What diseases is nocturia typical for? Causes of nocturnal polyuria: types and diagnosis

Nocturia - frequent urge to urinate at night, associated with the predominance of nighttime diuresis over daytime. Frequent urination at night may be a symptom of a serious medical condition.

Will a person sleep all night without voluntary urination, depends on the diuretic rhythm, according to which the volume of urine formed during night sleep should not exceed the capacity of the bladder. Abnormalities may occur due to decreased osmotic concentration in the kidneys, increased urinary sodium excretion, soluresis, or decreased bladder capacity. All polyuretic conditions can lead to the development of nocturia.

In most cases, kidney disease is associated with a decrease in their concentrating ability, and this often occurs at an early stage of the disease. Even if there is no profuse polyuria, the volume of urine produced at night often exceeds the capacity of the bladder.

Nocturia also occurs in clinical conditions for which swelling is typical. With congestive heart failure, nephrotic syndrome and liver cirrhosis with ascites, fluid accumulates in the certain parts bodies. At night, when a person takes horizontal position, the forces of action of tissue capillaries change, which contributes to the mobilization of some of the edematous fluid. The effect of intravenous administration occurs saline solution. Nocturia can also be caused by venous insufficiency, accompanied by swelling of the legs during the day and mobilization of edematous fluid at night. Nocturia can also be a consequence of reduced bladder capacity.

An infection, tumor or stone can cause inflammation and increase irritation of the mucous membrane. Chronic partial obstruction of the urine outlet from the bladder due to hypertrophy prostate gland, the structure of the urethra, a benign or malignant tumor, a stone, causes a frequent urge to urinate, and in addition, a thickening of the muscular wall of the bladder, reducing its compliance (extensibility). Based on frequent urination of small portions, it can be assumed that nocturia is associated with a process in the lower sections urinary tract. However, at an early stage chronic obstruction at night there may be a single urination, the volume is quite moderate.

Polyuria - pathological excess of the normal daily volume of urine excreted. A characteristic feature Polyuria is considered to be a volume of urine excreted more than 3 l/day. However, when diagnosing polyuria, one should exclude a person’s tendency to consume large number fluid and therefore produce more urine. Patients themselves usually cannot distinguish polyuria from increased frequency of urination, i.e. frequent urination in small portions. Since it is difficult to obtain clear information from a patient about the volume of urine excreted, before identifying the cause of the disease, the fact of polyuria is established by daily urine collection.

Causes of polyuria

Polyuria may be due to inappropriate secretion of vasopressin, loss of renal tubular responsiveness, diuresis of solutes (soluresis), or natriuresis. It may serve as a physiological adaptation mechanism to remove fluid.

The main causes of polyuria are as follows:

I. Insufficiency of the concentrating function of the kidneys:

1.Diabetes insipidus

a) Diabetes of central origin

• Posthypophysectomy syndrome; consequences of injury, removal of the pituitary gland; idiopathic; tumors or cysts located above and inside the sella turcica; histiocytosis or granuloma; compression by an aneurysm; Sheehan's syndrome; meningoencephalitis; Guillain-Barre syndrome; fat embolism; "empty" sella turcica

b) Nephrogenic diabetes

• Acquired tubulointerstitial kidney disease (pyelonephritis, analgesic nephropathy, multiple myeloma, amyloidosis, obstructive uropathy, sarcoidosis, hypercalcemic and hypokalemic nephropathy, Sjögren's syndrome, sickle cell disease, kidney transplant)
• The effect of drugs or toxic substances(lithium, demeclocycline, methoxyflurane, ethanol, diphenylhydantoin, propoxyphene, amphotericin)
• Congenital diseases(hereditary diabetes insipidus of nephrogenic nature, polycystic disease or cystic disease of the renal medulla)

2.Solurez (glucosuria, feeding the patient food through a gastric tube, rich in proteins, intravenous administration of urea or mannitol, introduction of radiographic contrast agent, chronic renal failure)

3.Natriuretic syndromes (nephritis accompanied by loss of salt; diuretic phase acute necrosis renal tubules; diuretics)

II. Primary polydipsia

1. Psychogenic polydipsia
2. Hypothalamic disease
3. Reception medicines (thioridazine, chlorpromazine (aminazine), anticholinergic drugs)

Diabetes insipidus

The term "diabetes insipidus" applies to those clinical conditions, in which inadequate concentrating function of the kidneys leads to polyuria and secondary thirst. The cause of the pathology is either insufficient secretion of vasopressin (diabetes insipidus of central origin) or insensitivity of the kidneys to it (nephrogenic diabetes insipidus). In both cases, water reabsorption is reduced throughout the entire distal portion of the nephron, since the passive transition of water from the lumen of the tubules to the hypertonic interstitium of the outer and inner medulla of the kidney occurs slowly. However, even though the rate of passage of water from the collecting ducts is low (for a given osmotic difference between the lumen of the tubule and the interstitial fluid), the fluid entering the collecting ducts of the kidney is so diluted and its volume is so large that the inner layer of the medulla more of its substances are supplied than with in good condition. This promotes the “washing out” of solutes from the renal medulla into the vasa recta. This process is not complete enough and therefore administration of vasopressin may result in the formation of osmotically concentrated urine. However, the maximum urine osmoticity that will be achieved with this drug will remain below normal.

