Nocturnal urination (Nocturia) is a condition where a person wakes up several times during the night to urinate. This phenomenon is also called “night-time urination.” This problem has various causes, however, this phenomenon could indicate a larger systemic problem, such as prostate cancer in men.

Nocturia is the most common symptom that severely affects a patient’s quality of life. Having to get up several times during the night does not allow for continuous quality sleep throughout the night, which causes fatigue, nervousness, depression and even a decline in mental and performance abilities during the day. In some rare cases, nocturnal urination may also reduce the life expectancy of the patient.

The prevalence of nocturnal urination is directly proportional to the age of the patient, as the probability of developing this phenomenon increases with age. The prevalence of this phenomenon ranges between 16% – 40% among those aged 40 – 45 years, and up to 50% – 90% among those aged 80 years and over. This is not surprising, because it is known that many problems in the urinary tract are more likely to appear, in greater proportion, in the elderly.

Normally, for anyone who is healthy, urine during sleep at night becomes more concentrated. When sleeping at a rate of 6-8 hours, the urine concentration is greatly raised to equal several times its concentration at the beginning of the night. The moment the concentration of osmolality in the urine rises above a certain threshold, special receptors in the bladder begin to signal this to the brain, which in turn awakens the body (this is why we feel the urge to urinate in the morning). The process of producing urine in the body is a cyclical process that is monitored and controlled by a hormone called Vasopressin. This hormone is produced in the pituitary gland (Hypophysis) and is secreted during the day to a lesser extent than during the night. The function of this hormone is to command more frequent absorption by the kidneys, which means that the amount of urine that is produced during the day is less than that which is produced during the night. If the amount of urine that is produced during the night exceeds 20% of the amount of urine produced during the day, this is a condition known as “nocturnal overproduction” (excessive production of urine during the night). According to some researchers, producing more than 0.9-1.3 cc of urine per minute during nighttime hours is considered a “nighttime plus”. A person who sleeps 6 hours during the night and has a production of nocturnal urine is 324 cc or more, is considered a person suffering from nocturnal urine production. Because it produces more than 0.9 cc per minute.

It should be noted that healthy people are not supposed to wake up from their night’s sleep to urinate.

In general, it is easy to diagnose, identify and treat the cause of nocturia. Avoiding drinking before bedtime can significantly reduce symptoms, especially avoiding alcoholic and caffeinated beverages (these drinks increase urine production in the body).

Sometimes, however, the cause of nocturia may be more serious and require medication.

Often nocturnal urination is caused by an enlarged prostate gland. However, this problem may have many other causes, such as:

• Irregular secretion of the hormone vasopressin during the night (this phenomenon may be inherited or acquired in an advanced age). The secretion of vasopressin decreases with age, so the prevalence of the disease increases in the elderly.
• Excessive secretion of water and / or salt due to congestive heart failure (CHF – congestive heart failure). Heart failure means that the heart cannot effectively pump all fluids or blood. As a result, some fluids remain in the body, mainly concentrated in the space between the cells in the legs. These fluids cause edema. The swelling goes away in the morning because, in a supine position, the fluid returns to the blood vessels, to the heart and to the kidneys, eventually.
• Renal Failure (Renal failure), apnea , sleepwalking (sleep apnea – Sleep Apnea) or venous failure – all of these problems caused, too, disturbance in the blood discharge of the two men. As a result, fluid builds up in the space between cells, as in heart failure. When you lie down at night, fluid leaks into the veins in the legs and eventually reaches the kidneys, which produce more urine.
• A deficiency in the hormone estrogen (estrogen) in women can also cause an imbalance in the functioning of the urinary system and lead to an increase in nocturnal urination, as is the case, too, for an overactive bladder .
• In the case of nocturnal urination due to an enlarged prostate gland, the gland presses on the urine drainage tube, so that the bladder is not completely emptied when urinating, and the need to empty the bladder of urine increases (also at night hours)

Nocturnal urination is characterized by the following symptoms: Excessive waking (more than once) from sleeping during the night for the purpose of urination. This awakening is characterized by excessive fatigue during the day, movement difficulties in performing relatively easy tasks (as a result of fatigue), lack of sleep, difficulty in waking up in the morning and sometimes it may cause pain in the lower abdomen

Diagnosis of nocturia requires a complete and comprehensive physical examination and knowledge of the patient’s health history. Important details such as: presence of illnesses, previous surgeries and taking medications – can indicate the source of the problem. In addition, the patient is required to document urination times during at least one day. In rare cases, an overnight visit to a sleep clinic is needed