Current Urology Reports

, 20:75 | Cite as

Management Strategies for Nocturia

  • Danielle J. GordonEmail author
  • Curran J. Emeruwa
  • Jeffrey P. Weiss
Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction


Purpose of Review

Nocturia is defined as awakening due to the desire to void during a period of intended sleep. The pathophysiology of nocturia is multifactorial and management remains a challenge. Herein, we provide an overview of the management strategies for nocturia and summarize the existing evidence for treatment of nocturia across the condition’s broad etiologic categories: nocturnal polyuria, diminished bladder capacity, and global polyuria.

Recent Findings

Treatment should begin with behavioral modification. A high level of evidence supports the efficacy of desmopressin in the treatment of nocturnal polyuria. Data supporting the efficacy of α-blockers, antimuscarinics, and surgical bladder outlet procedures in the treatment of nocturia remains limited.


Treatment options for nocturia are determined by underlying mechanism. Desmopressin is effective in treating nocturnal polyuria. Surgical intervention, α-blockers, and antimuscarinics may improve nocturia when associated with lower urinary tract symptoms or overactive bladder in the setting of diminished bladder capacity.


Nocturia Nocturnal polyuria Diminished bladder capacity Global polyuria Nocturia management Nocturia treatment 


Compliance with Ethical Standards

Conflict of Interest

Danielle J. Gordon, Curran Emeruwa, and Jeffrey P. Weiss each declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

