Mystery about Nocturia - Peeing at Night

    Getting up to urinate "often" at night has disturbed sleep of many of the so-affected as age runs up. As a result, they seek help
    from doctors, especially from urologists.

    As always, to truly and possibly solve or help improve any concerns of life, the first step is to realize, understand, and accept the
    truth and facts of life and disease as what we have known of and available. Likewise, let us take the same approach to unveil,
    help, and solve the multiple ramifying issues about the annoying getting-up to pee at night, that is, nocturia.

    Hereinbelow are what I have observed, collected, analyze, and summarized about nocturia from my personal (72 years) and
    professional (46+ years) lifelong experience; they are as follows:

    1. What are the duty and capacity of urinary bladder?
    Urinary bladder is genetically designed and designated to store and empty urine in and out of it so to provide us a reasonable
    daily convenience, so we may and can urinate at a time and location under a circumstance at will without embarrassment.
    Inherently, we are not born equal in any faucets of life; naturally we have to understand and accept that every part of body in every
    individual is unique.

    Anatomically we all share the same terminology for an organ and  physiologically it serves a same designated duty, but in a
    different capacity, which varies and fluctuates along the path of life.

    Common sense tells us that what and who we are, represents what and who we have been, and will make what and who we will
    be. Hence, how we function in an organ may evolve and change over lifetime in a wide range of variation.

    2. Why do we need to get up to urinate at night? Is it normal to pee at night?
    Known to us, the function of an organ is same, but its capacity differs and widely varies along the path of life. On average, urinary
    bladder of an adult can store and empty about 200 - 500 cc of urine with various pace of filling and various frequency to urinate
    (about 4-6 times daily, reflecting how fast urine is excreted from kidneys.

    At any given time, if the volume of urine production fills up the bladder to reach  the limit of its functional capacity, one has to
    urinate to empty it; if not, one would wet underwear or pants at wake usually in the daytime or wet the bed at sleep usually at
    night. In facing of high urine production, the following 4 conditions should be considered as its possible causes as follows:
    1. aging-related more urine production:
    As we age, kidney concentrating and bladder holding ability and capacity gradually declines -of course at variable pace
    among individuals. Then we make more urine from kidneys but hold less in the bladder than at younger age. Naturally we
    have to urinate more often than before. Yet, such changes are in a quiet slow pace and may elude personal attention until
    reaching the limit of personal adaptation and tolerance, that is, the time of being forced to go to see doctors for medical
    attention. On top of such, many elderly have marginal cardiac capacity or some degree of congestive heart failure, leading
    to have some degree of fluid retention in the daytime. Then for self protection, the body of such affected elderly will
    automatically mobilize the water excess accumulated during daytime out of the body at night.

    As a result, nighttime urine production at night of about 8 hours in young age, said, in 20s or 30s, is about 10-25% of total
    24-hour urine production; at age of 60-80, it may increase to 25-45% of total 24-hour urine production. Hence, the aged
    persons have to pee more often at night than the young.

    2. excess fluid intake:
      How much water do we need to drink a day? Eight glasses? Not quite. For details on this subject, go to
       Water Drinking, Eight Glasses a Day?

    3. disease-related more urine production:
      Blood sugar may act like a diuretic because of its osmotic effect; that obviously happens to poorly-controlled diabetic
       patients.

    4. high-out kidney failure:
      Many patients of kidney failure, mild or severe, tend to make more urine due to their disproportional loss in kidney    
       concentrating ability leading to less ability for water reabsorption for water physiological recycling.

    3. How can we ease nocturia?
    What we just review and elaborate above should guide our common sense to take the following actions to help
    improve/decrease the frequency of nocturia as follows:
    1. change the timing of taking diuretic, if you are on, from traditionally in the morning to some 6 hours before going to
       bed for sleep;

    2. stop oral fluid if any possible for 4-6 hours before going to bed;

    3. judicious use of synthetic anti-diuretic hormone like DDAVP (desmopressin):
      This agent has to be used with care under close monitoring electrolytes for water intoxication especially in those with  
       compromised heart function. In practice, I used it very rarely.

    4. adopt and adapt to the body change as described above: Many elderlies hear the above explanation of practical    
        necessity of either getting up to pee or peeing on the bed, they are glad they need and can get up to urinate 1-3 times
        in some 8 hours sleep at night.

    The above advices are much conforming to the life reality to attest: In medicine, medical professionals have never cured
    anything for anyone, but just modify something for someone to some degree with or without drug and/or surgery at
    reasonable time in reasonable way to reasonable patients.

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