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Management of Nocturia in the Female

  • Female Urology (K Kobashi, Section Editor)
  • Published:
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Abstract

Nocturia is a common but overlooked lower urinary tract symptom that substantially reduces patient health and quality of life. Though traditionally viewed as occurring predominantly in males, nocturia has been found to be equally as prevalent in females. The recent emphasis on the importance of nocturia has resulted in a surge of research studies, providing a foundation for current and future management decisions. In this review, we describe the current recommendations for the female patient in light of the most recently published studies, including a unique interest in predicting treatment response.

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References

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  1. Chen FY, Dai YT, Liu CK, Yu HJ, Liu CY, Chen TH. Perception of nocturia and medical consulting behavior among community-dwelling women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(4):431–6. doi:10.1007/s00192-006-0167-x.

    Article  PubMed  Google Scholar 

  2. Swithinbank LV, Donovan JL, du Heaume JC, Rogers CA, James MC, Yang Q, et al. Urinary symptoms and incontinence in women: relationships between occurrence, age, and perceived impact. Br J Gen Pract: J R Coll Gen Pract. 1999;49(448):897–900.

    CAS  Google Scholar 

  3. Cornu JN, Abrams P, Chapple CR, Dmochowski RR, Lemack GE, Michel MC, et al. A contemporary assessment of nocturia: definition, epidemiology, pathophysiology, and management—a systematic review and meta-analysis. Eur Urol. 2012;62(5):877–90. doi:10.1016/j.eururo.2012.07.004. This is a meta-analysis of the literature summarizing research regarding the epidemiology, etiology, evaluation and management of nocturia from 2000 to 2012.

    Article  PubMed  Google Scholar 

  4. Weiss JP, Blaivas JG, Bliwise DL, Dmochowski RR, Dubeau CE, Lowe FC, et al. The evaluation and treatment of nocturia: a consensus statement. BJU Int. 2011;108(1):6–21. doi:10.1111/j.1464-410X.2011.10175.x. This is a consensus opinion paper regarding evaluation and management of nocturia.

    Article  PubMed  Google Scholar 

  5. Van Kerrebroeck P. Standardization of terminology in nocturia: commentary on the ICS report. BJU Int. 2002;90 Suppl 3:16–7.

    Article  PubMed  Google Scholar 

  6. Tikkinen KA, Johnson 2nd TM, Tammela TL, Sintonen H, Haukka J, Huhtala H, et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol. 2010;57(3):488–96. doi:10.1016/j.eururo.2009.03.080.

    Article  PubMed  Google Scholar 

  7. Coyne KS, Zhou Z, Bhattacharyya SK, Thompson CL, Dhawan R, Versi E. The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA. BJU Int. 2003;92(9):948–54.

    Article  CAS  PubMed  Google Scholar 

  8. Weiss JP, Blaivas JG, Blanker MH, Bliwise DL, Dmochowski RR, Drake M, et al. The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: focus on outcomes of therapy. BJU Int. 2013;111(5):700–16. doi:10.1111/j.1464-410X.2012.11749.x. This is a consensus opinion paper regarded recent outcomes in nocturia therapy.

    Article  PubMed  Google Scholar 

  9. Osman NI, Chapple CR, Wein AJ. Nocturia: current concepts and future perspectives. Acta Physiol. 2013;207(1):53–65. doi:10.1111/apha.12013.

    Article  CAS  Google Scholar 

  10. Park HK, Kim HG. Current evaluation and treatment of nocturia. Kor J Urol. 2013;54(8):492–8. doi:10.4111/kju.2013.54.8.492.

    Article  Google Scholar 

  11. Easterling SA, Master V, Carney KJ. Evaluation and management of patients with nocturia. JAAPA: Off J Am Acad Physician Assist. 2014;27(2):36–42. doi:10.1097/01.JAA.0000442703.33717.85.

