Nocturia - Enuresis - Overactive Bladder

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Nocturia - Enuresis - Overactive Bladder

NIH - Medical Encyclopedia Urination - excessive at night

"Normally, urine decreases in amount and become more concentrated at night. That means, most people can sleep 6 to 8 hours without having to urinate. But, persons with nocturia get up more than once during the night to urinate. Because of this, those who have excessive urination at night often have disrupted sleep cycles. Common Causes • Benign prostatic hyperplasia • Certain drugs including diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D • Chronic or recurrent urinary tract infection • Chronic renal failure • Congestive heart failure • Cystitis • Diabetes • Drinking too much fluid before bedtime, particularly coffee, caffeinated beverages, or alcohol • Obstructive sleep apnea and other sleeping disorders"

NIH - Medical Encyclopedia Bedwetting

"Bedwetting is involuntary urination in children over 5 to 6 years old. It may occur at any time of the day or night. This article focuses on nighttime bedwetting. … Children who have never been consistently dry at night have primary enuresis. This usually occurs when the body makes more urine overnight than the bladder can hold and the child does not wake up when the bladder is full. The child's brain has not learned to respond to the signal that the bladder is full. It is not the child's or the parent's fault. Physical causes are rare, but may include lower spinal cord lesions, congenital malformations of the genitourinary tract, infections of the urinary tract, or diabetes. Bedwetting runs strongly in families. More than 5 million children in the U.S. wet the bed. About 9% of boys and 6% of girls still wet the bed at age 7. The numbers drop slightly by age 10. Although the problem goes away over time, many children and even a small number of adults continue to have bedwetting episodes."

Highlighted Articles

Me and My Kegels; Doing pelvic exercises the right way can pay off in the bathroom—and the bedroom.

"Two years after giving birth, I still can’t control my bladder. I’m one of 25 million Americans, the majority of them women, with incontinence. More than half of healthy women ages 42 to 50—I’m 45—have some form of chronic-peeing problem, usually linked to pregnancy and childbirth, coughing, constipation, heavy lifting, or hormonal changes. Yet, incredibly, 90 percent of us never seek treatment."

Benefits of Kegel exercises

"Kegel exercises strengthen some of the muscles that control the flow of urine. Doctors often prescribe Kegel exercises for people who have bladder control problems (urinary incontinence). Kegel exercises are also called pelvic floor exercises because they treat and prevent pelvic floor weakness "

Effects of walking exercise on nocturia in the elderly.

(Biomed Res. 2007) "The daytime urinary frequency, blood pressure, body weight, body fat ratio, edema ratio, serum catecholamines, triglycerides, and total cholesterol were also decreased. After 8 weeks of exercise, 20 of the subjects (67%) stated that sleep was deeper than before exercise. Assessment of the overall improvement showed that excellent or good results were obtained in 18 patients (60%). The main factor related to the influence of walking exercise on nocturia was that sleep became deeper, which increased the arousal threshold bladder volume. Walking exercise may also have a preventive effect on lifestyle-related diseases."

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Nocturia, Enuresis and Overactive Bladder

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Information for Healthcare Professionals Desmopressin Acetate (marketed as DDAVP Nasal Spray, DDAVP Rhinal Tube, DDAVP, DDVP, Minirin, and Stimate Nasal Spray) "Certain patients taking desmopressin are at risk for developing severe hyponatremia that can result in seizures and death. Children treated with desmopressin intranasal formulations for primary nocturnal enuresis (PNE) are particularly susceptible to severe hyponatremia and seizures. As such, desmopressin intranasal formulations are no longer indicated for the treatment of primary nocturnal enuresis and should not be used in hyponatremic patients or patients with a history of hyponatremia."

Overactive bladder and glaucoma: A survey at outpatient clinics in Japan. (Int J Urol. 2007) "Conclusions: As both OAB and glaucoma increase with age, it is not surprising that approximately 10% of OAB patients have glaucoma. Although the majority have had either open-angle glaucoma or angle-closure glaucoma already treated, some of them may be true contraindications for anticholinergics due to uncontrolled angle-closure glaucoma. It seems necessary to treat OAB patients based on accurate information on the relationship between glaucoma and anticholinergics."

