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Frequent urination at night: How do you treat it?


Waking up in the middle of the night with a need to go to the restroom, difficulty falling asleep due to needing to use the restroom during the night, and difficulty getting to sleep the next day.
These symptoms are called “nocturia.”
Is nocturia life-threatening, how can we treat nocturia, and are supplements effective? This article is based on the “Guidelines for the Treatment of Nocturia [2nd Edition],” edited by the
Japanese Society of Urinary Function and the Japanese Urological Association.

Do people with nocturia have a poor prognosis for life?

It has been reported that frequent nocturia, two or three (or more) times during the night, increases the risk of falls and fractures, as well as mortality.
On the other hand, a report on the relationship between nocturia and mortality based on a “urination diary,” which records the time and amount of urine voided, found that frequent urination two or more times during the night was not associated with mortality.

Should fluids be restricted if nocturia is present?

Many people are concerned about how much water to drink.
The guidelines state that information about drinking water is effective and recommended instruction as part of behavioral therapy for patients with nocturia. In other words, water intake is still important.
The appropriate amount of water to drink is about 2% of body weight.
For example, for a person weighing 50 kg, “50 (kg) x 0.02 = 1 (liter).
For a person weighing 70 kg, it would be “70 (kg) x 0.02 = 1.4 (liter).
Also, be careful about drinking alcohol and caffeine (coffee, tea, etc.), which have diuretic effects. Above all, do not drink too much.

Should I limit salt?

You may be thinking, “What does frequent urination at night (nocturia) have to do with salt?
When you eat a meal high in salt, you will want to drink more water than usual. That is one thing that leads to frequent urination. Another is that a high-salt diet leads to an imbalance in
the autonomic nervous system, which can easily lead to frequent urination at night.
The guidelines state that “it has been shown that reducing salt intake can reduce nocturnal urinary frequency, nocturnal urine volume and nocturnal polyuria index.” In other words, salt reduction may improve nocturia.

What about supplements and herbal remedies for nocturia?

There are many supplements, herbal medicines, and health foods that claim to help with nocturia.
Although there have been papers reporting their usefulness, none of them have been supported by multiple large-scale RCTs (*randomized controlled trials), and there is not enough evidence to say that they are useful.

How to Consult a Doctor

There are three major causes of nocturia: (1) polyuria and nocturia (high urine volume), (2) decreased bladder capacity (decreased capacity to hold urine), and (3) sleep disorders.
In addition, each of these can be due to a medical illness, the effects of medications taken, or a urologic-related illness. Treatment methods differ depending on those causes, so it is important to first determine the cause.
Having to get up more than once during the night to urinate is called “nocturia,” but if you get up once and can sleep soundly afterward with no particular problems, there is not much to worry about.
If you wake up to use the restroom two or more times a night, have difficulty sleeping once you wake up, or have trouble getting to sleep and feel tired, we recommend that you see a urologist.
Takada Uro Clinic, a urology clinic, has opened on the 6th floor of Medical Prime Nihonbashi Kodenmacho, a medical mall just a 2-minute walk from Kodenmacho Station on the Tokyo Metro Hibiya Line. If you suffer from frequent urination at night, please feel free to consult us.
Guidelines for the Treatment of Frequent Nocturia at Night [Second Edition], edited by the Japanese Society of Urinary Function and the Japanese Urological Association

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