    Google Scholar 

  12. Bosch JL, Weiss JP. The prevalence and causes of nocturia. J Urol. 2010;184(2):440–6. doi:10.1016/j.juro.2010.04.011.

    Article  PubMed  Google Scholar 

  13. Fitzgerald MP, Litman HJ, Link CL, McKinlay JB, Investigators BS. The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol. 2007;177(4):1385–9. doi:10.1016/j.juro.2006.11.057.

    Article  PubMed  Google Scholar 

  14. Asplund R. Nocturia: consequences for sleep and daytime activities and associated risks. Eur Urol Suppl. 2005;3(6):24–32.

    Article  Google Scholar 

  15. Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR, Rosen RC. Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol. 2011;185(2):571–7. doi:10.1016/j.juro.2010.09.108.

    Article  PubMed  Google Scholar 

  16. Kupelian V. Nocturia, sleep disturbance and the metabolic syndrome. J Urol. 2012;188(6):2041–2. doi:10.1016/j.juro.2012.09.064.

    Article  PubMed  Google Scholar 

  17. Kupelian V, Wei JT, O’Leary MP, Norgaard JP, Rosen RC, McKinlay JB. Nocturia and quality of life: results from the Boston area community health survey. Eur Urol. 2012;61(1):78–84. doi:10.1016/j.eururo.2011.05.065.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Brunner A, Riss P. Nocturia in women. Maturitas. 2011;70(1):16–21. doi:10.1016/j.maturitas.2011.06.004.

    Article  PubMed  Google Scholar 

  19. Bright E, Cotterill N, Drake M, Abrams P. Developing a validated urinary diary: phase 1. Neurourol Urodyn. 2012;31(5):625–33. doi:10.1002/nau.21254.

    Article  PubMed  Google Scholar 

  20. Bright E, Cotterill N, Drake M, Abrams P. Developing and validating the International Consultation on Incontinence Questionnaire bladder diary. Eur Urol. 2014. doi:10.1016/j.eururo.2014.02.057. This study unveils the first psychometrically validated bladder diary.

    PubMed  Google Scholar 

  21. Chapple CR. Is a voiding diary really necessary in 2014? Eur Urol. 2014. doi:10.1016/j.eururo.2014.05.001.

    Google Scholar 

  22. Salvatore S, Maggiore ULR. Incontinence: a novel, psychometrically validated bladder diary for LUTS. Nature Reviews Urology. 2014;11(6):314–5. doi:10.1038/nrurol.2014.110.

    Article  PubMed  Google Scholar 

  23. Abraham L, Hareendran A, Mills IW, Martin ML, Abrams P, Drake MJ, et al. Development and validation of a quality-of-life measure for men with nocturia. Urology. 2004;63(3):481–6. doi:10.1016/j.urology.2003.10.019.

    Article  PubMed  Google Scholar 

  24. Mock LL, Parmelee PA, Kutner N, Scott J, Johnson 2nd TM. Content validation of symptom-specific nocturia quality-of-life instrument developed in men: issues expressed by women, as well as men. Urology. 2008;72(4):736–42. doi:10.1016/j.urology.2008.04.014.

    Article  PubMed  Google Scholar 

  25. Fung MM, Peters K, Redline S, Ziegler MG, Ancoli-Israel S, Barrett-Connor E, et al. Decreased slow wave sleep increases risk of developing hypertension in elderly men. Hypertension. 2011;58(4):596–603. doi:10.1161/HYPERTENSIONAHA.111.174409.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Weiss JP, Zinner NR, Klein BM, Norgaard JP. Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. Neurourol Urodyn. 2012;31(4):441–7. doi:10.1002/nau.22243.

    Article  CAS  PubMed  Google Scholar 

  27. Graham Jr JN, Desroches BR, Weiss JP. Nocturia causes vary with each decade. Curr Opin Urol. 2014;24(4):358–62. doi:10.1097/MOU.0000000000000061.