[Medical treatment of voiding problems in men] (Ugeskr Laeger. 2007)

Therapeutic options in childhood nocturnal enuresis. (Minerva Urol Nefrol. 2007)

Bladder drug may cause hallucinations "Johnson & Johnson's drug Ditropan for overactive bladders needs stronger cautions about the risk of hallucination and similar problems in children and older patients, U.S. Food and Drug Administration staff said in documents released on Monday. The drug, also known as oxybutynin, already lists insomnia, nervousness, confusion and other central nervous system risks on its label, but staff reviewers said more explicit cautions are needed."

Drugs

Anticholinergic drugs versus other medications for overactive bladder syndrome in adults. (Cochrane Database Syst Rev. 2007)

Muscarinic receptor antagonists for overactive bladder. (BJU Int. 2007)

Treatment of Nocturnal Enuresis in Children With Attention Deficit Hyperactivity Disorder. (J Urol. 2007) "CONCLUSIONS: Our data show that there is a high incidence of voiding dysfunction in children with attention deficit hyperactivity disorder. Combination therapy with desmopressin and oxybutynin is a feasible, safe and effective treatment for nocturnal enuresis in these children."

Darifenacin treatment of patients >/= 65 years with overactive bladder: results of a randomized, controlled, 12-week trial. (Curr Med Res Opin. 2007)

Management of the overactive bladder: a review of pharmacological therapies and methods used by the urological specialist. (Can J Urol. 2007)

Maximizing anticholinergic therapy for overactive bladder: has the ceiling been reached? (BJU Int. 2007)

Anticholinergic drugs versus other medications for overactive bladder syndrome in adults. (Cochrane Database Syst Rev. 2007) "There was no evidence of a difference in cure rates between anticholinergics and flavoxate. Adverse effects were more frequent in anticholinergic groups versus flavoxate groups (RR 2.28 95% CI 1.45 to 3.56). There was no strong evidence to favour either anticholinergic drugs or the comparators."

Agents for treatment of overactive bladder: a therapeutic class review. (Proc (Bayl Univ Med Cent). 2007) "Overactive bladder (OAB) is a medical syndrome defined by symptoms of urgency, with or without urge urinary incontinence (any involuntary loss of urine), usually with frequency and nocturia. Although anticholinergic agents have been the first-line treatment for OAB for many years, the efficacious pharmacologic management of this condition has been compromised by concerns regarding tolerability. … In 2004, the FDA approved the three newest agents for the class: darifenacin, solifenacin, and trospium. Compared with oxybutynin and tolterodine, these agents have a more favorable side effect profile, which can enhance tolerability and patient compliance. Side effects are reduced in part because of the drugs' greater tissue selectivity for inhibiting the bladder muscle contraction over other anticholinergic receptors in the body."

The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis. (J Urol. 2007) "PURPOSE: Desmopressin is a well established and effective therapy for nocturnal enuresis. Water intoxication leading to hyponatremia is an infrequent but serious adverse event associated with desmopressin. . CONCLUSIONS: Data suggest that there is a decreased risk of hyponatremia with oral desmopressin compared with intranasal desmopressin. Identifiable and preventable risk factors for hyponatremia are inappropriately high fluid intake, administration of a larger than recommended dose, young age (less than 6 years) and concomitant administration of another medication. When desmopressin is prescribed, patients should be instructed to avoid high fluid intake when the medication is ingested, not ingest a higher than recommended dose and promptly discontinue the medication and seek assessment if headache, nausea or vomiting develops."

The clinical efficacy of tolterodine extended-release is maintained for 24 h in patients with overactive bladder. (BJU Int. 2007)

The Effects of Long-Term Administration of Oral Desmopressin on the Baseline Secretion of Antidiuretic Hormone and Serum Sodium Concentration for the Treatment of Nocturia: A Circadian Study. (J Urol. 2007) "CONCLUSIONS: Long-term desmopressin administration gradually decreased the serum concentration and induced significant hyponatremia from 6 months in patients who did not show initial hyponatremia. Long-term administration of desmopressin for 1 year in elderly patients did not affect baseline antidiuretic hormone secretion. For long-term desmopressin administration serum sodium should be assessed regularly, at least every 6 months."

