Tag Archives: nocturia

Nighttime Toileting and Osteoporosis

1 Jul

Despite the significant effort in public education messages and pharmaceutical advertising, osteoporosis-linked fractures have risen dramatically over the past decade.  According to the Agency for Healthcare Research and Quality (AHRQ) in the Department of Health and Human Services, the hospitalization rate of patients admitted for treatment of hip, pelvis and other fractures associated with osteoporosis increased by 55% between 1995 and 2006.  An estimated 10 million Americans suffer from osteoporosis, which causes bones to become brittle and subject to easy fracture.  Even worse, osteoporosis slows healing following fracture and can contribute to multiple fractures leading to excessive pain, disability and permanently impaired mobility, and eventually death.  Because osteoporosis is involved mostly in older adults, with 90% of hospitalizations for patients 65 and older, the increasing longevity of our country has only increased the likelihood of higher prevalence, all else being equal.

Couple this trend with the heightened risk factor for overactive bladder (OAB) accompanied by aging, and we are facing the perfect storm.  Overactive bladder, including symptoms of nocturia or being awakened more than once nightly to urinate, affects an estimated 33 adult Americans, with prevalence increasing with age.  Impaired mobility coupled with middle of the night toileting in the dark is an equation leading to disaster for millions.  And with increasing numbers of the elderly living along, the problem is only exacerbated.

Our country has to get smarter about the convergence of these risk factors and wiser about how to practice practical, preemptive intervention.  Yes, it’s important to have bone density screening and  for patients to be compliant with osteoporosis-prescribed medication.  However, it’s equally important to take steps to strengthen bone, with strength-building exercises, with supervised instruction and in a safe environment.  If OAB is in the equation, then a full-scale intervention with behavioral therapy including pelvic floor muscle exercises, bladder retraining, and dietary changes and possibly medication is called for.   And watch out for medications prescribed for other problems that can cause you to be unsteady on your feet or easily disoriented, as research shows a link between sedatives/narcotics and falls.  Even chronic pain has been found to increase the risk of falls in older adults.

If nighttime toileting and overactive bladder problems persist, there are other remedies including peripheral nerve stimulation and device implants for sacral nerve modulation.

We’ve got to wise up to the combination of factors and preempt the perfect storm before it comes to shore.

Nancy Muller, Ph.D.
Executive Director,
National Association for Continence

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Sleepless Nights

23 Jun

Getting up every night to use the toilet?  Often more than once?  Waking once or more during the night to urinate is referred to as nocturia.  As we get older, we seem to get up more frequently.

Some causes are gender specific.  For example, nocturia in men is often linked to an enlarged prostate that blocks the flow of urine from the bladder.  Such men fail to fully empty their bladder during the day, sending themselves to bed with a partially full bladder that soon sends a wake-up call to be emptied. This is helpful to understand because getting the prostate enlargement diagnosed and treated may allow the symptoms of nocturia to all but disappear.  The onset of nocturia in women is generally linked to the consequences from childbirth, menopause, and even pelvic organ prolapse.

It is often difficult to separate the cause of awakening from the tendency to get out of bed, once awakened, to use the toilet.  If the problem is at least partly due to sleep disorders including sleep apnea and restless leg syndrome, these problems need to be investigated and treated separately.  Sometimes nocturia is a symptom of a greater medical problem that alters the way in which the body functions during sleep.  If the problem is excessive nighttime urine production, the first step is to look for the cause.  Targets include:

  • Diabetes
  • High blood pressure
  • Heart disease/Congestive heart failure
  • Vascular disease/Varicose veins/Swelling due to fluid accumulation in lower extremities

There may be steps you can take on your own (to read more, visit http://www.nafc.org/bladder-bowel-health/nocturia/)

  • Eliminating caffeine and alcohol from the diet, especially 3 – 4 hours prior to bedtime
  • Taking prescribed diuretic medications about 6 hours before bedtime
  • Minimizing all fluid intake 2 – 3 hours before bedtime, including foods with high water content
  • Avoiding strenuous exercise within 3 hours of retiring for bed
  • Avoiding engaging mental activity or stressful dialogue within several hours of bedtime
  • Turning off the television
  • Darkening the bedroom and sleeping with blinders
  • Kicking your pet out of the bed!

Of course……fall prevention is of major concern with nocturia.  That’s the next blog just around the corner.