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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Notes

Overactive Bladder treatment articles began to be inserted June 24, 2006.

The Guidelines section will contain 2008 and some 2007 updated published guidelines. To view Guidelines from previous years, view the Guideline sections or the Article sections or our Monthly Online Newsletter (under the Guidelines section).

Nocturia, Enuresis and Overactive Bladder

Daily Treatment Report

In this Report:

Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Drugs
Exercise
General Information
Guidelines
Immunotherapy
Internet Sites
Nutrition
Other
Radiotherapy
Supplements-Vitamins-CAM
Surgery
Transplantation

Cognitive Therapy-CBT-Psychotherapy

Behavioral therapies for overactive bladder: making sense of the evidence. (J Wound Ostomy Continence Nurs. 2008)

Device Therapy

Drug Side-Effects and Interactions

Use of desmopressin and concomitant use of potentially interacting drugs in elderly patients in Sweden. (Eur J Clin Pharmacol. 2008) "CONCLUSIONS: The use of desmopressin in the elderly after the new approval in 2002 showed a similar prescription pattern to any newly introduced drug or after a changed indication. A large part of the elderly on desmopressin also receives other drugs that are potentially harmful in combination with desmopressin. Increased awareness of potentially interacting concomitant medication can improve medication safety in this fragile group."

Drugs

Nocturia: a blinded, randomized, parallel placebo-controlled self-study of the effect of 5 different sedatives and analgesics. (Can Urol Assoc J. 2008)

Evidence for Partial Anti-Enuretic Response Related to Poor Pharmacodynamic Effects of Desmopressin Nasal Spray. (J Urol. 2008)

A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Antimuscarinic Drugs for Overactive Bladder. (Eur Urol. 2008)

DDAVP Spray (desmopressin acetate nasal spray) and DDAVP Rhinyle (desmopressin acetate nasal solution) have been associated with an increased risk of hyponatremia “Bedwetting must not be treated with any nasal form of desmopressin (e.g., DDAVP® Spray, DDAVP® Rhinyle Solution). It must only be treated with desmopressin taken by mouth (e.g., DDAVP® Melt).”

[Anticholinergic drugs in overactive bladder.] (Gynecol Obstet Fertil. 2008)

Exercise

Evaluation and treatment of enuresis. (Am Fam Physician. 2008)

General Information

Management of Childhood Enuresis Reviewed “The main classifications of enuresis are primary vs secondary and monosymptomatic (uncomplicated) vs nonmonosymptomatic (eg, accompanied by lower urinary tract symptoms). Children with primary nocturnal enuresis are monosymptomatic, with no history of bladder dysfunction and no lower urinary tract symptoms other than nocturia. Secondary causes of enuresis, which account for less than 25% of cases, include urinary tract infection, bladder dysfunction, chronic renal failure, constipation, pinworm infection, diabetes insipidus or diabetes mellitus, hyperthyroidism, sickle cell disease, obstructive sleep apnea, psychological stress, or seizure disorder. When enuresis develops during a period of stress in a child with no history of the condition, underlying psychological stressors should be suspected. “

Evaluation and treatment of enuresis. (Am Fam Physician. 2008) “If the condition is not distressing to the child, treatment is not needed. However, parents should be reassured about their child's physical and emotional health and counseled about eliminating guilt, shame, and punishment. Enuresis alarms are effective in children with primary nocturnal enuresis and should be considered for older, motivated children from cooperative families when behavioral measures are unsuccessful. Desmopressin is most effective in children with nocturnal polyuria and normal bladder capacity. Patients respond to desmopressin more quickly than to alarm systems. Combined treatment is effective for resistant cases.”

What to Do When a Patient Presents With Urinary Frequency: Urologic Symptoms in Primary Care

How should patients with an overactive bladder manipulate their fluid intake? (BJU Int. 2008) "CONCLUSIONS Fluid manipulation is a cheap, noninvasive and easy way to help control the symptoms of OAB. Patients have difficulty in either decreasing or increasing their fluid input by 50%. Patients can now be told to expect a significant improvement in urgency, frequency and nocturia episodes if they reduce their fluid input by 25%."