Treatment of Nocturia in the Elderly

Abstract

The aging process, behavioural habits and a multitude of pathological conditions are the main contributors to the development of nocturia in the elderly. Age-related physiological changes can alter the regular pattern of urine excretion and lead to increased nocturnal frequency of voiding. In addition, aging is associated with anatomical and physiological changes of the urinary tract itself that predispose to increased urinary frequency without affecting urine volume. Several urinary and extra-urinary tract conditions may have nocturia as a prominent symptom. These conditions can be grouped as those associated with bladder overactivity, bladder outlet obstruction, bladder hypotonicity and an increased urine volume. A detailed assessment that gathers clues from the medical history, physical examination and laboratory is of utmost importance in identifying the specific causes. Overactive bladder can be idiopathic or associated with different triggers such as UTI, bladder stones, bladder tumours and CNS diseases that disrupt the normal inhibitory signals to the bladder. It may be cured by the successful elimination of the trigger conditions. Therapeutic modalities include behavioural therapies with scheduled voiding, anticholinergic drugs and in women the use of transvaginal electrical stimulation. Benign prostatic hyperplasia is the most common cause of bladder outlet obstruction in men. Different drug classes (e.g. peripheral alpha-adrenoceptor blockers and 5 alpha-reductase inhibitors) are now available for the treatment of mild to moderate symptoms. Surgery is reserved for patients with severe symptoms or with complications, with new and less invasive surgical techniques being preferred. Bladder hypotonicity is usually caused by peripheral neuropathies, spinal cord lesions and the indiscriminate use of drugs with anticholinergic actions. Treatment involves discontinuation of implicated drugs, short term use of cholinergic drugs and urinary catheterisation. Increased urine volumes and nocturia are frequently seen in hyperosmolar and oedematous states. Excessive ingestion of fluids, caffeinated or alcoholic beverages are habits that commonly produce nocturia. Although more definitive studies are awaited, low dose loop diuretics given a few hours prior to bedtime and desmopressin nasal spray or tablets may be useful alternatives for the control of nocturic symptoms in elderly patients with nocturnal polyuria syndrome. Whenever nocturia is present, clinicians should try to identify its causes by means of a thorough history, physical examination and pertinent complimentary tests. Once the specific cause or causes are found, most cases can be satisfactorily managed with behavioural, pharmacological or surgical therapies.

Age Related Change of Nocturia in Women

“…When nocturia is present, clinicians should try to identify its exact causes by exclude significant lower urinary tract pathology and associated disease. Once the specific cause or causes are found, most cases can be satisfactorily managed using specific management strategy based on the specific cause of nocturia [24]. …”

Increase in 24‐hour urine production/weight causes nocturnal polyuria due to impaired function of antidiuretic hormone in elderly men

“…The most effective treatment for patients with NP and an age‐related decrease in AVP secretion 11 is an AVP replacement therapy, which helps restore its physiological level in these patients at night‐time. However, AVP replacement therapy has adverse reactions, such as hyponatremia, headache, nausea, vomiting, and light‐headedness 12 .…”

Clinical observations of the effect of antidiuretic hormone on nocturia in elderly men

“…Treatment for nocturia in elderly men should always depend on a correct diagnosis [9]. The present patients were those refractory to drugs like antismuscarinics or anticholinergics and α‐blockers.…”