    Article  PubMed  Google Scholar 

  28. Kamperis K, Hagstroem S, Radvanska E, Rittig S, Djurhuus JC. Excess diuresis and natriuresis during acute sleep deprivation in healthy adults. Am J Physiol Renal Physiol. 2010;299(2):F404–11. doi:10.1152/ajprenal.00126.2010.

    Article  CAS  PubMed  Google Scholar 

  29. Kim SO, Kim JS, Kim HS, Hwang EC, Oh KJ, Kwon D, et al. Age related change of nocturia in women. Int Neurourol J. 2010;14(4):245–9. doi:10.5213/inj.2010.14.4.245.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Weiss JP, Blaivas JG, Jones M, Wang JT, Guan Z, Study G. Age related pathogenesis of nocturia in patients with overactive bladder. J Urol. 2007;178(2):548–51. doi:10.1016/j.juro.2007.03.117. discussion 51.

    Article  PubMed  Google Scholar 

  31. Hofmeester I, Kollen BJ, Steffens MG, Bosch JL, Drake MJ, Weiss JP, et al. The association between nocturia and nocturnal polyuria in clinical and epidemiological studies: a systematic review and meta-analyses. J Urol. 2014;191(4):1028–33. doi:10.1016/j.juro.2013.10.100. This study indicates that nocturnal polyuria is highly prevalent in the population and may not be of clinical importance if considered as an isolated predictor of nocturia.

    Article  PubMed  Google Scholar 

  32. Kok AL, Burger CW, van de Weijer PH, Voetberg GA, Peters-Muller ER, Kenemans P. Micturition complaints in postmenopausal women treated with continuously combined hormone replacement therapy: a prospective study. Maturitas. 1999;31(2):143–9.

    Article  CAS  PubMed  Google Scholar 

  33. Endeshaw YW, Johnson TM, Kutner MH, Ouslander JG, Bliwise DL. Sleep-disordered breathing and nocturia in older adults. J Am Geriatr Soc. 2004;52(6):957–60. doi:10.1111/j.1532-5415.2004.52264.x.

    Article  PubMed  Google Scholar 

  34. Umlauf MG, Chasens ER. Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep Med Rev. 2003;7(5):403–11.

    Article  PubMed  Google Scholar 

  35. Hoshiyama F, Hirayama A, Tanaka M, Taniguchi M, Ohi M, Momose H, et al. The impact of obstructive sleep apnea syndrome on nocturnal urine production in older men with nocturia. Urology. 2014. doi:10.1016/j.urology.2014.02.073.

    PubMed  Google Scholar 

  36. Epstein LJ, Kristo D, Strollo Jr PJ, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med: JCSM : Off Publ Am Acad Sleep Med. 2009;5(3):263–76.

    Google Scholar 

  37. Fitzgerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol. 2006;194(5):1399–403. doi:10.1016/j.ajog.2006.01.048.

    Article  PubMed  Google Scholar 

  38. Tyagi S, Resnick NM, Perera S, Monk TH, Hall MH, Buysse DJ. Behavioral treatment of chronic insomnia in older adults: does nocturia matter? Sleep. 2014;37(4):681–7. doi:10.5665/sleep.3568.

    PubMed Central  PubMed  Google Scholar 

  39. Tyagi S, Resnick NM, Perera S, Monk TH, Hall MH, Buysse DJ. Behavioral treatment of insomnia: also effective for nocturia. J Am Geriatr Soc. 2014;62(1):54–60. doi:10.1111/jgs.12609.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Hashim H, Abrams P. How should patients with an overactive bladder manipulate their fluid intake? BJU Int. 2008;102(1):62–6. doi:10.1111/j.1464-410X.2008.07463.x.

    Article  PubMed  Google Scholar 

  41. Johnson 2nd TM, Burgio KL, Redden DT, Wright KC, Goode PS. Effects of behavioral and drug therapy on nocturia in older incontinent women. J Am Geriatr Soc. 2005;53(5):846–50. doi:10.1111/j.1532-5415.2005.53260.x.