Diabetes insipidus of central origin It happens primary(idiopathic) ill secondary caused by such reasons as hypophysectomy, trauma, tumor, inflammation, infection, vascular diseases.

ANDdiopathic diabetes insipidus can be inherited in a dominant autosomal manner, but most often it is sporadic and develops in childhood. With any form of central diabetes mellitus in the supraoptic nucleus of the hypothalamus, neurons producing the antidiuretic hormone vasopressin are selectively damaged.

Nephrogenic diabetes insipidus It is rarely hereditary. It is usually associated with kidney disease. Its important and opposite causes include hypercalcemia and hypokalemic nephropathy. Exposure to lithium carbonate, narcotic drug methoxyfuran (1,1-difluoro-2,2-dichloroethyl methyl ether) and demeclocycline (a tetracycline derivative) can also cause the development of this type of diabetes.

Solurez

Excessive filtration of poorly absorbed solutes, such as glucose, mannitol, or urea, inhibits proximal tubular reabsorption of water and sodium chloride, leading to urinary loss and polyuria. Since the concentration of sodium ions in the urine is lower than in the blood, then from the body to more water is excreted rather than salt, which can result in the serum becoming hypertonic. Glucosuria in diabetes mellitus - the most common case of soluresis. Intravenous administration mannitol, angiographic X-ray contrast agent, as well as feeding the patient through a gastric tube with drugs containing high content proteins cause excessive urea secretion and can lead to the development of iatrogenic soluresis. Soluresis of any degree can cause polyuria, so the study of the concentrating ability of the kidneys should be postponed until soluresis is corrected.

Natriuretic syndromes

Chronic excessive urinary sodium loss is possible in tubulointerstitial or cystic kidney disease. Polyuria and polydipsia are accompanied by unusually high daily sodium requirements. Examples of this phenomenon, when the excretion of water and sodium from the body is very large, include renal medulla cystosis, Barter's syndrome and the diuretic phase of acute tubular necrosis.

Primary polydipsia

Psychogenic polydipsia. Some people, either due to their habit, inclination, mental disorders, specific brain damage, or because of taking medications, they consume so much water during the day that they develop polyuria. With chronic polydipsia, the body and kidneys are very rarely affected, but it can be mistaken for diabetes insipidus due to the very similarity of their symptoms. In intentional polydipsia, extracellular fluid volume remains normal or increased, and vasopressin secretion is reduced to basal levels as serum osmoticity tends to the lower limit of normal.

Since reabsorption of water from the lumen of the distal convoluted tubule and collecting duct is reduced, all excess water is excreted in the urine. Due to the washout process that occurs when diabetes insipidus, in the inner layer of the renal medulla, the gradients of urea and sodium chloride decrease. However, the washout process is more intense than in diabetes.

The fact is that with primary polydipsia there is a tendency to increase the volume of extracellular fluid, while with diabetes insipidus the loss of primary urine in the kidneys leads to the opposite effect. An increase in the volume of extracellular fluid increases the total amount of sodium chloride and water delivered to the dilated portion of the ascending limb of the nephron loop (Henle), and therefore to the inner layer of the renal medulla, all processes being equal. Renal blood flow also increases. Increased blood flow through the vasa recta reduces their ability to retain solutes in the renal medulla.

Examination of a patient with polyuria

Soluresis (osmotic diuresis) and natriuretic syndromes are usually detected during questioning of the patient, physical examination, urine analysis (glucosuria), clinical symptoms, leukocyte formula, the amount of glucose in the blood, serum creatinine or blood urea nitrogen. Difficulties in diagnosis are associated mainly with stable chronic polyuria and polydipsia of unknown origin. In such cases, one should try to differentiate central diabetes insipidus from nephrogenic and primary polydipsia. For this purpose, a well-proven method, the essence of which is to study the dynamics of the osmotic concentration of urine when water consumption is stopped and vasopressin is prescribed.

The patient is allowed free consumption of water for 3 days against the background of a normal diet that provides the body with sodium chloride in an amount of approximately 100 mmol/day. Then complete fasting is prescribed, during which the patient’s pulse rate is measured every 30 minutes and blood pressure, every hour he is weighed precise scales. After reducing the patient’s body weight by 3% or after. A 14-hour fast measures serum and urine osmolality. U healthy person in this case, the volume of urine excreted will decrease and be less than 0.5 ml/min, and its osmotic concentration will reach approximately 700 mOsmol/kg (water).

In complete diabetes insipidus (central or nephrogenic), urine osmoticity remains below 200 mOsmol/kg, and its excretion remains above 0.5 ml/min. However, with incomplete diabetes there will be a slight increase in urine osmoticity and a decrease in its volume. If by the end of fasting the osmotic concentration is less than 700 mOsmol/kg, then intravenous (drip) administration is prescribed. aqueous solution vasopressin at a dose of 5 mU/min. In patients with complete or partial diabetes insipidus of central origin, urine osmoticity will increase by more than 9%. In complete diabetes insipidus of a nephrogenic nature, there is no response to vasopressin. Still, some reaction sometimes occurs in incomplete nephrogenic diabetes. To determine violations of the osmoregulatory function of the kidneys, it is advisable to prescribe an intravenous hypertonic saline solution.

