16-Sep-19

Nocturia in Elderly

dr Vera, SpPD-KGer
Maranatha Christian University
Bandung

Definition of Nocturia

• Nocturia, defined as voiding at least twice per night that interrupts

sleep, is a common complaint in older adults.
• Nocturnal polyuria is a syndrome where the usual day to night ratio of
urine production is altered.
• 33% of the total daily urine output occurs at night, although the daily
total urine output remains normal.
• A careful voiding diary, incorporating measurements of voided volumes

Hitoshi Oh-oka
Nocturia: Pathogenesis and Diagnosis From a New Viewpoint
UroToday 2008; vol 1 issue 5

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Diagnosis of Nocturia

Nocturia is present when one of the following criteria is met:

-Urine production during 8 hour of sleep > 33% of 24-h urine production
-Nighttime urine production rate is > 0.9 mL/min
-7 AM to 7 PM → urine volume is > 50% of total urine

Hitoshi Oh-oka
Nocturia: Pathogenesis and Diagnosis From a New Viewpoint
UroToday 2008; vol 1 issue 5

Consequences of Nocturia

-Falls
-Hip fractures → immobility
-Poorer sleep quality
-Increased fatigue
-Depression
-Higher rate of death in patients with CAD

Varilla V, Samala RV, Galindo D, Ciocon J.

Nocturia in the elderly : A wake up call
Cleveland Clinic Journal of Medicine 2011; 78(11): 757-64.

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Common Cause of Nocturia in Elderly

-Bladder dysfunction
-BPH
-UTI
-Uterine prolapse
-Bladder tumor or stones

-Excessive nocturnal urine production

-CHF
-Parkinson
-Alzheimer
-Diabetes mellitus
-Drugs
-CKD
-Autonomic neuropathy
-Venous stasis

Uterine Prolapse

-Involuntary leakage of urine

-Constant pressure or heaviness
felt in the pelvis / vagina
-Recurrent UTI
-Uterus / cervix protruding out of
the vagina

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Hypertension and Nocturia

Sone A, Kondo N, Tanaka H.

Decreased cardiac function and nocturia - Association of natriuretic peptide and nocturnal polyuria.
Voiding Disorders Digest. 2005,13:15-21.

Voiding Diary

06.00 300 cc
06.10 Susu 200 cc
07.00 Sup krim 100 cc
07.15 Air putih 200 cc
07.50 50 cc
07.55 150 cc

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Evaluation

-History : -medications
-comorbidities

-Physical examination :
-orthostatic vital signs
-signs of CHF
-abdominal & genitourinary exams

Rattu MA.
Pharmacists’ role in managing male urinary incontinence.
US Pharm. 2015;40(8):35-38

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Management

-Address underlying causes and treat

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Common Cause of Nocturia in Elderly

-Bladder dysfunction
-BPH
-UTI
-Uterine prolapse
-Bladder tumor or stones

-Excessive nocturnal urine production

-CHF
-Parkinson
-Alzheimer
-Diabetes mellitus
-Drugs
-CKD
-Autonomic neuropathy
-Venous stasis

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Management

-Address underlying causes and treat

-Review patient’s medications → stop medications without strong indications

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Prince D, Pedler K, Rashid P.

Nocturia : A guide to assessment and management.
Australian Family Physician 2012 ; 41(6): 399-402.

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Management

-Address underlying causes and treat

-Review patient’s medications → stop medications without strong indications

-Compression therapy to prevent third spacing of fluid in the legs, and afternoon
elevation of the legs to encourage reabsorption of postural induced clinical or sub-
clinical oedema has been shown to be effective.

-BPH → α-blocker or prostatectomy causes a reduction of the nocturnal frequency in

around 70% of men

-Moderate exercise

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Pelvic Floor Exercise

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Take Home Message

-Nocturia is common in elderly

-Clinical consequence of nocturia is decreased quality of life

-Review side effects of medications is a must

-Identify underlying causes and treat → the best management

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Thank You

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