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


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Bosch JR, Weiss JP. The prevalence and causes of nocturia. J Urol. 2010;184:440–6.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    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;185:571–7.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Weiss JP, Marshall SD: Nocturia. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology, Eleventh Edition. Elsevier (2016).Google Scholar
  4. 4.
    Hall MH, Muldoon MF, Jennings JR, Buysse DJ, Flory JD, Manuck SB. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep. 2008;31:635–43.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Ancoli-Israel S, Bliwise D, Noorgaard JP. Nocturia and sleep disorders. In: Weiss JP, Blaivas JG, Van Kerrebroeck PEV, et al., editors. Nocturia: causes, consequences, and clinical approaches. New York: Springer-Verlag; 2012. p. 37.CrossRefGoogle Scholar
  6. 6.
    Endeshaw YW, Johnson TM, Kutner MH, Ouslander JG, Bliwise DL. Sleep-disordered breathing and nocturia in older adults. J Am Geriatr Soc. 2004;52:957–60.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Holm-Larsen T, Weiss JP, Langkilde LK. Economic burden of nocturia in the us adult population. J Urol. 2010.
  8. 8.
    Asplund R. The nocturnal polyuria syndrome (NPS). Gen Pharmacol Vasc Syst. 1995;26:1203–9.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Weiss JP. Nocturia: "do the math". J Urol. 2006.
  11. 11.
    Rottmann CN. SSRIs and the syndrome of inappropriate antidiuretic hormone secretion. Am J Nurs. 2007;107:51–8 quiz 58–9.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Asplund R, Johansson S, Henriksson S, Isacsson G. Nocturia, depression and antidepressant medication. BJU Int. 2005;95:820–3.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Otsuka K, Tanaka H, Horinouchi T, Koike K, Shigenobu K, Tanaka Y. Functional contribution of voltage-dependent and Ca2-activated K (BKCa) channels to the relaxation of Guinea-pig aorta in response to natriuretic peptides. J Smooth Muscle Res. 2002;38:117–29.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Guzzo J, Cox M, Kelley AB, Singer I. Tetracycline-induced inhibition of Na transport in the toad urinary bladder. Am J Physiol Ren Physiol. 1978;235:F359–66. Scholar
  15. 15.
    Marples D, Christensen S, Christensen EI, Ottosen PD, Nielsen S. Lithium-induced downregulation of aquaporin-2 water channel expression in rat kidney medulla. J Clin Investig. 1995;95:1838–45.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Reynard C, Yang A. A novel therapy for nocturnal polyuria: a double-blind randomized trial of frusemide against placebo. Br J Urol. 1998;81:215–8.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Guilleminault C, Lin C, Gonçalves M, Ramos E. A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia. J Psychosom Res. 2004;56:511–5.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    •• Victor RG, Li N, Blyler CA, et al. Nocturia as an unrecognized symptom of uncontrolled hypertension in Black men aged 35 to 49 years. J Am Heart Assoc. 2019. This study links uncontrolled hypertension as an independent determinant of clinically important nocturia in a large cross-sectional community-based study of non-hispanic black men aged 35–49 years. Among 1673 black men, those with hypertension were 56% more likely than men with normotension to have nocturia after adjustment for diabetes mellitus and sleep apnea (adjusted odds ratio, 1.56; 95% CI, 1.25–1.94 [P< 0.0001]).
  19. 19.
    Feldstein CA. Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association. J AM Soc Hypertens. 2013;7:75–84.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Mattiasson A, Abrams P, Kerrebroeck PV, Walter S, Weiss J. Efficacy of desmopressin in the treatment of nocturia: a double-blind placebo-controlled study in men. BJU Int. 2002;89:855–62.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Lose G, Lalos O, Freeman RM, Kerrebroeck PV. Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women. Am J Obstet Gynecol. 2003;189:1106–13.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Weiss JP, Zinner NR, Klein BM, Nørgaard JP. Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. Neurourol Urodyn. 2012;31:441–7.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Sand PK, Dmochowski RR, Reddy J, Meulen EAVD. 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;190:958–64.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Weiss JP, Jumadilova Z, Johnson 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;189:1396–401.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    •• Zong H, Yang C, Peng X, Zhang Y. Efficacy and safety of desmopressin for treatment of nocturia: a systematic review and meta-analysis of double-blinded trials. Int Urol Nephrol. 2011;44:377–84 A meta-analysis of five studies involving 619 participants revealed that desmopressin significantly decreases the frequency of nocturnal voids, nocturnal urine volume, and nocturnal diuresis, resulting in extended duration of the first sleep period and improved sleep quality. The adverse effects of desmopressin were similar to those in the placebo group.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Juul KV, Klein BM, Sandström R, Erichsen L, Nørgaard JP. Gender difference in antidiuretic response to desmopressin. Am J Physiol Ren Physiol. 2011;300:F1116–22. Scholar
  27. 27.
    Yamaguchi O, Nishizawa O, Juul KV, Nørgaard JP. Gender difference in efficacy and dose response in Japanese patients with nocturia treated with four different doses of desmopressin orally disintegrating tablet in a randomized, placebo-controlled trial. BJU Int. 2012;111:474–84.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Tomasi P, Siracusano S, Monni A, Mela G, Delitala G. Decreased nocturnal urinary antidiuretic hormone excretion in enuresis is increased by imipramine. BJU Int. 2002;88:932–7.CrossRefGoogle Scholar
  29. 29.
    Giardina EG, Bigger JT, Glassman AH, Perel JM, Kantor SJ. The electrocardiographic and antiarrhythmic effects of imipramine hydrochloride at therapeutic plasma concentrations. Circulation. 1979;60:1045–52.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Swanson JR, Jones GR, Krasselt W, Denmark LN, Ratti F. Death of two subjects due to imipramine and desipramine metabolite accumulation during chronic therapy: a review of the literature and possible mechanisms. J Forensic Sci. 1997;42:14124J. Scholar
  31. 31.
    Brubaker L, Fitzgerald MP. Nocturnal polyuria and nocturia relief in patients treated with solifenacin for overactive bladder symptoms. Int Urogynecol J. 2006;18:737–41.CrossRefGoogle Scholar
  32. 32.
    Djavan B, Milani S, Davies J, Bolodeoku J. The impact of tamsulosin oral controlled absorption system (OCAS) on nocturia and the quality of sleep: preliminary results of a pilot study. Eur Urol Suppl. 2005;4:61–8.CrossRefGoogle Scholar
  33. 33.
    Epstein MR, Monaghan T, Weiss JP. Etiology of nocturia response in men with diminished bladder capacity. Neurourol Urodyn. 2018;38:215–22.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Cumming JA, Chisholm GD. Changes in detrusor innervation with relief of outflow tract obstruction. Br J Urol. 1992;69:7–11.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Margel D, Lifshitz D, Brown N, Lask D, Livne PM, Tal R. Predictors of nocturia quality of life before and shortly after prostatectomy. Urology. 2007;70:493–7.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Housami F, Abrams P. Persistent detrusor overactivity after transurethral resection of the prostate. Curr Prostate Rep. 2007;5:126–32.CrossRefGoogle Scholar
  37. 37.
    Yoshimura K, Ohara H, Ichioka K, Terada N, Matsui Y, Terai A, et al. Nocturia and benign prostatic hyperplasia. Urology. 2003;61:786–90.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Van Dijk MM, Wijkstra H, Debruyne FM, De La Rosette JJ, Michel MC. The role of nocturia in the quality of life of men with lower urinary tract symptoms. BJU Int. 2010;105:1141–6.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Simaioforidis V, Papatsoris AG, Chrisofos M, Chrisafis M, Koritsiadis S, Deliveliotis C. Tamsulosin versus transurethral resection of the prostate: effect on nocturia as a result of benign prostatic hyperplasia. Int J Urol. 2011;18:243–8.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Johnson TM, Jones K, Williford WO, Kutner MH, Issa MM, Lepor H. Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative study trial. J Urol. 2003;170:145–8.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Cornu J-N, 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;62:877–90.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Rackley R, Weiss JP, Rovner ES, Wang JT, Guan Z. Nighttime dosing with tolterodine reduces overactive bladder-related nocturnal micturitions in patients with overactive bladder and nocturia. Urology. 2006;67:731–6.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Weiss JP, Herschorn S, Albei CD, Meulen EAVD. Efficacy and safety of low dose desmopressin orally disintegrating tablet in men with nocturia: results of a multicenter, randomized, double-blind, placebo controlled, parallel group study. J Urol. 2013;190:965–72.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Johnson TM, Burrows PK, Kusek JW, Nyberg LM, Tenover JL, Lepor H, et al. The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. J Urol. 2007;178:2045–51.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. Jama. 2006;296:2319–28.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Wilt TJ, Ishani A. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 1998.
  47. 47.
    Wilt TJ, Macdonald R, Ishani A, Rutks I, Stark G. Cernilton for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2011.
  48. 48.
    Weiss JP, Blaivas JG, Stember DS, Brooks MM. Nocturia in adults: etiology and classification. Neurourol Urodyn. 1998;17:467–72.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Vaughan CP, Endeshaw Y, Nagamia Z, Ouslander JG, Johnson TM. A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results. BJU Int. 2009;104:69–74.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Johnson TM, Markland AD, Goode PS, Vaughan CP, Colli JL, Ouslander JG, et al. Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia. BJU Int. 2013;112:100–8.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 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. 2014;21:595–600.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Danielle J. Gordon
    • 1
    Email author
  • Curran J. Emeruwa
    • 1
  • Jeffrey P. Weiss
    • 1
  1. 1.Department of Urology, SUNY Downstate College of MedicineBrooklynUSA

Personalised recommendations