The reaction of patients suffering from primary polydipsia is somewhat different. When fluid intake is stopped, vasopressin secretion increases. By the time the test is completed, urine output rate and urine osmoticity will reflect a certain physiological level vasopressin, which acts on intact renal tubules penetrating the interstitium of the medulla, the same interstitium in which the concentration of urea and sodium chloride turned out to be low due to their chronic leaching. In other words, the washout process determines the upper limit of urine osmolality. Consequently, in patients with primary polydipsia, the concentrating ability of the kidneys will be submaximal, despite normal secretion vasopressin.

Exogenous vasopressin can increase the osmotic concentration of urine, but only slightly, by less than 9%. The main reason for the limitation of osmoticity is precisely the process of leaching of solutes from the renal medulla, and not the lack of sufficient secretion of vasopressin or the insensitivity of the renal tubules to it. Typically, by the end of the fluid deprivation test, the urine osmoticity exceeds 400 mOsmol/kg. On the contrary, in patients with diabetes insipidus, the values ​​of this indicator are lower (approximately 200 mOsmol/kg). In some cases, using the fluid deprivation test alone, it is impossible to distinguish incomplete diabetes insipidus from primary polydipsia. However, diagnostics can be improved using radioimmunoassay of the concentration of antidiuretic hormone in serum.

Nocturia (derived from the Latin nox, night, and Greek [τα] ούρα, urine), also called nocturia (Greek νυκτουρία), is defined by the International Continence Society (ICS) as “the complaint that the subject wakes one or more times during the night. times for urination.” Its causes vary and are difficult to identify in many patients. To diagnose nocturia, the patient's nocturnal urine volume (NUV) must be known. The ICS defines nocturnal urine volume as “the total volume of urine excreted during the period of time between the time the subject went to bed with the intention of sleeping and the time of awakening with the intention of getting up.” Thus, the nightly urine volume does not include the last void before going to bed, but does include the first void in the morning if the urge to urinate wakes the patient. Although not every patient needs treatment, most people seek treatment for severe nocturia, which involves the urge to urinate 2-3 times a night. The amount of sleep patients get and the amount of sleep they desire also factor into the diagnosis.

Reasons

The two main causes of nocturia are hormonal imbalances and problems with bladder. The two main hormones that regulate water levels in the body are arginine vasopressin (AVP) and atrial natriuretic hormone (ANH). AVP is an antidiuretic hormone produced in the hypothalamus and stored and released from the neurohypophysis. AVP increases water absorption in the collecting duct system renal nephrons, further reducing urine production. It is used to regulate the body's water saturation levels. ANG, on the other hand, is released by cardiac muscle cells in response to high blood volume. When activated, ANG releases water, further increasing urine production. Nocturia has four fundamental causes: general polyuria, nocturnal polyuria, impaired bladder continence, or mixed etiology. The first two processes are associated with impaired levels of AVP or ANG. The third process is a bladder problem.

General polyuria

General polyuria is a continuous overproduction of urine that is not limited by hours of sleep. General polyuria occurs in response to increased fluid intake and is defined as urine output in an amount of more than 40 ml/kg/day. Common reasons General polyuria primarily consists of thirst-related disorders such as diabetes mellitus and diabetes insipidus. Diabetes insipidus is caused by impaired water levels in the body. Unbalanced urination can lead to polydipsia or excessive thirst to prevent circulatory collapse. Central diabetes insipidus is caused by low level WUA, which helps regulate water levels. In nephrogenic diabetes insipidus, the kidneys do not respond appropriately to the amount of AVP. Diabetes insipidus can be diagnosed using an overnight water deprivation test. This test requires the patient to increase their fluid intake over a period of time, usually around 8-12 hours. If the first morning urination is not sufficiently concentrated, the patient is diagnosed with diabetes insipidus. Central diabetes insipidus can usually be treated with a synthetic SGA substitute called desmopressin. Desmopressin is taken to control thirst and frequent urination. Although there is no substitute for nephrogenic diabetes insipidus, it can be treated through careful management of fluid intake.

Nocturnal polyuria

Nocturnal polyuria is defined as an increase in urine production at night, but with a proportional decrease in daytime urine production, resulting in a normal daily urine volume. Due to daily urine production within normal limits, nocturnal polyuria is determined by the nocturnal polyuria index (NPi) of more than 35% of the normal daily urine volume. The nocturnal polyuria index is calculated by simply dividing the nighttime urine volume by the daily urine volume. Similar to inability to control urination, disturbances in arginine vasopressin (AVP) levels lead to nocturia. Compared with normal patients, patients with nocturia show a nocturnal decrease in AVP levels. Other causes of nocturnal polyuria include conditions such as congestive heart failure, nephritic syndrome, and liver failure; or lifestyle factors such as excessive nightly fluid intake. Increased resistance respiratory tract, which has been associated with obstructive sleep apnea, can also cause nocturnal polyuria. Obstructive sleep apnea demonstrates an increase in kidney sodium levels and water excretion, which is caused by increased level in plasma ANG.

Bladder retention

Bladder continence disorders are defined as any factors that increase the frequency of urinating in small volumes. These factors are usually associated with lower urinary tract symptoms that affect bladder capacity. Patients with nocturia who do not have general or nocturnal polyuria, according to the criteria above, most likely have a bladder continence disorder that reduces nocturnal voiding volume or sleep disturbance. Nocturnal bladder capacity (NBC) is defined as the largest volume of urine voided during the sleep period. Reduced nocturnal bladder capacity results in decreased maximum urinary volume or decreased bladder continence. Reduced nocturnal bladder capacity may be associated with other disorders such as prostatic obstruction, neurogenic bladder dysfunction, acquired voiding dysfunction, anxiety disorders, or certain medications.

