A review of 43 epidemiological studies reported prevalence rates of 11%‐35% for ≥1 void per night and 2%‐17% for ≥2 voids per night for men aged 20‐40 years, whilst for women in the same age group, rates of 20%‐44% for ≥1 void per night and 4%‐18% for ≥2 voids per night were reported. 27, 28, 29 The prevalence varies depending on the definition (from 1 to 3 voids per night). 7, 25, 26 The prevalence of nocturia is high and broadly similar in men and women, affecting 28%‐93% of those aged 40 years or older. Nocturia is one of the most bothersome LUTS according to most epidemiological studies. The treatment of nocturia should be according to its causative factors and aetiology where possible, as recommended in the European Association of Urology guidelines on the treatment of male LUTS 20 however, specific guidelines for nocturia have not yet been published as a journal article. 17, 18, 19 As such, it is essential that physicians and other healthcare professionals understand the aetiology, burden and the most effective methods for diagnosing, assessing and treating nocturia. However, because nocturia is often associated with nocturnal polyuria-the overproduction of urine during the night-such treatments will not be effective for all patients and appropriate patient selection is essential. 15, 16 Nocturia was oftentimes considered a symptom associated with functional issues, such as overactive bladder syndrome (OAB) and/or benign prostatic hyperplasia (BPH), with treatments focused on increasing bladder capacity and/or lowering bladder outlet obstruction. 5, 14Īlthough very common, nocturia remains an underreported, undertreated and poorly managed medical and social problem in adults. 5, 6, 7, 8, 9, 10, 11, 12, 13 Nocturia also places a considerable economic burden on the individual and healthcare services, in terms of direct (falls and fractures), indirect (decreased work productivity and activity levels) and intangible costs (reduction in QoL). 3, 4, 5 It is associated with falls and fall‐related injuries, primarily in the elderly but also in younger age groups, reduced quality of life (QoL), mainly due to fragmented sleep, and an increased prevalence of depressive symptoms, particularly in younger men and women.
Nocturia is a highly prevalent lower urinary tract symptom (LUTS), defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times to void … each void is preceded and followed by sleep.” 1, 2 Nocturia equally affects men and women of all ages, with higher rates in older populations. Patients not responding to these basic treatments should be referred for specialist management. The timing of diuretics is an important consideration, and they should be taken mid‐late afternoon, dependent on the specific serum half‐life.
For patients with sustained bother, medical therapies should be introduced low‐dose, gender‐specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. Accurate assessment is predicated on frequency‐volume charts combined with a detailed patient history, medicine review and physical examination. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Nocturia‐related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014.
Consequences include the following: lowered quality of life falls and fractures reduced work productivity depression and increased mortality. Clinically relevant nocturia (≥2 voids per night) affects 2%‐18% of those aged 20‐40 years, rising to 28%‐62% for those aged 70‐80 years. Nocturia is defined as the need to void ≥1 time during the sleeping period of the night.
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