Short-term effects of desmopressin on water and electrolyte excretion in adults with nocturnal polyuria. (J Urol. 2007) "CONCLUSIONS: Desmopressin reduces nocturnal urine volume and nocturnal voiding frequency in male patients with nocturnal polyuria. However, increased calcium and decreased potassium excretion following desmopressin treatment deserve attention particularly when it is used on a long-term basis."

Treatment of overactive bladder: Selective use of anticholinergic agents with low drug-drug interaction potential. (Geriatrics. 2007)

Pharmacotherapy for nocturia in the elderly patient. (Drugs Aging. 2007) "A disorder of the vasopressin (antidiuretic hormone) system with very low or undetectable levels of vasopressin at night, affecting some elderly people, may cause an increase in the nocturnal urine output, which in the most extreme cases accounts for 85% of the 24-hour diuresis. The increased urine output can be treated with desmopressin orally at bedtime, generally using low doses. Self-imposed fluid restrictions before bedtime are not effective in reducing the nocturnal urine output in this condition.Nocturia is also more prevalent in association with a reduced bladder capacity."

Solifenacin for Overactive Bladder with Incontinence: Symptom Bother and Health-Related Quality of Life Outcomes (March). (Ann Pharmacother. 2007)

Desmopressin in the Treatment of Nocturia: A Double-Blind, Placebo-Controlled Study. (Eur Urol. 2007) "CONCLUSIONS: Oral desmopressin tablets provide an effective and well-tolerated treatment for nocturia. Compared with placebo, nocturnal voiding frequency is reduced, duration of the first sleep period is increased, and sleep quality may be improved."

Consumer Reports Best Buy Drugs: Treating Overactive Bladder

Pharmacological characterization of a new antimuscarinic agent, solifenacin succinate, in comparison with other antimuscarinic agents. (Biol Pharm Bull. 2007)

Exercise

Do Holding Exercises or Antimuscarinics Increase Maximum Voided Volume in Monosymptomatic Nocturnal Enuresis? A Randomized Controlled Trial in Children. (J Urol. 2007) "CONCLUSIONS: In the treatment of children with monosymptomatic nocturnal enuresis maximum voided volume can be increased significantly through holding exercises, but not with oxybutynin chloride alone. Compared to controls, increasing maximum voided volume had a minimal effect on monosymptomatic nocturnal enuresis."

Me and My Kegels; Doing pelvic exercises the right way can pay off in the bathroom—and the bedroom. "Two years after giving birth, I still can’t control my bladder. I’m one of 25 million Americans, the majority of them women, with incontinence. More than half of healthy women ages 42 to 50—I’m 45—have some form of chronic-peeing problem, usually linked to pregnancy and childbirth, coughing, constipation, heavy lifting, or hormonal changes. Yet, incredibly, 90 percent of us never seek treatment."

Benefits of Kegel exercises "Kegel exercises strengthen some of the muscles that control the flow of urine. Doctors often prescribe Kegel exercises for people who have bladder control problems (urinary incontinence). Kegel exercises are also called pelvic floor exercises because they treat and prevent pelvic floor weakness "

Effects of walking exercise on nocturia in the elderly. (Biomed Res. 2007) "The daytime urinary frequency, blood pressure, body weight, body fat ratio, edema ratio, serum catecholamines, triglycerides, and total cholesterol were also decreased. After 8 weeks of exercise, 20 of the subjects (67%) stated that sleep was deeper than before exercise. Assessment of the overall improvement showed that excellent or good results were obtained in 18 patients (60%). The main factor related to the influence of walking exercise on nocturia was that sleep became deeper, which increased the arousal threshold bladder volume. Walking exercise may also have a preventive effect on lifestyle-related diseases."

General Information

Nocturia: Etiology, diagnosis, and treatment. (Neurourol Urodyn. 2007)

The Effect of Obesity on Treatment Efficacy in Children With Nocturnal Enuresis and Voiding Dysfunction. (J Urol. 2007)

Nonpharmacologic vs. anticholinergic therapies for overactive bladder. "Overactive bladder can be associated with urge incontinence, urinary frequency, and nocturia. Causes of chronic bladder irritation include urinary tract infection; pelvic surgery; estrogen deficiency; diabetes; multiple sclerosis; medications (e.g., neuroleptics, diuretics); cerebral ischemia; dementia; and overflow incontinence."