Mixed etiology

A significant number of cases of nocturia have mixed etiology. Mixed nocturia is more common than many individual types and a combination of nocturnal polyuria and decreased nocturnal bladder capacity. In a study of 194 patients with nocturia, 7% had usual nocturnal polyuria, 57% had decreased nocturnal bladder capacity, and 36% had a mixed etiology of the first two. The etiology of nocturia is multifactorial and often unrelated to the underlying urological condition. Mixed nocturia is diagnosed by monitoring and analyzing the patient's urination diaries. Determination of etiological factors is carried out using formulas.

Diagnostics

As with any patient, detailed history problems are required to determine what is normal for the patient and what is not. The main diagnostic tool for nocturia is a voiding diary. Based on the information in the diary, the doctor can determine whether the patient is suffering from polyuria, nocturnal polyuria, or a problem with bladder continence. The time of urination, their number and the volume of urine excreted should be recorded in a diary. The amount of fluid consumed and the time of consumption should also be recorded. Patients should include the first void in the morning in their nocturnal void volume, however, the first void in the morning is not included in the nocturnal void count.

Control

Lifestyle change

Although there is no cure for nocturia, there are a number of actions people can take to control symptoms. Avoiding caffeine and alcohol consumption has useful action on some subjects with the disease. Compression stockings can be worn during the day to prevent fluid from accumulating in the legs, causing less urine output, although their use is contraindicated due to heart failure. Drugs that increase urinary flow may help reduce the spatial distribution of fluid, but may also worsen nocturia. A common action that patients take is to avoid drinking any liquids an hour before bed, which is especially helpful for people with urge incontinence. However, research on this has demonstrated that it reduces nighttime urination in minor degree and is not optimal for controlling nocturia in older adults. For people suffering from nocturnal polyuria, this action provides no benefit at all due to impaired AVP levels and the inability to be responsible for inhibiting increased urination. Limiting fluid intake also does not help people with nocturia due to the gravitational distribution of fluid as fluid is mobilized when they lie in a reclining position.

Surgical intervention

In cases of nocturia associated with prostate obstruction or an overactive bladder, surgery may be undertaken. Transurethral prostatectomy/prostate dissection and surgical correction omissions pelvic organs, sacral nerve stimulation, cytotoplasty, and detrusor myectomy are treatment options and may help relieve symptoms of nocturia.

Medicines

Desmopressin has some effect beneficial effect in adults who have problems urinating at night. One thing was observed negative impact in the form of dilutional hyponatremia. Usage this method Treatment in the elderly and people at risk of hyponatremia should be accompanied by monitoring of serum sodium levels because this carries significant risks if concentrations fall. Other drugs that are often used to treat nocturia include oxybutynin, tolterodine, solifenacin, and other antimuscarinic agents. These drugs are especially used in patients suffering from nocturia caused by overactive bladder and urge incontinence, as they cause the bladder to narrow.

Effect

Although nocturia is little known to the general public, some studies suggest that more than 60% of people are affected by it. negative influence. Insomnia and sleep deprivation can cause exhaustion, mood swings, drowsiness, impaired productivity, fatigue, increased risk accidents and cognitive dysfunction. 25% of falls observed in elderly subjects occur at night, of which 25% occur during awakening to urinate. In addition, nocturia may also increase the risk of mortality and complications. The Quality of Life Test for People with Nocturia was published in 2004. The pilot study was conducted on men only.

Prevalence

Research shows that 5-15% of people aged 20-50, 20-30% of people aged 50-70 and 10-50% of people over 70 urinate at least twice a night. Nocturia becomes more common with age. More than 50 percent of men and women over the age of 60 suffer from nocturia in many populations. Even subjects over 80 years of age show symptoms of nocturia. Symptoms of nocturia often get worse with age. Although the prevalence of nocturia is approximately the same in both sexes, evidence suggests that it is more common in young women than in young men and more common in older men than in older women.

:Tags

List of used literature:

Van Kerrebroeck, Philip; Abrams, Paul; Chaikin, David; Donovan, Jenny; Fonda, David; Jackson, Simon; Jennum, Poul; Johnson, Theodore; Lose, Gunnar; Matthiasson, Anders; Robertson, Gary; Weiss, Jeff; Standardization Sub-committee of the International Continence Society (2002). "The standardization of terminology in nocturia: Report from the standardization sub-committee of the International Continence Society." Neurourology and Urodynamics 21(2):179–83. doi:10.1002/nau.10053. PMID 11857672.

Diseases of the urinary system are characterized depending on their etiology. Some types of malfunctions genitourinary system are hereditary, some pathologies are acquired. One of characteristic violations genitourinary system is nocturia.

What is nocturia can be explained in simple language: This predominance of night natural secretions urine over daytime. To treat nocturia, it is necessary to identify the cause and nature of the pathology.

Nocturia and nocturia - the difference

IN medical practice It is customary to classify diseases according to diagnoses. ICD is international classification diseases. Depending on the course, nature and etiology of the disease, in each class of pathologies there are groups that include specific disease. Class 10 falls under the tenth revision category.

