatment of their heart failure or diabetes. Appropriate use of timed diuretics or eliminating certain medications that can cause nocturia can help in relief of symptoms.
Medical treatment of prostate enlargement or overactive bladder may be required in other patients. Most men who have surgical treatment for prostate enlargement such as green light laser or transurethral resection (TURP) notice an improvement in their urinary symptoms including nocturia. Occasionally, medications that reduce the excretion of water by the kidneys may be required, but their use in the elderly population requires caution.
Talk to your physician about your nighttime urinary symptoms.
Udaya Kumar. M.D., FRCS Urol, Dip. Urol (London), is certified by the American Board of Urol-ogy and the Board of Urology of U.K. and Ireland. He is a former professor of urology with University of Arkansas for Medical Sciences. Contact him at 3475 S. Suncoast Blvd., Homosassa, FL 34448 or 352-628-7671.