A Problem of Overproduction

By Professor Dato' Dr Zulkifli Md Zainuddin (Consultant Urologist Surgical Department) | Hospital Canselor Tuanku Muhriz, UKM Medical Centre | Wed Feb 28, 2018 9:59am

Nocturia is defined as a condition in which a person wakes up from sleep to urinate at least once a night. One of its more common causes is nocturnal polyuria, which causes the bladder to produce a greater volume of urine during the night.

Consultant urologist Professor Dato’ Dr Zulkifli Md Zainuddin shares that the bladder of people with nocturnal polyuria produces over one third or about 30% of its daily urine output during the night.1 This causes the affected person to experience frequent need to go to the toilet, thus interrupting their sleep.



Is this a serious problem?

It can be. Prof Dr Zulkifli shares that he has patients who have to go to the toilet every hour or so during the night. The lack of sleep can cause fatigue and lack of concentration during the day, which in turn can affect the person’s performance at work or school as well as his or her relationship with other people.

Furthermore, elderly people face the risk of sustaining injuries due to falls while going to the toilet at night. Hip fracture is especially a cause for concern: risk of death among the elderly within a year after sustaining one is 15% to 20%, while about 50% of patients face ongoing disability and require institutionalization.2

Therefore, people who find themselves often waking up at night more than once to urinate should see a doctor, advises Prof Dr Zulkifli.



Treatment of nocturia often involves two components: behavioural modification and medication.


Behavioural modification

The urologist will advise patients to take measures to improve their condition.

These measures may include:

  • Reducing the amount of fluids consumed throughout the day (especially coffee, caffeinated drinks and alcohol).
  • Improving ‘sleep hygiene’ (the bedroom lighting, ventilation, temperature, ambiance, etc) to be more conducive for better sleep.



Prof Dr Zulkifli points out that there are two types of medications that are in use.

Timed diuretics. Diuretics are medications that promote increased production of urine. For patients with heart failure, for example, they tend to have considerable fluid retention in their extremities such as the legs. This accumulated fluid can seep back into the bladder when these patients lie down to sleep, giving rise to nocturia. In such a situation, diuretics can be prescribed so that the patient can take them during the day and ‘let everything flow out’ before bedtime arrives.

Timed antidiuretics. According to Prof Dr Zulkifli, treatment is increasingly shifting towards the use of timed antidiuretics.

Unlike diuretics, antidiuretics suppress urine production. They are normally taken by patients before bedtime.

It is Prof Dr Zulkifli’s opinion that, while antidiuretics also may cause side effects, they are generally safe for use provided that there is proper monitoring by the patient’s healthcare team.



Visit www.waketopee.ie for more information on nocturnal polyuria as well as nocturia.

References: 1. Kujubu, D.A. (2009). Nocturia in elderly persons and nocturnal polyuria. In Geriatric nephrology curriculum. Retrieved from https://www.asn-online.org/education/ distancelearning/curricula/geriatrics/Chapter19.pdf 2. Brunner, L.C., Eshilian-Oates, L., & Kuo, T.K. (2003). Hip fractures in adults. American Family Physician;67:537-42.



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The original version of this article was first published in December HealthToday 2017.




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