New research reveals night-time toilet trips are not a trivial problem

New research reveals night-time toilet trips are not a trivial problem
02 September 2011 pulse

New research reveals night-time toilet trips are not a trivial problem

Glasgow – 2 September 2011 –

New data, presented at the International Continence Society (ICS) Congress, highlight the significant detrimental impact of nocturia on the quality of life of patients who suffer from this under-reported and often misunderstood condition.1

Nocturia – the medical term for the complaint of needing to wake one or more times to pass urine at night – is commonly trivialized and often thought of as being a natural and inevitable part of growing older. As such, many patients suffer in silence without discussing their problem with their clinician.

The new research1 involved 5,503 men and women, aged 30-79 years from the city of Boston. Quality of life, from both a mental and physical health perspective, was measured using the internationally recognized SF-12 questionnaire.

Results from the study reveal the extent to which nocturia is associated with a decrease in overall quality of life, comparable to other chronic conditions such as hypertension, diabetes and arthritis. Nocturia was associated with a significant decrease in quality of life indicators, including sleep disturbance, and both the physical and mental health component scores of the SF12 (p-value<0.05).1

The data also suggest that repeated night time trips to the toilet significantly increase the likelihood of patients experiencing depression, especially among younger men and women.1

This data sheds light on the real impact nocturia can have on the mental well-being and overall quality of life of patients with this under-reported condition” explained Dr Varant Kupelian, New England Research Institutes. “It is important that healthcare professionals engage with their patients to understand if they are experiencing nocturia related sleep disruption, and to discuss how best to manage their condition” he continued.

Results of a separate study2 also presented at ICS showed that nocturia is a problem for shift workers who sleep through the day and work during the evening. The study, involving more than 1,000 men and women aged 18-65, suggests that an increase in the number of night shifts undertaken over the course of a week correlates to a higher prevalence of nocturia.

Investigators concluded the survey results warranted a deeper investigation into the extent to which nocturia is more of a problem in people working night shifts due to a disturbance in their circadian clock which results in a disruption of vasopressin (anti-diuretic hormone) production.

Whilst many other studies have focused on the impact of distributed sleep patterns, the authors believe this is the first time a possible relationship between changes in circadian rhythm due to night time work and nocturia have been examined.

This finding is especially relevant as an estimated 17% of the European workforce are thought to be shift workers.3

Nocturia is the complaint that an individual has to wake and pass urine one or more times at night. The condition is equally common in men and women,4 and although it increases with age, it affects a significant proportion of younger, as well as, older people.5 On average, up to around 20% of adults aged 40-59 years have ≥ two toilet visits per night,67 this increases to around 35% in those over 60 years.5

Nocturia is the leading cause of sleep disruption in older adults.8 Sleep is crucial for well-being, health, vitality and essential biological rhythms;9 disrupted sleep impairs all of these and studies show that insufficient or disrupted sleep can lead to physical and mental problems including depression and mood alteration.10, 11 Indeed, poor sleep is associated with disrupted endocrine and immune functioning, reduced health, and increased mortality.12131415

Nocturia is a treatable condition and people making repeated night-time visits to the toilet are urged to seek help. Nocturnal polyuria – the production of an abnormally large volume of urine during sleep – is present in the majority of patients with nocturia (60-80%).16171819, 20, 21

– ENDS –

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Patrick Gorman
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  1. ICS Abstract 543. Nocturia and Quality of Life. Results from the Boston Area Community Health (BACH) Survey. September 2011.
  2. ICS Abstract 360. An explorative epidemiological patient-reported survet investigating a potential relation between night time work and nocturia.
  3. Agnès Parent-Thirion et al. Fourth European Working Conditions Survey. The European Foundation for the Improvement of Living and Working Conditions, 2007 Date Accessed 18th August 2011
  4. Schatzl G, Temml C, Schmidbauer J, Dolezal B, Haidinger G, Madersbacher S. Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project. Urology 2000; 56: 71-75
  5. Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50: 1306-1315
  6. Yoshimura K, Terada N, Matsui Y, Terai A, Kinukawa N, Arai Y. Prevalence of and risk factors for nocturia: Analysis of a health screening program. Int J Urol 2004; 11: 282-287
  7. Brieger GM, Yip SK, Hin LY, Chung TK. The prevalence of urinary dysfunction in Hong Kong Chinese women. Obstet Gynecol 1996; 88: 1041-1044
  8. Bliwise DL, Foley DJ, Vitiello MV, et al. Nocturia and disturbed sleep in the elderly. Sleep Med 2009; 10:540-548.
  9. Hunter. To sleep, perchance to live. EMBO Rep 2008;9:1070-1073
  10. Naitoh P, Kelly TL, Englund C. Health effects of sleep deprivation. Occup Med 1990; 5: 209-237
  11. Hetta J, Rimon R, Almqvist M. Mood alterations and sleep. Ann Clin Res 1985; 17: 252-256
  12. Cohen S, Doyle WJ, Alper CM, Janicki-Deverts D, Turner RB. Sleep habits and susceptibility to the common cold. Arch Intern Med 2009; 169: 62-67
  13. Dew MA, Hoch CC, Buysse DJ et al. Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med 2003; 65: 63-73
  14. Tasali E, Leproult R, Ehrmann DA, Van CE. Slow-wave sleep and the risk of type 2 diabetes in humans. Proc Natl Acad Sci U S A 2008; 105: 1044-1049
  15. Gottlieb DJ, Punjabi NM, Newman AB et al. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 2005; 165: 863-867
  16. van Kerrobroeck P, Abrams P, Chaikin D, et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:179-183.
  17. Weiss J. Prevalence of nocturnal polyuria in nocturia. J Urol 2009; 181: 538
  18. Chang SC, Lin AT, Chen KK, Chang LS. Multifactorial nature of male nocturia. Urology 2006; 67: 541-544
  19. Swithinbank LV, Vestey S, Abrams P. Nocturnal polyuria in community-dwelling women. BJU Int 2004; 93: 523-527
  20. Yoong HF, Sundaram MB, Aida Z. Prevalence of nocturnal polyuria in patients with benign prostatic hyperplasia Med J Malaysia 2005; 60: 294-296
  21. Klingler HC, Heidler H, Madersbacher H, Primus G. Nocturia: an austrian study on the multifactorial etiology of this symptom. Neurourol Urodyn 2009; 28: 427-431

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