The abdomen
Peter Kopelman, Dame Jane Dacre in Handbook of Clinical Skills, 2019
IrritativeDysuria – typically described as a burning pain on micturition, and most often due to urinary tract infection.Frequency – establish whether this is a frequent voiding of small amounts of urine or of normal volumes, to differentiate problems with bladder capacity or irritation from polyuria.Nocturia – may be due to mobilisation of peripheral oedema at night causing polyuria, reduced bladder capacity or bladder irritation.Strangury – a painful desire to pass urine with either an empty or completely obstructed bladder.
Frailty
Shibley Rahman in Living with frailty, 2018
A frailty index can be generated from almost any set of health-related variables, as long as a few criteria are met. The criteria for an item to be considered as a deficit are that the item needs to be acquired, age-associated and associated with an adverse outcome, and should not saturate too early. An example would be nocturia in men. Although nocturia is age associated, interrupts sleep, and is a deficit, the problem is common, typically seen in more than 90 per cent of men older than 75 years (Rockwood and Mitninski, 2011). There is a growing literature on the interaction between comorbid illness and frailty, which suggests that rather than taking these concepts separately, frailty can be viewed, at least in part, as one result of the accumulation of the burden of chronic, multiple comorbid illness over time (Sales, 2009). Whilst the trajectory of ageing can differ among older people, there is general agreement that ageing is associated with an accumulation of cellular damage (Soysal et al., 2017).
Urinary tract disorders
Henry J. Woodford in Essential Geriatrics, 2022
‘Clinically significant' nocturia is often defined as two or more episodes of urination interrupting sleep. Older age is associated with loss of the diurnal variation in vasopressin secretion, leading to a greater proportion of urine being formed at night. There may also be reduced bladder storage capacity. Co-morbidities such as obstructive sleep apnoea, heart failure and conditions producing polyuria (e.g. diabetes) may contribute. It is an important potential contributor to nocturnal falls. Relevant lifestyle advice includes avoidance of alcohol and caffeine, not drinking any fluids in the two hours before bed, elevating legs in evenings if they are oedematous and dietary salt restriction.139
Comparison of sleep and chronotype between senior and undergraduate university students
Published in Chronobiology International, 2019
P Núñez, C Perillan, J Arguelles, E Diaz
In older people, sleep is characterized by an increased number of awakenings (Duffy et al. 2015). Sleep homeostasis regulates wakefulness and sleep and generates sleep pressure as a function of time of being awake. Sleep pressure increases during waking and sleep deprivation, and decreases during sleep (Dijk et al. 2000). The age-related sleep efficiency may be partially due to the reduced homeostatic sleep pressure with aging. This contributes to an increased number of nocturnal awakenings and reduced daytime sleepiness (Mander et al. 2017), as observed in the present study. For another part, nocturia, defined as the complaint of waking from sleep at night to void, occurs with increasing frequency as adults age. A recent review reports nocturia incidence at a rate of 11.5% per year in people aged >60 years (Pesonen et al. 2016), agreeing with our results. Among older adults, nocturia typically occurs due to multiple potential causes, which include lower urinary tract dysfunction, increased urine production, sleep dysfunction or a combination of these conditions (Inouye et al. 2007). Disturbed sleep and persistent pain are also common in old people (Onen and Onen 2018). The relationship between pain and sleep disturbance appears straightforward. Pain provokes disturbed sleep, and sleep disturbances interfere with the ability to initiate and maintain sleep (Frohnhofen 2018).
Nocturia in female patients: Current clinical features, treatment patterns and outcomes at a tertiary referral centre
Published in Arab Journal of Urology, 2019
Siri Drangsholt, Benoit Peyronnet, Maria Arcila-Ruiz, Rachael D. Sussman, Ricardo Palmerola, Dominique R. Pape, Nirit Rosenblum, Victor W. Nitti, Benjamin M. Brucker
A retrospective chart review of all new female patients seen in a single-centre functional urology practice with the diagnosis of nocturia was performed. Billing records were mined from 2010 to 2016, (a period after the initiation of electronic medical records) for patients with a primary diagnosis of nocturia, with an International Classifications of Disease ninth revision (ICD-9) code 788.43 and ICD-10 code R35.1. All patients were evaluated and treated by one of three Female Pelvic Medicine and Reconstructive Surgery (FPMRS)-certified urologists. The inclusion criterion was a primary diagnosis of nocturia. Patients were excluded if they were male, if they had undergone a treatment for bladder cancer, had a history of recurrent UTIs or had OAB predominant daytime symptoms. Up to three visits within a 12-month period from the time of presenting were reviewed.
Systematic review of proposed definitions of nocturnal polyuria and population-based evidence of their diagnostic accuracy
Published in Acta Clinica Belgica, 2018
Tine Kold Olesen, Marie-Astrid Denys, Johan Vande Walle, Karel Everaert
Nocturia is a symptom with many different causes mainly related to a mismatch between nocturnal diuresis and functional bladder capacity overnight. In the past decades, major attention was given to bladder dysfunction. A key factor is the bladder storage capacity. A reduced functional bladder index, bladder hypersensitivity/over activity, or bladder outlet obstruction (prostate hypertrophy) will increase the likelihood of nocturia. Increase in production of urine during sleep (nocturnal polyuria) has been ambiguous in the absence of good definitions and standardization of the diagnostic approach. The pathophysiology of nocturnal polyuria is multi-factorial [1]. Conditions associated with water/solute diuresis may relate to disturbances in the circadian rhythm of producing the antidiuretic hormone (ADH), congestive heart failure, renal insufficiency, or estrogen deficiency. Also, the conditions associated with sleep disorders may relate to sleep apnea or restless leg syndrome. Further, symptomatic nocturia may be due to a nocturnal urine overproduction, but disrupted sleep, secondary to overactive bladder contractions might increase nocturnal diuresis-rate. Based on the diverse pathophysiology, nocturnal polyuria occurs at all adult ages, in both sexes, and any ethnicity. The first definition accepted and endorsed by an international scientific organization, the International Continence Society, ICS [1] described the condition as abnormally high ratio of urine production at night versus the total 24-h urinary volume.
Related Knowledge Centers
- Diabetes
- Diuresis
- Insomnia
- Sleep Deprivation
- Urination
- Polyuria
- Frequent Urination
- Diabetes Insipidus
- Signs & Symptoms
- Central Diabetes Insipidus