ICD-10 codes refer to diseases and health-related problems and are classified into classes. Nocturia belongs to the fourteenth class: diseases of the genitourinary system.

Class 14 involves the classification of diseases with clarification of the diagnosis and has eleven groups. Group No. 30-39 - other diseases of the urinary system - includes nocturia.

The term "nocturia" is characterized increased nocturnal diuresis associated with cardiovascular problems or renal failure at an early stage chronic course, which forces a person to get up at night to satisfy the need for natural urination.

There is a concept similar to nocturia - nocturia. Pathology has an etiology irritating factor, in which the volume of fluid released is significantly less than with nocturia. The nature of the origin of the pathology determines the difference between these terms.

The international medical community has decided to combine these terms into a single one - nocturia, which is characterized as awakening to satisfy urination at night.

Thus, you can find nocturia in the ICD-10 reference book as follows:

14th grade- Diseases of the genitourinary system;

№30-39 - other diseases of the urinary system;

code 35- polyuria. Frequent urination, nocturnal polyuria (nocturia).

Causes of the disease in men and women

To prescribe treatment for the disease, the cause of night urination is identified.

Night awakenings that occur in in rare cases, are not a pathology: They can be caused by drinking plenty of fluids at night, taking diuretics, or drinking drinks containing caffeine at night. In this case, no treatment is required. Elimination of the cause leads to normalization of the functioning of the urinary system.

Another factor in nighttime urges is age. Decreased muscle tone pelvic floor, leading to weakening of the muscle activity of the bladder. In this case, the bladder is unable to hold sufficient quantity urine for a long time, which sends a signal to the brain to empty.

If nighttime trips to the toilet are stable, then in this case the cause of the pathology should be identified. The main reasons for the development of nocturia, regardless of the gender of the patient, are:

• diabetes mellitus;
• anemia;
• swelling due to venous stagnation of blood;
• thyroid diseases;
• disruption of cardiac function (heart failure);
• renal failure.

In most cases, nocturia develops in women, depending on the presence of third-party diseases. Men with prostate adenoma are more susceptible to developing nocturia, women - with or acute.

Symptoms of nocturia

The main symptom of nocturia is Frequent getting up at night to satisfy the need to urinate.

If a person empties more often at night than during the day, and the volume of fluid released is significant, then this indicates the presence of nocturia. Even when emptying the bladder with a small amount of fluid, the patient feels significant relief.

This sign is the basis for examination by a doctor.

In addition to frequent urges, there may be a significant increase in fluid secretion - polyuria, which also indicates pathology.

Since frequent awakenings at night contribute to poor sleep quality, associated symptoms nocturia may result in increased fatigue, weakness, nervous irritability, and depression.

Unlike women, nocturia develops in men at an older age, since in most cases the cause of pathology in them is inflammatory processes in. Women more often suffer from nocturia due to inflammation of the bladder.

Frequent urination at night with nocturia occurs painlessly. If there is pain or other symptoms during urination, they may indicate about the presence of third-party diseases.

Diagnosis of the disease

The main task in diagnosing nocturia is to identify the ratio of fluid secreted at night and during the day.

To do this, a method is used to collect urine. The conditions for holding events are:

1. refusal to take diuretics (if any were taken);
2. a constant amount of fluid intake throughout the day;
3. refusal of foods that provoke the use of large amounts of liquid (salty, spicy, sweet).

The essence of the method is to collect urine during habitual urination. throughout the day every three hours. Urination is performed into a container, the amount of fluid released within a period of three hours is recorded and recorded. In this case, the amount of liquid drunk is taken into account and recorded.

Thus, the difference between daytime and nighttime urine output is determined, as well as the dynamics of the pathology is monitored.

To exclude concomitant diseases carry out the following activities:

After determining the etiology of the disease, appropriate treatment is carried out.

Treatment and prognosis

Most often, treatment for nocturia involves to eliminate the cause of the urge to urinate at night. If the cause of the development of pathology is infectious diseases, then appropriate antibacterial drugs are prescribed.

In the presence of prostate adenoma, a set of measures is prescribed to treat the disease: the use of medications, exercise therapy, as a last resort, surgical intervention.

If the cause of nocturia is contractile muscular walls of the bladder, then medications are prescribed that reduce tissue contraction.

Prognosis for treatment of the disease depends on treating the cause of the pathology. If the cause is eliminated and awakening occurs, then sleeping pills are prescribed to normalize sleep.

Nocturia in women old age may develop as a result of a deficiency of sex hormones, which causes incorrect operation pelvic organs. Subject to compliance with the conditions of therapy and therapeutic exercises to strengthen muscles pelvic area older patients can achieve good results.

Possible consequences

After the cause of nocturia is cured, nocturnal urges stop, however, sleep disorders, neuropathy due to insomnia and fatigue are possible, which can be restored over time with the help of special drugs and certain therapy.

If nocturia is not treated, the consequences of the disease can be serious consequences. Since nocturia is a disease that is more often is a symptom of other pathologies, they must be treated without fail.

If left untreated, complications of the disease can even lead to death.

Prevention of disease

In order to prevent nocturia, you should be careful about your health, especially if you have prerequisites for the occurrence of the disease:

• for chronic kidney disease inflammatory processes you should follow your doctor’s advice to prevent complications;
• if you are prone to cardiovascular diseases, you should adhere to an appropriate diet and cardiac support therapy;
• Hypothermia should be avoided;
• do simple things regularly physical exercise to strengthen the pelvis (especially for women);
• Have an annual examination with a urologist.