Overactive Bladder in Children. Part 2: Management. (J Urol. 2007) "CONCLUSIONS: The treatment of pediatric overactive bladder syndrome is not as simple as placing children on anticholinergics and, if there is no response, simply saying that they will outgrow it. The causes of overactive bladder syndrome are multifactorial and a better understanding of the pathophysiology will allow us to target treatments appropriately for individuals."

Management of overactive bladder syndrome. (Postgrad Med J. 2007)

[Medical treatment of voiding problems in men.] (geskr Laeger. 2007)

Urodynamic Evaluation in Primary Enuresis: An Investigative And Treatment Outcome Correlation. (J Trop Pediatr. 2007)

Nonpharmacologic vs. anticholinergic therapies for overactive bladder.

Maximizing anticholinergic therapy for overactive bladder: has the ceiling been reached? (BJU Int. 2007)

Management of the overactive bladder: a review of pharmacological therapies and methods used by the urological specialist. (Can J Urol. 2007) "Commencement of therapy should start with conservative measures such as lifestyle modifications including pelvic floor exercises and bladder drill followed by the introduction of pharmacological treatments if necessary. The patient should be fully educated about their disorder and about the potential side effects of the medication they are given in order to improve compliance."

Self management for men with lower urinary tract symptoms: randomised controlled trial (BMJ 2007) "A recent survey of British healthcare professionals involved in the care of men with lower urinary tract symptoms showed that many routinely advise lifestyle modifications (such as fluid management, avoidance of caffeine, and bladder retraining). . The results from this small two centre study are sufficiently impressive that a policy of self management as described in this paper has the potential to become the ideal first line treatment for men with uncomplicated lower urinary tract symptoms, provided that further studies show their generalisability. An additional argument for this conclusion is that the only imaginable harm that can result from self management is that for some patients medical or surgical treatment is postponed."

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Nutrition

Other

Other Treatments

[Botulinum toxin for the treatment of overactive bladder - an overview.] (Urologe A. 2007)

Allergic inflammation as one of the factors of pathogenesis of overactive urinary bladder] (Urologiia. 2007) "In view of the detected inflammatory pathogenetic aspects it is recommended to add antiallergic drugs improving detrusor bioenergetics to combined treatment of OAB."

Efficacy of botulinum toxin-A for treating idiopathic detrusor overactivity: results from a single center, randomized, double-blind, placebo controlled trial. (J Urol. 2007)

Botulinum toxin injections for adults with overactive bladder syndrome. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: Intravesical botulinum toxin shows promise as a therapy for overactive bladder symptoms, but as yet too little controlled trial data exist on benefits and safety compared with other interventions, or with placebo. Practitioners should be aware that at present there is little more than anecdotal evidence, in the form of case reports to support the efficacy of intravesical botulinum toxin; there is not much in the way of substantial, robust safety data. Furthermore, the optimal dose of botulinum toxin for efficacy and safety has not yet been demonstrated."

Botulinum toxin for detrusor overactivity and symptoms of overactive bladder: where we are now and where we are going. (Nat Clin Pract Urol. 2007)

Botox May Improve Idiopathic Detrusor Overactivity in Patients With Overactive Bladder "Botulinum toxin type A (Botox) can improve idiopathic detrusor overactivity (IDO) in patients with symptoms of overactive bladder (OAB), according to the results of a randomized, double-blind, placebo-controlled study reported in the June issue of the Journal of Urology. Treatment benefits, including improved quality of life, were maintained for at least 24 weeks."

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Surgery

A prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transvaginal surgery for advanced pelvic organ prolapse. (Am J Obstet Gynecol. 2007) "CONCLUSION: Vaginal surgery for stage III or IV pelvic organ prolapse significantly reduces overactive bladder symptoms in elderly women. In our cohort, symptom reduction was unrelated to the type of vaginal surgery (obliterative vs reconstructive) or the inclusion of a procedure to treat stress incontinence. Furthermore, preoperative urodynamic findings did not correlate with the presence or absence of overactive bladder symptoms."

Transplantation

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