Nocturia is. .. Definition, causes, signs, symptoms and treatment
Nocturia is a urination at night, which can talk about negative processes in the body. The condition is considered pathological if a person systematically rises at night to the toilet more than 2 times for a long time( days, weeks, etc.).It is a kind of violation of urination and is more common in the male population.
The problem of nocturnal urination was actively studied in the late 90's. Domestic urologists identified two medical terms - "nocturia" and "nocturia".The meaning of these words is different. Nocturia implies an unblooded bladder at bedtime. Because of this, there is a need to urinate at night. Nicturia - an increase in nocturnal diuresis in pathological processes in the body.
Physiology of correct urination
Normally, 24-hour urine excretion presupposes the prevalence of diuresis( urine volume) over night. The ratio is 3: 1.During the day a person consumes a liquid whose volume should be equal to the amount of urine extracted.
When does diuresis prevail?
During the day, a person is in an upright position and the renal arteries stretch, because they are part of the kidney's supporting system. Nocturia is a compensatory mechanism for getting rid of excess fluid in the body. With various pathologies, the kidneys can not adequately cope with the excretion of urine. Developed edematous syndrome. When a person occupies a horizontal position, the degree of tension of the renal artery falls and the kidney is better supplied with blood. The filtration rate is increased, and urine is formed.
In what situations does nocturia arise?
Pathology can occur at any age. Here are some reasons:
- Congenital anomaly of the genitourinary system. For example, a small bladder.
- Pathology of the urinary tract - nephrosclerosis( wrinkled kidney), glomerulonephritis, chronic pyelonephritis, cystitis. With infectious and inflammatory processes, irritation of receptors in the urinary tract and urge to act of urination occurs. When the kidney parenchyma wrinkles, the vasculature expands and daily and nighttime diuresis increases.
- Diabetes mellitus. The increase in blood glucose levels is accompanied by polyuria( increased daily urine output) at any time of the day. Glucose is an osmotic diuretic, because it attracts a large amount of urine to itself.
- Diabetes insipidus. Occurs with a deficit of antidiuretic hormone( vasopressin).Diuresis occurs at any time, and the body can not make up for water supplies. Dehydration develops.
- Prostate adenoma in men is the bulk formation of the prostate gland, which compresses the urethra and disrupts the outflow of urine. The male population is over 50 years old. A man experiences constant urge to urinate, which is observed at night.
- Cardiovascular and renal failure. There is a chronic impairment of the circulation of the kidneys and other organs. And nocturia is an unfavorable sign for these pathologies, especially against the background of oliguria( small amount of urine) in the daytime. There is a venous fluid stagnation with the formation of subcutaneous edema. With the development of pathology, edema can spread in the body cavities( in the chest, in the abdominal cavity, in the skull).
- Cirrhosis of the liver. Arterial hypertension develops, and pressure in the renal arteries increases, which is accompanied by increased filtration and urination.
- Pelvic floor muscle atrophy. It occurs more often in women. There is an omission of the pelvic organs, a violation of their proper location. At night, the force of gravity does not affect the pelvic floor and the organs take a more advantageous position. The process of urination is improving. Pathology is associated with a lack of estrogens, which affect the tone of muscles and connective tissue structures.
- Hyperactive Bladder. In the muscle layer, the number of nerve impulses increases and there is a need for urination. It is observed more often in persons with neurological and psychiatric disorders.
- Reception of diuretics( diuretics).
- Age. There is a sclerotherapy of the kidney vessels, the level of ADH decreases. Older people experience nocturnal urge to urinate. In childhood, nocturia is normally observed up to 2 years. Children older than this age can urinate at night involuntarily( enuresis) or experience anxiety in their sleep. Often, nocturia in children is observed because of stressful situations.
Types of nocturia
- Physiological - observed with the use of fluids before bedtime. Tea, coffee and alcohol have a diuretic effect. May occur during pregnancy, when the fetus during the day squeezes the structure of the kidneys and urinary tract. At night the compression is eliminated and the renal blood flow and urine filtration increase. Symptoms of nocturia disappear when the causative factor is eliminated.
- Pathological - develops in pathological processes in the body and has a persistent character. Requires appropriate treatment, without which the symptoms of nocturia will not disappear.
How does nocturia manifest itself?
The highest percentage of patients with nicture are complaining that they do not get enough sleep because of night trips to the toilet. Symptoms of nocturia:
- Nocturnal excretion of urine predominates over day diuresis.
- Restless sleep. A filled bladder can cause disturbing dreams with a corresponding plot in search of a toilet. Man, knowing about this, gets up at night.
- Decreased performance the next day.
- Drowsiness, irritability, apathy, depression.
Nocturia is a common symptom of serious illnesses.
Diagnostics of nocturia
The problem can be identified in the early development of pathology. Diagnosis is as follows:
- Collecting appropriate complaints from the patient( how many times urinates during the day and at night).
- Clarification of the process of development of nocturia, with which it is associated( taking drugs, taking fluids before bedtime).