If you suspect nocturia, you should immediately consult a doctor.

Thus, nocturia is a symptomatic disease, it is caused by the presence of other pathologies. Once the cause is treated, the symptoms of nocturia go away on their own.

What to do if you often wake up at night to go to the toilet, find out from the video:

Increased nighttime urination, characterized by an increased volume of urine at night, is called nocturnal polyuria. In men, this pathology may also be called nocturia. But here it is worth understanding the difference in terms. Polyuria, in principle, is characterized by an increase in the daily volume of urine, and nocturia is characterized by a frequent urge to urinate at night and with large single portions of urine. With nocturia and polyuria, the volume of urine per day exceeds the norm and is equal to 1.8 liters or more. Sometimes the volume can reach up to 3 l/day. We will understand what these pathologies are and how to deal with them in the material below.

Important: nocturia (polyuria) is a pathology that more often overtakes men against the background of prostate adenoma. Polyuria can also occur in both men, women and children.

The main symptoms of the pathology

Polyuria is characterized by a frequent urge to urinate. Especially at night. However, polyuria should not be confused with frequent urges to the toilet with small amounts of urine. The latter is more likely to be typical for cystitis and urethritis. It is worth knowing that if normally the human body produces and excretes up to 1.5 liters of urine per day, then with nocturia and polyuria its daily volume can reach 3 liters or more. The mistake of patients faced with polyuria is that they accept pathology as the norm and continue to live with it. But polyuria in most cases is a consequence of kidney disease, heart disorders or endocrine apparatus, and also possible problems with the nervous system. Therefore, if a problem such as frequent urination with an increase in urine volume occurs, you should immediately contact a specialist.

It is worth knowing that in children polyuria is often physiological process. That is, a consequence of drinking large amounts of liquid at night. As a rule, against the background of regulating the drinking regime and diet, everything returns to normal. In rare cases, childhood polyuria is a sign of pathological processes in the body. This is more common in older patients.

Causes of polyuria

The causes of this pathological condition can be a wide variety of diseases. But first of all, the focus is on kidney and cardiovascular diseases. In addition to these, the reasons may be:

• Chronic renal failure;
• Central nervous system disorders;
• Malignant formations in the kidneys, ureters and other pelvic organs;
• Heart failure;
• Pathological processes in the prostate (in men);
• Chronic urolithiasis;
• Diabetes mellitus, etc.

It is worth noting here that pregnancy can also be a provoking factor for polyuria. Because the growing uterus puts pressure on the urinary organs. Moreover, changed by pregnancy hormonal background additionally plays in favor of increasing urine volume.

External causes of polyuria include the following:

• Uncontrolled and long-term use of diuretics and medications;
• Abuse of products with a diuretic effect (parsley, coffee, green tea etc.);
• Excessive water consumption.

Types of polyuria

The pathological process called polyuria (nocturia) can be classified according to several criteria. So, regarding the duration of the process, polyuria can be:

• Temporary. Characterized by a short duration within one night or a certain period. It can be triggered by infection, pregnancy, or simply excessive drinking.
• Constant. It is relatively constant and in most cases develops against the background of kidney diseases.

Regarding the cause of development, polyuria can be classified into the following groups:

• Pathological. Develops as secondary process against the background of other chronic diseases. Often formed against the background of diabetes or heart failure.
• Physiological. Develops after drinking large amounts of liquid or using diuretics.

Clinical picture of the pathology

Polyuria is characterized by one single symptom - frequent urination (especially at night) with large single portions of urine. It is worth knowing that in an uncomplicated form of the pathology the volume of urine reaches two liters, and in a complicated form or during pregnancy it can reach three liters. If the cause of polyuria is diabetes, then the volume can reach 10 liters of urine per day.

Otherwise clinical picture pathologies are most often symptoms of the disease that became the root cause of the increase in urine volume. That is, it is against the background of the existing symptoms that the attending physician will make an accurate diagnosis.

Diagnosis of polyuria

It is worth knowing that polyuria can be diagnosed only on the basis laboratory research. Since this pathology is characterized by changes in the specific gravity of urine and its total daily volume. The following methods are used for research:

• Laboratory analysis urine according to Zimnitsky. In this case, the patient urinates in separate containers throughout the day, collecting only eight portions of urine. During urination, the patient must note the duration of the act (beginning and end, calculated in minutes). Daytime urine collection is carried out from 9:00 to 21:00. This is where the first five portions are collected. Night - from 21:00 to 9:00. Collect three servings. Based on the obtained biomaterial, the laboratory technician displays data on its specific gravity in each portion.
• Method for determining the cause of pathology. In this case, the patient is subjected to so-called forced dehydration. That is, for 4-18 hours the patient is not given liquid in any form. During this period, all the urine that can be collected is taken. Then an antidiuretic hormone is injected into the subject's body. And again the entire volume is collected. The water-electrolyte balance of blood plasma is studied in the resulting biomaterial. Based on the data obtained, the specialist can accurately determine the cause of the development of the pathology and prescribe additional hardware diagnostic methods to confirm the diagnosis.

