Differentiating the causes of nocturia
Nocturnal polyuria (NP) is a common underlying condition of nocturia1
Nocturia has been traditionally regarded by urologists as a urine storage symptom associated with benign prostatic hyperplasia (BPH) and/or overactive bladder (OAB).1 BPH can result in bladder outlet obstruction (BOO) causing nocturia symptoms.1 Studies show that NP presents in 76–88% of reported nocturia cases – the majority of patients suffering from nocturia.1 More importantly, patients who suffer from OAB or BOO with persistent nocturia despite treatment may have underlying nocturnal polyuria as well.1 These findings are consistent regardless of gender, age, ethnicity and/or country;1 this discovery suggests NP can have its own pathology.1 A fuller understanding of the underlying causes of nocturia and correct diagnosis of patients suffering from nocturnal polyuria will help clinicians provide better patient care.
Common nocturia causes
Adapted from: Van Karrebroeck et al. Neurourol Urodyn 2002;21:179-183.6 Copyright © 2002.
For more information, download our differentiation guide for further guidance in correctly diagnosis the aetiology of nocturia symptoms in your patients.
Nocturnal polyuria is an important contributing factor to nocturia
|Common conditions causing nocturia7,8|
|Overactive bladder (OAB)9–12||Bladder outlet obstruction (BOO)1,12–16||Nocturnal polyuria (NP)1,6,12,17,18|
|Description||Muscles of bladder start to contract involuntarily even when volume of urine in bladder is low||Blockage to the base of the bladder, reducing or stopping the flow of urine into the urethra||Passing of large volumes of urine at night due to absence of diurnal rhythm of antidiuretic hormone (ADH) system
24-hour urine output is normal or only moderately increased
|Gender||Female & male||Male > female||Female = male|
|Symptoms||Nocturia, urinary incontinence, urinary urgency, increased frequency of urination, sleep disturbance, fatigue||Abdominal pain, frequent urination, dysuria, hesitancy, poor stream, intermittent stream, terminal dribbling, nocturia, urinary tract infection, sleep disturbance||Nocturia, sleep disturbance|
Specific cause of OAB is still unknown
Large prevalence due to benign prostatic hyperplasia among men
Can be idiopathic
|Risk factors for development||Elderly patients with cognitive decline||Largely dependent on cause||Largely dependent on cause|
Fluid and bladder diary
Digital rectal exam
Prostate-specific antigen testing
Cystoscopy and retrograde urethrogram
Urinalysis / urine culture
3-day bladder diary
|Treatment||Behavioural strategies such as pelvic floor exercises or scheduled toilet trips
Lifestyle modifications such as fluid restriction
Bladder injections (e.g. botox)
Invasive/non-invasive nerve stimulation
Surgery (last resort)
|Largely dependent on cause
|Largely dependent on cause
ADH analogues (desmopressin)
- Nocturnal polyuria – often the underlying cause of noctuia1
- Noqdirna – proven to reduce bothersome nigh time voiding19,20
- The only licensed medication for the treatment of nocturnal polyuria including the over 65s21
Prescribing Information and Adverse Event Reporting
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Ferring Pharmaceuticals Ltd.
Tel: 0844 931 0050, Email: email@example.com