WHAT CAUSES NOCTURIA?

The following lifestyle habits are known to cause nocturia or frequent urination at night in either men or women:

• Drinking too much fluid before bedtime (especially caffeine or alcohol)
• Behavioral patterns (you've trained your body to wake up during the night to use the bathroom, even if you don't necessarily have to go)
• The timing or dose of medicines, such as: diuretic medicine (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
• Sleep disorders, like insomnia or sleep apnea
• Reduced bladder activity

Underlying health conditions can cause nocturia. For example:

• Diabetes
• Aging
• High blood pressure
• Heart disease, vascular disease or congestive heart failure
• Bladder obstruction (stones), inflammation or other problems that affect bladder capacity (like bladder surgery or fibrosis from radiation)
• Overactive bladder symptoms
• Prostate obstruction
• Vaginal prolapse
• Uterine prolapse
• Menopause
• Childbirth
• Pelvic prolapse
• Enlarged prostate (prostatic hyperplasia (BPH)
• Restless leg syndrome
• Malignant tumour of the bladder
• Malignant tumour of the prostate
• Edema in the lower limbs, or leg swelling
• Interstitial cystitis
• Reduced bladder capacity
• Nocturnal polyuria (when your body produces too much urine at night for your bladder to hold)

Often, several of these issues may be going on at once.

WHAT ARE THE TYPES OF NOCTURIA?

There are four types of nocturia:

Nocturnal polyuria : You produce an excessive amount of urine during the night.

Global polyuria : Your body produces excess urine in a 24-hour period.

Low nocturnal bladder capacity : Your bladder can’t hold as much fluid during the night.

Mixed nocturia : This is a combination of the previous three types of nocturia.

WHAT ARE THE SYMPTOMS OF NOCTURIA or FREQUENT URINATION AT NIGHT?

Normally, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. People who have nocturia wake up more than once a night to urinate. This can cause disruptions in a normal sleep cycle. Nocturia OR frequent urination at night may accompany other symptoms affecting the urinary tract including

• Waking up more than once a night to urinate.
• Fatigueness
• Cloudy urine
• Difficult or painful urination, or burning with urination (dysuria)
• Foul-smelling urine
• Frequent urination
• Frequent urination that often produces only a small amount of urine
• Urgent need to urinate
• Urinary retention

Nocturia or frequent urination at night may accompany symptoms related to other body systems including:

• Chest pain or pressure
• Difficulty breathing or rapid breathing
• Feeling very thirsty
• Fever and chills
• Loss of bladder or bowel control
• Missed menstrual periods
• Night sweats
• Sleep disturbances
• Unexplained weight loss

THE RISK FACTORS OF NOCTURIA OR FREQUENT URINATION AT NIGHT

The results of previous studies on nocturia have made it possible to distinguish factors that increase the risk of this symptom :

• Age – numerous studies have unequivocally demonstrated that the risk of nocturia or frequent urination at night increases with age. For adults aged ≤24 years the symptoms of clinically relevant nocturia (at least 2 micturitions during nighttime) are observed in less than 5% of the respondents, while that percentage increases to 15% in the 45–54 age group. Among the group of people aged 65–74 years, the symptoms occur in up to 25% of the subjects
• Sex – the symptoms of nocturia or frequent urination at night are more common among women than men up until about the 6th decade of life. In addition, in women, more frequent occurrences of nocturia are observed during pregnancy and the postpartum period, as well as during the postmenopausal period. In the 6th decade of life there is a reversal of the trend described above; the symptoms of nocturia or frequent urination at night are more commonly observed among men, which is probably associated mainly with the onset of prostate diseases
• Obesity – it has been observed that excess weight and obesity may, regardless of gender, increase the risk of nocturia or frequent urination at night even by 2–3 times.

Simultaneously, the protective impact of physical activity has been demonstrated in relation to the occurrence of the previously mentioned symptom.

IN WHAT WAY COULD NOCTURIA OR FREQUENT URINATION AT NIGHT BE DIAGNOSED?

The diagnosis is based on patient history.Your health care provider may also ask you to keep a bladder diary in order to help with a diagnosis. This diary is used to keep track of things like the kind and amount of liquids you drink, trips to the bathroom, etc. to track trends over a period of time which can lead to best treatments for frequent urination at night.