Treatment

Such a piquant pathology must be treated by combating the underlying disease that caused the development of polyuria. That is, in each specific case, the tactics will be very different depending on the original disease. However, when diagnosing polyuria and thorough examination In the patient's body, the doctor can identify a lack of electrolytes such as potassium, magnesium, sodium and calcium. In this case, their balance will have to be restored. To do this, adjust the patient’s diet and the amount of fluid consumed.

Important: if, against the background of polyuria, the patient experiences severe dehydration, then infusion therapy is used in relation to the patient (administration of drugs intravenously through a dropper). Kegel exercises, which are aimed at strengthening the muscles of the perineum, can also play an additional role in the treatment of this problem.

Preventive measures

To avoid the possibility of encountering polyuria, you need to take care of your health from the very beginning. Namely:

• Lead a healthy and active lifestyle;
• Eat properly without overusing foods high in salt and seasonings;
• Avoid overuse marinades, smoking;
• Do not take alcohol or drugs;
• Treat all chronic diseases in a timely manner or at least keep them under control;
• Avoid diuretic products (coffee, chocolate);
• Maintain normal drinking regime(at least 1.5 liters of water per day).

Remember: preventive measures will allow you to stay healthy without unnecessary medical intervention and lengthy medical procedures.

Nocturia is urination at night, which can indicate negative processes in the body. The condition is considered pathological if a person systematically gets up to go to the toilet at night more than 2 times for a long time (days, weeks, etc.). It is a type of urination disorder and is more common in the male population.

Historical background

The problem of night urination began to be actively studied in the late 90s. Domestic urologists have identified two medical term- “nocturia” and “nocturia”. The meaning of these words is different. Nocturia involves not emptying the bladder before bed. Because of this, there is a need to urinate at night. Nocturia is an increase in nocturnal diuresis due to pathological processes in the body.

Physiology of proper urination

Normally, daily urine output implies a predominance of daytime diuresis (urine volume) over nighttime. The ratio is 3:1. During the day, a person drinks liquid, the volume of which should be equal to the amount of urine excreted.

When does nocturnal diuresis predominate?

During the day, a person is in an upright position and the renal arteries are stretched because they are part of the supporting system of the kidney. Nocturia is compensatory mechanism getting rid of excess fluid in the body. At various pathologies the kidneys cannot adequately handle urine excretion. Develops When a person takes a horizontal position, the degree of tension in the renal artery falls and the kidney is better supplied with blood. The filtration rate increases and urine is produced.

In what situations does nocturia occur?

Pathology can occur at any age. Here are some reasons:

1. Congenital anomaly of the genitourinary system. For example, a small bladder.
2. Pathology of the urinary tract - glomerulonephritis, chronic pyelonephritis, cystitis. During infectious and inflammatory processes, irritation of receptors in the urinary tract and the urge to urinate occur. When the kidney parenchyma shrinks, vasculature daytime and nighttime diuresis expands and increases.
3. Diabetes mellitus. An increase in blood glucose levels is accompanied by polyuria ( increased secretion daily amount of urine) at any time of the day. Glucose is osmotic diuretic, because it attracts a large amount of urine to itself.
4. Diabetes insipidus. Occurs when there is a deficiency of antidiuretic hormone (vasopressin). Diuresis occurs at any time, and the body cannot replenish water reserves. Dehydration develops.
5. Prostate adenoma in men - extensive education prostate gland, which compresses the urethra and interferes with the outflow of urine. It affects the male population over 50 years of age. The man experiences a constant urge to urinate, which is also observed at night.
6. Cardiovascular and renal failure. Observed chronic disorder blood circulation of the kidneys and other organs. And nocturia is an unfavorable sign in these pathologies, especially against the background of oliguria (small amount of urine) in daytime. Venous stagnation of fluid occurs with the formation of subcutaneous edema. With the development of pathology, edema can spread in body cavities (in chest, V abdominal cavity, in the skull).
7. Cirrhosis. Developing arterial hypertension, and the pressure in renal arteries, which is accompanied by increased filtration and urination.
8. Muscle atrophy Occurs more often in women. There is prolapse of the pelvic organs and a violation of their correct location. At night, gravity does not act on the pelvic floor and the organs occupy a more advantageous position. The process of urine formation improves. The pathology is associated with a lack of estrogens, which affect the tone of muscles and connective tissue structures.
9. Overactive bladder. IN muscle layer the number is increasing nerve impulses and the need to urinate arises. It is observed more often in people with neurological and mental disorders.
10. Taking diuretics (diuretics).
11. Age. Sclerosis of the kidney vessels occurs, and the level of ADH decreases. Older people experience the urge to urinate at night. In childhood, nocturia is normally observed up to 2 years of age. Babies older than this age may urinate involuntarily at night (bedwetting) or have trouble sleeping. Nocturia in children is often observed due to stressful situations.

Types of nocturia

1. Physiological - observed when drinking liquid before bedtime. Tea, coffee and alcohol have a diuretic effect. It can occur during pregnancy, when the fetus puts pressure on the structures of the kidneys and urinary tract during the day. At night, the compression is relieved and renal blood flow and urine filtration are increased. Symptoms of nocturia disappear when the causative factor is eliminated.
2. Pathological - develops during pathological processes in the body and is persistent. Requires appropriate treatment, without which the symptoms of nocturia will not disappear.

How does nocturia manifest?