- Definition of the type of nocturia. Patients should keep a diary of urination for 5 days to see if this is a pathology or not.
- Detection of the presence of chronic diseases of the kidneys, cardiovascular and other systems.
- General examination of the patient.
To confirm the pathology laboratory and instrumental diagnostics are necessary:
- General urine analysis with revealing its specific gravity, signs of inflammation, bacteria. At night, the density of urine should normally be higher. With diabetes in the urine will be sugar.
- Bacteriological culture of urine. To determine the flora that caused inflammation. There is also a sensitivity to antibiotics in order to choose a drug of a narrow spectrum of action.
- The sample of Zimnitsky. Examine 8 portions of urine every 3 hours. Determine the ratio of diurnal and night diuresis and examine the specific gravity of each serving. For nocturia, a decrease in the density of urine and a predominance of nocturnal diuresis are characteristic. Due to this research, it is possible to suspect kidney failure, diabetes insipidus, inflammatory kidney disease.
- Determination of the level of antidiuretic hormone( ADH).Its level is lowered in diabetes insipidus.
- ultrasound of the bladder organs( allows to determine the residual volume in the bladder), kidneys and abdominal organs.
- Study of men - conduct transrectal ultrasound and finger examination of the prostate through the rectum to detect adenoma. Symptoms and treatment of nocturia in men is determined by a urologist.
- What is nocturia in women? This decrease in the level of estrogen( determined laboratory).At the same time, the muscle tone of the bladder falls, the pelvic floor muscles weaken. Developing disorders of urination. Symptoms and treatment of nocturia in women is determined by a gynecologist.
Treatment of nocturia
First of all, you need to identify the cause. Only a doctor can diagnose and treat nocturia.
General recommendations of
They are aimed at eliminating the provoking factors of the development of nocturia. To reduce the discomfort of the disease, you need:
- To exclude the intake of liquids and products with a diuretic effect( watermelon, melon) 3 hours before bedtime. Water stress on the body is better limited after 6 pm.
- Avoid overcooling.
- Do not take diuretics for the night. Usually, these drugs are taken in the morning together with antihypertensive drugs.
- Empty the bladder before bed.
Etiotropic and pathogenetic treatment of
- Reception of antibiotics and herbal medicines( "Kanefron", "Uriflorin") for infectious and inflammatory diseases of the urinary system.
- Achieving compensation for diabetes mellitus. Glucose is found in the urine with blood sugar levels above 10 mmol / l. It is necessary to consult an endocrinologist and correct treatment.
- Analogues of ADH in diabetes insipidus( substitution therapy).
- Prostate adenoma in men. Drug therapy is aimed at relaxing the smooth muscles of the neck of the bladder and prostate, as well as reducing the volume of the prostate. For this purpose, alpha-adrenoblockers and 5-alpha reductase inhibitors are used. The outflow of urine becomes better. Surgical treatment is to remove the prostate.
- Cardiologists and nephrologists deal with cardiovascular and renal failure. They struggle with arterial hypertension and edema.
- Cirrhosis is treated by therapists or hepatologists. The goal is to fight with secondary arterial hypertension.
- Symptoms and treatment of nocturia in women is determined by a gynecologist. Therapy is aimed at eliminating hormonal failures, strengthening the muscles of the perineum with the help of special gymnastics.
- Hyper-reactive bladder is treated with several groups of drugs. Use selective antispasmodics( "Driptan"), which act purposefully on the muscle, which reduces the bladder( detrusor).M-holinoblokatory( "Spazmeks", "Detrusitol") reduce the detrusor contractile activity. Antidepressants( "Imipramine") also block m-holinoretseptory, have a weak sedative effect. Applied with enuresis in children older than 6 years. Botulinum toxin( "Botox", "Disport") is injected inside the bladder at 30 points of its cavity, resulting in relaxation of the muscular wall of the bladder.
Prevention of nocturnal urination
This kind of pathology can be avoided if you take your health seriously and undergo a routine examination. Prevention measures include:
- Passing preventive medical examinations to identify pathological abnormalities of health from the norm.
- Timely treatment of diseases that can cause nocturia.
- Supervision at the specialized doctor who will help to compensate the course of a chronic illness( urologist, nephrologist, cardiologist, etc.).
- Proper nutrition for the prevention of atherosclerosis and cardiovascular pathologies. You need to eat more fiber, low-fat varieties of fish and meat, complex carbohydrates( cereals, pasta).
- Avoid hypothermia.
- Coping with stress. Disorders of urination can be on the background of psychoemotional problems.
- Regular exercise in sports, which will help maintain the muscles of the pelvic floor in a tone and perfectly improve the entire body.
Nocturia is not a harmless symptom, it is an indicator of a malfunction in the body. It is important in time to see a doctor who will prescribe the necessary types of diagnosis. The results of the study will allow the timely appointment of treatment and get rid of the problem. Often the body himself hints at us for various failures in the body, which can not be overlooked. It is necessary to observe your condition.