What Are the Causes of Nocturia in Elderly Men?

Nocturia is a part of life for most older persons, especially men, nearly 90% of whom experience at least one episode of nighttime voiding. It is often cited as one of the most bothersome of lower urinary tract symptoms (LUTS). Unlike the other common LUTS, nocturia can cause significant morbidity and even mortality for elderly persons.

At the same time, our understanding of nocturia in older persons is complicated by how this condition has been defined. The ICS definition of nocturia, the number of voids recorded during a night's sleep with each void preceded and followed by sleep, assumes that "a night's sleep" is relatively stable and consistently understood by patients. However, older persons spend more time in bed before falling asleep, and may count time in bed rather than time asleep when self-reporting nocturia. Older persons also experience more awakenings from sleep independent of comorbidity. When these awakenings are combined with age-associated shifts in diurnal urine output to later in the day and night, nocturia becomes essentially normal. In older persons, the number of nocturia episodes also should be placed in context of actual hours asleep and/or in bed, which can vary greatly.

For example, three episodes of nocturia over 6 h likely have a different pathophysiology and impact than three episodes over 12 h.

Causes

In general nocturia affects older people more than younger adults, and those aged 65 or greater are more likely to experience a need to urinate at night. Many people with nocturia, especially elderly men, also experience concomitant lower urinary tract problems, such as frequency, urgency, weak stream, and incontinence -symptoms often attributed to benign prostatic obstruction. Age, childbirth, and menopause are often suggested contributors to nocturia in women. Multiple factors may cause nocturia in both men and women; these include behavioural patterns, diuretic medications, caffeine, alcohol, or excessive fluids before bedtime, and pathological conditions, such as prostatic disease, diabetes mellitus or diabetes insipidus, obstruction of the lower urinary tract, anxiety, or sleep disorders. The condition may also result from stroke, cardiovascular disease, peripheral oedema, and myeloneuropathy.

What are the causes of nocturia?

There are many possible causes of nocturia, depending on the type:
Causes of polyuria

High fluid intake
Untreated diabetes (Type 1 and Type 2)
Diabetes insipidus, gestational diabetes (occurs during pregnancy)

Causes of nocturnal polyuria

Congestive heart failure
Edema of lower extremities (swelling of the legs)