The largest percentage of patients with nocturia complain that they do not get enough sleep due to night trips to the toilet. Symptoms of nocturia:

1. Nocturnal urine output prevails over daytime diuresis.
2. Restless sleep. A full bladder can cause disturbing dreams with a corresponding plot in search of a toilet. A person, knowing this, gets up at night.
3. Decreased performance the next day.
4. Drowsiness, irritability, apathy, depression.

Nocturia is common symptom serious illnesses.

Diagnosis of nocturia

You can identify the problem in early dates development of pathology. Diagnostics proceed as follows:

1. Collection of relevant complaints from the patient (how many times he urinates during the day and at night).
2. Finding out the process of development of nocturia, what it is associated with (taking medications, taking fluids before bed).
3. Determination of the type of nocturia. Patients should keep a urination diary for 5 days to understand whether it is a pathology or not.
4. Detecting the presence of chronic diseases of the kidneys, cardiovascular and other systems.
5. General examination of the patient.

To confirm the pathology, laboratory and instrumental diagnostics are required:

1. General analysis of urine to identify its specific gravity, signs of inflammation, and bacteria. At night it should normally be higher. If you have diabetes, there will be sugar in your urine.
2. Bacteriological culture of urine. To determine the flora that caused the inflammation. Sensitivity to antibiotics is also revealed in order to select a drug with a narrow spectrum of action.
3. Zimnitsky's test. Examine 8 portions of urine every 3 hours. Determine the ratio of daytime and nighttime diuresis and examine specific gravity each serving. Nocturia is characterized by a decrease in urine density and a predominance of nocturnal diuresis. Thanks to this study, one can suspect renal failure, diabetes insipidus, inflammatory diseases kidney
4. Determination of level Its level is reduced in diabetes insipidus.
5. Ultrasound of the bladder (allows you to determine the residual volume in the bladder), kidneys and abdominal organs.
6. Research on men - carried out and finger examination prostate through the rectum to identify adenoma. The symptoms and treatment of nocturia in men are determined by a urologist.
7. What is nocturia in women? This is a decrease in estrogen levels (determined by laboratory). At the same time there is a fall muscle tone bladder, weakening of the pelvic floor muscles. Urinary disorders develop. The symptoms and treatment of nocturia in women are determined by a gynecologist.

Treatment of nocturia

First of all, you need to identify the cause. Only a doctor can diagnose and treat nocturia.

They are aimed at eliminating the provoking factors for the development of nocturia. To reduce discomfort from the disease, you need to:

1. Avoid taking liquids and foods with a diuretic effect (watermelon, melon) 3 hours before bedtime. It is better to limit the water load on the body after 6 pm.
2. Avoid hypothermia.
3. Do not take diuretics at night. Typically, such drugs are taken in the morning along with antihypertensives.
4. Empty your bladder before bed.

Etiotropic and pathogenetic treatment

1. Taking antibiotics and herbal medications (Canephron, Uriflorin) for infectious and inflammatory diseases of the urinary system.
2. Achieving diabetes compensation. Glucose is detected in urine when blood sugar levels are above 10 mmol/l. Consultation with an endocrinologist and treatment adjustment are necessary.
3. ADH analogues for diabetes insipidus (replacement therapy).
4. Prostate adenoma in men. Drug therapy aimed at relaxation smooth muscle bladder neck and prostate gland, as well as a decrease in prostate volume. For this purpose, alpha-blockers and 5-alpha reductase inhibitors are used. Urine flow improves. Surgical treatment involves removing the prostate.
5. Cardiologists and nephrologists treat cardiovascular and renal failure. Are struggling with arterial hypertension and swelling.
6. Liver cirrhosis is treated by internists or hepatologists. The goal is to combat secondary arterial hypertension.
7. The symptoms and treatment of nocturia in women are determined by a gynecologist. The therapy is aimed at eliminating hormonal imbalances and strengthening the muscles of the perineum with the help of special gymnastics.
8. Overactive bladder is treated with several groups of drugs. Selective antispasmodics (“Driptan”) are used, which act specifically on the muscle that contracts the bladder (detrusor). M-anticholinergic agents (Spazmex, Detrusitol) reduce contractile activity detrusor. Antidepressants (Imipramine) also block m-cholinergic receptors and have a weak sedative effect. Used for enuresis in children over 6 years of age. (“Botox”, “Dysport”) are injected into the bladder at 30 points in its cavity, leading to relaxation of the muscular wall of the bladder.

Prevention of night urination

This type of pathology can be avoided if you take your health seriously and undergo routine examinations. Prevention measures include:

1. Taking preventive medical examinations in order to identify pathological abnormalities health from normal.
2. Timely treatment of diseases that can cause nocturia.
3. Observation by a specialized doctor who will help compensate for the course of a chronic disease (urologist, nephrologist, cardiologist, etc.).
4. Proper nutrition to prevent atherosclerosis and cardiovascular pathologies. You need to eat more fiber low-fat varieties fish and meat, complex carbohydrates (cereals, pasta).
5. Avoid hypothermia.
6. Fighting stress. Urinary disorders can be caused by psycho-emotional problems.
7. Regular exercise will help keep your pelvic floor muscles toned and improve the health of your entire body.

Nocturia is not harmless symptom, it is an indicator of a malfunction in the body. It is important to consult a doctor in time, who will prescribe required types diagnostics The results of the study will allow you to prescribe treatment in a timely manner and get rid of the problem. Often the body itself hints to us about various malfunctions in the body that should not be overlooked. You need to monitor your condition.