Many patients are referred for LUTS/BPH and you talk to them and they say, "I'm getting up at night." When you ask, how about during the day, they say, "No, during the day there's no problem." That's not really going to be OAB unless there's a strong urgency component. It's important to distinguish between daytime and nighttime LUTS. Otherwise, if they have no urgency, the chances are that antimuscarinics, which are so overused for nocturia, will not work. Now, it is true that if they have nocturnal urgency, there is some evidence that they might benefit from an antimuscarinic. If a patient has urgency, day or night, then they have overactive bladder symptoms. It's very simple you go right to the definition of overactive bladder. As urologists, we certainly pay attention to lower urinary tract symptoms (LUTS), but nocturia typically is not a normal lower urinary tract symptom.įrom the urologist's point of view, what is the key question that they should be asking in order to separate nocturia from overactive bladder? I would purport that none of these require the skill set of a urologist. The real question is, who's responsible for synthesizing all of that? Is it general medicine, or is it urology? It's not a turf battle it's whoever is going to take an interest in it.
Nocturnal polyuria symptoms free#
If they have renal insufficiency and they have problems with excretion of free water at certain times during the night, do they take diuretics? Are they taking long- or short-term thiazides? These are all basic internal medicine principles. People who stand a lot and people who eat a lot of sodium may get some fluid accumulation in the lower extremities during the day and excrete that at night.Īssessing a patient for peripheral edema, heart failure, and venous disease is general medicine. Even dependent edema, which is not related to venous insufficiency, can cause nocturnal polyuria. Do they have peripheral edema? A routine physical exam would disclose, for example, peripheral edema, that could be due to third spacing. These things should be elicited by the primary care physician.ĭo they have hypertension? Could they have nondipping hypertension, which can cause natriuresis at night and nocturnal polyuria. Patients should also be asked about general sleep architecture-some people nap a lot during the day or have trouble sleeping at night. Questions should cover drinking habits-types of fluids, amount of caffeine, amount of alcohol. Nocturia is a symptom that has so many different causes. They should take a history and physical examination. If a person is bothered by getting up at night to urinate and they see their primary care physician, what should do that physician do for the patient? Technically, that would not be nocturia, but from a practical standpoint, it's always going to be captured as a nocturic episode when analyzing a voiding diary.
What if you get up at night for some other reason, without the desire to urinate, and then you urinate? That is basically a convenience void with no desire and antecedent whatsoever. There are patients for whom nocturia times 1 is a chief complaint. Most of the literature considers 2 times to be significant. We know from epidemiological studies that moderate to severe bother really begins at 3 times. In terms of how many times it takes for it to be bothersome enough to merit treatment, it's up to the patient. That could be once or any number of times. It means that somebody has arisen from intended sleep time because of the desire to pass urine.
How do you define nocturia? Is it the number of times someone awakens to pass urine, or is it the bother related to it? Disclosure: Weiss is a consultant/study investigator for Ferring. Badlani, an editorial consultant for Urology Times®, is professor and vice chair of urology at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. Weiss is professor and chair of urology at SUNY Downstate Health Sciences University, Brooklyn, New York. Overactive bladder, and how he conducts patient work-ups for nocturia.
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