Demystifying Nocturia: Identifying the Cause and Tailoring the Treatment

Paula Laureanno, RN; Pamela Ellsworth, MD, FACS, FAAP

Disclosures

Urol Nurs. 2010;30(5):276-287. 

In This Article

Treatment of Nocturia

Once a patient has undergone an evaluation of nocturia and the etiology has been defined, treatment will then be tailored to the specific etiology. A formalized diagnostic and treatment algorithm may be useful in directing clinical care. An algorithm developed and used in the authors' clinical practice is presented in Figure 1.

Figure 1.

Clinical Algorithm for the Diagnosis and Treatment of Nocturia

In most individuals, the first steps in treatment are lifestyle and behavioral changes. Fluid intake in the evening should be discontinued, if possible, and alcohol and caffeine consumption reduced. For individuals with lower extremity edema and venous stasis, the use of compression stockings and afternoon leg elevation may combat fluid retention before retiring at night. The use of nasal continuous positive airway pressure can be used to treat sleep apnea, therefore reducing associated nocturia (Appell & Sand, 2008).

Diuretic use is associated with a two-fold increase in nocturia (Asplund, 2003). Diuretics are generally taken in the morning, which can lead to increased thirst and increased fluid intake later in the day, thereby increasing nocturnal urine output (Asplund, 2007). If furosemide (Lasix®) is taken six hours before going to bed, nocturnal diuresis may be reduced (Reynard, Cannon, Yang, & Abrams, 1998). In a randomized, placebo-controlled trial comparing night time doses of placebo and bumetamide (Bumex®) 1 mg, bumetamide treatment decreased nocturia episodes by 25% compared with placebo (Pedersen & Johansen, 1988).

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