Nocturia: Evaluation and Management

Nocturia (ie, awakening to void one or more times per night) is common in adults, with increasing prevalence in older age. Nocturia is associated with increased risk of falls and fractures, cognitive impairment, and depressed mood. In general, mechanisms for nocturia fall into one of four categories: increased nighttime urine production, decreased storage ability, incomplete bladder emptying, or primary sleep disorder. Although screening for nocturia currently is not recommended, patients reporting bothersome symptoms should be evaluated and treated. Initial workup includes assessing urinary symptoms, fluid intake, and comorbidities. Using validated nocturia questionnaires and frequency-volume charts (bladder diaries) can aid in diagnosis. A urinalysis should be performed for all patients. Lifestyle modifications and treatment of underlying comorbidities are first-line therapies for nocturia. Limitation of fluid intake, especially in the evening; addressing timing of diuretic intake; and sleep hygiene are recommended. Pharmacotherapy should be reserved for those unresponsive to lifestyle modifications and adequate treatment of comorbidities. Pharmacotherapy should target the etiology of nocturia, such as nocturnal polyuria, overactive bladder, benign prostatic hyperplasia, and genitourinary syndrome of menopause. Patients with refractory symptoms should be referred for further treatment (eg, onabotulinumtoxinA injection, sacral neuromodulation, surgical management of benign prostatic hyperplasia).