By Abdul Kadir
Nocturia or nighttime urination is among the common complaints in aged men. Nocturia is described as waking during the night to urinate once or twice. Nocturnal urination appears to be a minor problem, but it is generally an indication of subtle underlying changes and conditions. With age, nocturia becomes increasingly common and encroaches on sleep, overall health, and even health risk. Recognising why nocturia becomes more frequent with ageing men uncovers significant interactions among urinary function, sleep, and health.
In older men, the bladder becomes less compliant and cannot stretch as easily to accommodate urine. The smooth muscle lining of the bladder becomes less elastic and less effective at retaining urine during nighttime. Older men will therefore require more frequent emptying of their bladder, leading to more frequent nighttime urination.
Ageing kidneys undergo changes in their filtering capacity and regulation of hormones. The most significant is the reduction in vasopressin secretion (a hormone that makes the urine concentrate during the night). Reduced vasopressin leads to more diluted urine and increased volumes being excreted during the night, a disorder termed nocturnal polyuria.
Benign prostatic hyperplasia (BPH), also known as benign enlargement of the prostate, is the most common aetiology of nocturia among elderly male patients. As the size of the prostate increases, it can compress the urethra, thus causing diminished capacity to empty the bladder completely. This leads to the requirement to micturate numerous times during the day as well as at night. Medications like urimax 0.4 tablet are regularly prescribed to relax the muscles of the urinary tract and improve urine flow in men with symptomatic BPH.
Consumption of fluids in the later part of the day, particularly caffeinated or alcohol-based drinks, stimulates the production of urine. This raises the risk of nighttime urination.
Poor quality sleep, such as insomnia or disrupted sleep based on diseases like obstructive sleep apnea (OSA), may be a contributor to nocturia. OSA disrupts breathing and oxygenation, causing the body to make more urine at night and causing individuals to wake up and feel the urge to pee.
Nocturia can be caused by common age-related diseases such as congestive heart failure and diabetes. Diabetes increases the blood glucose level, thus enhancing the production of urine. Kidney disease and congestive heart failure also disrupt the balance of fluids within the body, and this can result in nocturia.
Some medications, such as diuretics and others used for high blood pressure or heart disease, cause increased urine production. Taking diuretics later in the evening is a common reason for nocturia in older adults.
Nocturia is more than it appears; it significantly affects daily functioning. Chronic sleep disturbance has the potential to contribute to fatigue, irritability, decreased concentration, and increased risk of falls and fractures. The syndrome is linked with increased depression, loneliness, and impaired quality of life. In severe cases, nocturia contributes to increased morbidity and, according to studies, can be linked to increased mortality risk in elderly men, particularly when chronic disease is present.
The convergence of decreasing organ function, anatomical alterations (prostate and bladder), accretive effects of lifelong lifestyle, and rising prevalence of chronic disease come together as a man grows older. Nocturia is not necessarily unavoidable, but the risk does escalate because:
● The urinary system and bladder become less efficient.
● Disease states such as BPH and diabetes grow more prevalent and more severe.
● Hormone secretion regulates the amount of urine changes in a predictable fashion.
● Lifestyle habits and drug usage change with age.
Careful assessment of nocturia requires consideration of fluid intake, history, medication, sleep, and underlying illness. Treatment may entail:
● Behavioural adjustments include limiting fluids at night, prohibiting alcohol/caffeine at bedtime, practising timed voiding, and taking safety precautions at night.
● Medical management: Medications such as temsunol tablet can alleviate urinary obstruction and symptoms in BPH.
● Management of underlying medical conditions: Managing diabetes, heart or kidney disease, and sleep disorders can help decrease nocturia episodes.
● Timing of medicine: Frontloading diuretic doses early in the day can decrease nighttime urination.
Men can take steps to minimise the effect of nocturia on ageing:
● Track fluid intake during the day, particularly in the late evening before bedtime.
● Look out for signs and symptoms of an enlarged prostate, including slowed urine stream, urgency, or trouble initiating urination.
● Maintaining a healthy weight and being physically active are beneficial for both urinary and overall health.
● Go after chronic disease with the assistance of health professionals.
● Practice sleep hygiene, including an orderly sleep schedule and a sleep-conducive environment, in order to optimise the quality of sleep.
Nocturia rises with increasing age in men because of a synergistic impact of anatomical, hormonal, and lifestyle elements. All of these are involved in bladder capacity, prostate function, kidney hormone secretion, and chronic disease. Although nocturia appears to be an unavoidable part of ageing, it is not necessary to experience it. Proper management, either behavioural or medical, can reduce symptoms, improve sleep, and improve quality of life. Early care to maintain urinary health, healthy lifestyle modification, and cooperation with medical practitioners will assist men in dealing with nocturia as they age.
(NG-FA)
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