    Article  PubMed  Google Scholar 

  42. Sand PK, Dmochowski RR, Reddy J, van der Meulen EA. Efficacy and safety of low dose desmopressin orally disintegrating tablet in women with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J Urol. 2013;190(3):958–64. doi:10.1016/j.juro.2013.02.037. This study demonstrates the safety and efficacy of low dose desmopressin in women with nocturia.

    Article  CAS  PubMed  Google Scholar 

  43. Rudy D, Cline K, Harris R, Goldberg K, Dmochowski R. Multicenter phase III trial studying trospium chloride in patients with overactive bladder. Urology. 2006;67(2):275–80. doi:10.1016/j.urology.2005.08.017.

    Article  PubMed  Google Scholar 

  44. Chapple CR, Dvorak V, Radziszewski P, Van Kerrebroeck P, Wyndaele JJ, Bosman B, et al. A phase II dose-ranging study of mirabegron in patients with overactive bladder. Int Urogynecol J. 2013;24(9):1447–58. doi:10.1007/s00192-013-2042-x.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Rios LA, Panhoca R, Mattos Jr D, Srugi M, Bruschini H. Intravesical resiniferatoxin for the treatment of women with idiopathic detrusor overactivity and urgency incontinence: a single dose, 4 weeks, double-blind, randomized, placebo controlled trial. Neurourol Urodyn. 2007;26(6):773–8. doi:10.1002/nau.20300.

    Article  CAS  PubMed  Google Scholar 

  46. Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438–43. doi:10.1016/j.juro.2009.12.036. Sham-controlled study that demonstrates the potential of PTNS for treating nocturia in OAB patients.

    Article  PubMed  Google Scholar 

  47. Fitzgerald MP, Lemack G, Wheeler T, Litman HJ, Urinary Incontinence Treatment Network. Nocturia, nocturnal incontinence prevalence, and response to anticholinergic and behavioral therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1545–50. doi:10.1007/s00192-008-0687-7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Mangera A, Chapple CR, Kopp ZS, Plested M. The placebo effect in overactive bladder syndrome. Nat Rev Urol. 2011;8(9):495–503. doi:10.1038/nrurol.2011.99.

    Article  CAS  PubMed  Google Scholar 

  49. Song C, Park JT, Heo KO, Lee KS, Choo MS. Effects of bladder training and/or tolterodine in female patients with overactive bladder syndrome: a prospective, randomized study. J Korean Med Sci. 2006;21(6):1060–3.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Natsume O. A clinical investigation of nocturnal polyuria in patients with nocturia: a diurnal variation in arginine vasopressin secretion and its relevance to mean blood pressure. J Urol. 2006;176(2):660–4. doi:10.1016/j.juro.2006.03.028.

    Article  PubMed  Google Scholar 

  51. Tani M, Hirayama A, Torimoto K, Matsushita C, Yamada A, Fujimoto K. Guidance on water intake effectively improves urinary frequency in patients with nocturia. Int J Urol : Off J Jpn Urol Assoc. 2014;21(6):595–600. doi:10.1111/iju.12387.

    Article  Google Scholar 

  52. Weiss JP, Juul KV, Wein AJ. Management of nocturia: the role of antidiuretic pharmacotherapy. Neurourol Urodyn. 2014;33 Suppl 1:S19–24. doi:10.1002/nau.22592.

    Article  CAS  PubMed  Google Scholar 

  53. Goessaert AS, Krott L, Walle JV, Everaert K. Exploring nocturia: gender, age, and causes. Neurourol Urodyn. 2014. doi:10.1002/nau.22638.

    Google Scholar 

  54. Burton C, Weiss JP, Parsons M, Blaivas JG, Coats AC. Reference values for the Nocturnal Bladder Capacity Index. Neurourol Urodyn. 2011;30(1):52–7. doi:10.1002/nau.20924.

