Nocturia
| Nocturia | |
|---|---|
| Classification and external resources | |
| ICD-10 | R35 |
| ICD-9-CM | 788.43 |
| Patient UK | Nocturia |
| MeSH | D053158 |
Nocturia (derived from Latin nox, night, and Greek [τα] ούρα, urine), also called nycturia (Greek νυκτουρία), is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding (i.e. to urinate).” Its causes are varied and, in many patients, difficult to discern.
Diagnosing nocturia requires knowing the patient's nocturnal urine volume (NUV). The ICS defines NUV as “the total volume of urine passed between the time the individual goes to bed with the intention of sleeping and the time of waking with the intention of rising.” Thus, NUV excludes the last void before going to bed, but includes the first morning void if the urge to urinate woke the patient. Although not every patient needs treatment, most people seek treatment for severe nocturia, waking up to void more than 2-3 times per night. The amount of sleep a patient gets, and the amount they intend to get, are also considered in a diagnosis.
The two primary causes of nocturia are hormone imbalances and vesical problems. It also tied to circadian biology.
Two major hormones that regulate the body’s water level are arginine vasopressin (AVP) and atrial natriuretic hormone (ANH). AVP is an antidiuretic hormone produced in the hypothalamus and stored in and released from the posterior pituitary gland. AVP increases water absorption in the collecting duct systems of kidney nephrons, subsequently decreasing urine production. It is used to regulate hydration levels in the body. ANH, on the other hand, is released by cardiac muscle cells in response to high blood volume. When activated, ANH releases water, subsequently increasing urine production.
Nocturia has four major underlying causes: global polyuria, nocturnal polyuria, bladder storage disorders, or mixed cause. The first two processes are due to irregular levels of AVP or ANH. The third process is a vesical problem.
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