Some questions your doctor may ask:

• When did your symptoms first start?
• How many times do you need to go to the bathroom each night?
• Is there a large or small amount of urine when you go?
• Has the amount of urine you make changed (increased or decreased)?
• How much caffeine or alcohol do you drink each day? When?
• Do you feel like you're getting enough sleep?
• Has your diet changed recently?
• Do you wake up wet? (Are you leaking?)

To provide best remedies for frequent urination at night , doctors may recommend further tests which will be the key decision makers to treat Nocturia or frequent urination at night through acupuncture

• Urine culture and urinalysis : check for infection, unwanted blood, and other elements in your urine.
• Blood test : checks the kidney and thyroid, cholesterol levels and the presence of anemia, diabetes or other problems
• Bladder scan : shows how much urine is still in the bladder after you go to the bathroom
• Cystoscopy : checks for a tumor or other causes of your symptoms by having the doctor insert a narrow tube with a tiny lens inside the bladder.
• Urodynamic testing : checks to see how well your lower urinary tract stores and releases urine

POTENTIAL COMPLICATIONS OF NOCTURIA OR FREQUENT URINATION AT NIGHT

Because nocturia or frequent urination at night affects your sleep cycle and can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including

• Difficulty sleeping
• Drowsiness
• Mood changes
• Embarrassment
• Progression of prostate disease
• Spread of cance
• Spread of infection

WHAT ARE THE CONVENTIONAL TREATMENT FOR NOCTURIA

Lifestyle Modification can be useful to some extent.Some of them are:

• Restrict fluid intake at night . Drink plenty of fluids during the day (especially water), but limit fluids 2-4 hours before you go to sleep. Be sure to limit alcohol and caffeine (soda, tea and coffee)
• Manage your use of diuretics. If you have to take a diuretic, then do so at least 6 hours before you go to sleep. This will help reduce the number of times you urinate during the night
• Elevate your legs or use compression socks. Some people experience fluid build-up in their legs. When you elevate your legs, it helps to redistribute fluids back into the bloodstream, reducing the need to urinate. Elastic compression stockings help by putting pressure on your legs to prevent fluid build-up.
• Enjoy afternoon naps. When you sleep poorly, a nap can help you feel better during the day. Naps can also allow liquids to be absorbed into the bloodstream. However, be careful not to nap too long or too often. You don't want to disrupt night time sleep patterns with naps
• Medicine If lifestyle changes alone don't help with your nocturia or frequent urination at night, some medicines may. Medicines help the kidneys produce less urine. For example, Desmopressin

Anticholinergic medicines to treat bladder muscle problems. They relax the bladder if it spasms. These are used to correct overactive bladder. For example, Darifenacin, Oxybutynin , Tolterodine , Trospium Chloride or Solifenacin.

Diuretic medicines to regulate urine production and high blood pressure. For example, Bumetanide, Furosemide

BEST TREATMENT FOR NOCTURIA

Researchers have discovered that Acupuncture is effective for controlling frequent urination at night or overactive bladder syndrome. The research team, a combination of Whipps Cross University Hospital and University College of London Hospital investigators, document that 79% of patients in the study showed clinically significant improvements. The researchers conclude that acupuncture is an effective treatment modality for patients with overactive bladder syndrome and “is well tolerated with no side effects or complications.” As a result, the research team notes that acupuncture “should be considered as a potential alternative to our current therapeutic regimes” for patients with Nocturia.

The researchers note that acupuncture is safe and effective. All patients in the study had already tried conventional approaches to care: behavioral modifications and pharmaceutical medications including anticholinergics and beta agonists. Although surgical procedures are often part of conventional treatment regimes of care for Overactive bladder sufferers, all candidates were pre-surgical. The research team notes, “The aim of the study is to assess if acupuncture is effective in the treatment of patients with Overactive Bladder in whom conservative measures and oral medications have failed, but are unwilling or unsuitable for invasive therapies.”

The study focused on 3 acupuncture points. This protocolized approach is common in scientific investigations and varies from standard clinical practice in which customization of the acupuncture point prescription is applied for specific diagnostic considerations. Despite the limitations of a standardized set of acupuncture points across all patients in the study, 79% of all patients showed significant clinical improvements. In a real-life situation, a licensed acupuncturist has the ability to adjust the protocol to meet the specific individual needs of the patients. As a result, a licensed acupuncturist can potentially exceed the success rate achieved in this protocolized approach to care.