    Article  PubMed  Google Scholar 

  55. Ouslander JG. Management of overactive bladder. N Engl J Med. 2004;350(8):786–99. doi:10.1056/NEJMra032662.

    Article  CAS  PubMed  Google Scholar 

  56. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66. doi:10.1038/nrn2401.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  57. Cipullo LM, Cosimato C, Filippelli A, Conti V, Izzo V, Zullo F, et al. Pharmacological approach to overactive bladder and urge urinary incontinence in women: an overview. Eur J Obstet Gynecol Reprod Biol. 2014;174:27–34. doi:10.1016/j.ejogrb.2013.12.024.

    Article  CAS  PubMed  Google Scholar 

  58. Andersson KE, Yoshida M. Antimuscarinics and the overactive detrusor—which is the main mechanism of action? Eur Urol. 2003;43(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  59. Weiss JP, Jumadilova Z, Johnson 2nd TM, Fitzgerald MP, Carlsson M, Martire DL, et al. Efficacy and safety of flexible dose fesoterodine in men and women with overactive bladder symptoms including nocturnal urinary urgency. J Urol. 2013;189(4):1396–401. doi:10.1016/j.juro.2012.11.067.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  60. Weiss JP, van Kerrebroeck PE, Klein BM, Norgaard JP. Excessive nocturnal urine production is a major contributing factor to the etiology of nocturia. J Urol. 2011;186(4):1358–63. doi:10.1016/j.juro.2011.05.083.

    Article  PubMed  Google Scholar 

  61. Brubaker L, FitzGerald MP. Nocturnal polyuria and nocturia relief in patients treated with solifenacin for overactive bladder symptoms. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(7):737–41. doi:10.1007/s00192-006-0239-y.

    Article  PubMed  Google Scholar 

  62. Weiss JP, Blaivas JG, Stember DS, Chaikin DC. Evaluation of the etiology of nocturia in men: the nocturia and nocturnal bladder capacity indices. Neurourol Urodyn. 1999;18(6):559–65.

    Article  CAS  PubMed  Google Scholar 

  63. Chapple CR, Rechberger T, Al-Shukri S, Meffan P, Everaert K, Huang M, et al. Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder. BJU Int. 2004;93(3):303–10.

    Article  CAS  PubMed  Google Scholar 

  64. Han YK, Lee WK, Lee SH, Yang DY, Kim H. Effect of desmopressin with anticholinergics in female patients with overactive bladder. Kor J Urol. 2011;52(6):396–400. doi:10.4111/kju.2011.52.6.396.

    Article  Google Scholar 

  65. Klijer R, Bar K, Bialek W. Bladder outlet obstruction in women: difficulties in the diagnosis. Urol Int. 2004;73(1):6–10. doi:10.1159/000078795.

    Article  PubMed  Google Scholar 

  66. Kalsi V, Apostolidis A, Gonzales G, Elneil S, Dasgupta P, Fowler CJ. Early effect on the overactive bladder symptoms following botulinum neurotoxin type A injections for detrusor overactivity. Eur Urol. 2008;54(1):181–7. doi:10.1016/j.eururo.2007.12.029.

    Article  CAS  PubMed  Google Scholar 

  67. Leong FC, McLennan MT, Barr SA, Steele AC. Posterior tibial nerve stimulation in patients who have failed anticholinergic therapy: efficacy and time to response. Female Pelvic Med Reconstr Surg. 2011;17(2):74–5. doi:10.1097/SPV.0b013e31820dbf81.

    Article  PubMed  Google Scholar 

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Dr. Andrew Chang, Dr. Eugene W. Lee, and Dr. Alvaro Lucioni each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Medical Scientist Training Program, Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA

    Andrew Chang

  2. Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, 98101, USA

    Eugene W. Lee & Alvaro Lucioni

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  1. Andrew Chang
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Correspondence to Alvaro Lucioni.

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Chang, A., Lee, E.W. & Lucioni, A. Management of Nocturia in the Female. Curr Urol Rep 16, 10 (2015). https://doi.org/10.1007/s11934-015-0485-y

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