Acupuncture was applied at a rate of once per week for a total of 10 weeks. Each acupuncture treatment session was 30 minutes in length. Urodynamic studies and evaluations confirm that this regime of care is both safe and effective for the treatment of Nocturia or frequent urination at night.

The researchers conclude that acupuncture is an effective treatment modality for patients suffering from frequent urination at night or overactive bladder syndrome and “is well tolerated with no side effects or complications.” As a result, the research team notes that acupuncture “should be considered as a potential alternative treatment to our current therapeutic regimes” for patients with Nocturia or frequent urination at night.

CLINICAL DIAGNOSIS OF NOCTURIA AND ACUPUNCTURE TREATMENT

The main basis for treatment is that illness and pain occur when the body’s qi, or vital energy, cannot flow freely. There can be many reasons for this; emotional and physical stress, poor nutrition, infection or injury are among the most common.Even without increased nighttime urine production, reduced bladder capacity and increased urinary frequency can give rise to nocturia or frequent urination at night.

Urinary tract infections are one of the most common causes of changes to bladder capacity. They can also occur among people who have enlarged prostate, benign prostatic hyperplasia , or overactive bladder.

A heightened urge to urinate, inflammation of the urinary tract, and bladder stones can all be risk factors for diminished bladder capacity and increased urinary frequency that can lead to nocturia or frequent urination at night.

Some people experience increased urinary frequency and urgency throughout the day while others find them to occur primarily at night.

Because it can have significant health consequences and connections to other illnesses, it is important to talk to your doctor about bothersome nocturia or frequent urination at night. The Acupuncture doctor can help identify the most likely cause and give the best therapy for any specific individual.

When an underlying condition is causing nocturia or frequent urination at night, treating that condition may reduce the nighttime trips to the bathroom. Many patients with nocturia are treated with medications or have adjustments to their existing medications (such as diuretics).

A number of lifestyle changes and Acupuncture treatment can help reduce problematic nocturia and give complete relief. These changes are designed to reduce nocturnal urine production or frequent urination at night.

EFFECTIVENESS OF ACUPUNCTURE TREATMENT

Overactive bladder is a clinical diagnosis characterized by the presence of bothersome urinary symptoms including urgency, frequency, nocturia and urgency incontinence. Although Overactive Bladder symptoms with and without incontinence place a considerable burden on quality-of-life, quality-of-sleep, and mental health in both men and women, medical options (both medication and behavioral approaches) are only partially effective.

Acupuncture is defined as a method of relieving symptoms or curing illness by placing needles into the skin at particular points, known as acupoints, on the body. Needles can be stimulated electrically (electroacupuncture), and heat and moxibustion can be applied through the needle. Studies suggest that acupuncture compares favorably to tolterodine and is a viable long term therapy.

Acupuncture is known to have analgesic, neuromodulation or hormonal effects via peripheral and central mechanisms and gives the best remedy for frequent urination at night. Among the possible mechanisms, acupuncture may act as a method of neuromodulation in controlling Overactive Bladder. The mechanism of action of acupuncture that induces the stimulation of neuromodulation of the bladder is not precisely understood. Mechanical stimulation seems to produce signaling via the sensory ganglia and interneurons to the spinal cord which modulates the activity of the motor neurons in the brainstem that control autonomic function, including urogenital activity, such as the detrusor and sphincter muscles. Several studies support acupuncture as an effective treatment option for Nocturia or frequent urination at night.Several reviews of Overactive Bladder symptoms have focused on acupuncture or included acupuncture as one of the best treatment modalities.

MECHANISM OF ACUPUNCTURE

Acupuncture was described as a successful treatment for certain overactive bladder symptoms in the 1980s and since then, a number of clinical trials on incontinence and Nocturia or frequent urination at night have been carried out. There have been numerous clinical trials and some randomized controlled trials on urinary incontinence and Nocturia or frequent urination at night due to bladder instability or stress incontinence.

The acupoints used in the studies were selected based on Korean Medicine theory, and their mechanism may be understood with reference to the autonomic and somatic nerve innervations to the bladder. Certain studies have indicated that acupuncture may influence the autonomic nerve system

The muscles controlling micturition are controlled by the autonomic and somatic nervous system. The detrusor muscle is relaxed by sympathetic stimulation that originates from the lumbar spinal cord T11-L2 region, and contracted by parasympathetic stimulation from the sacral spinal cord S2-4 region. The external urethral sphincter is under somatic control. Therefore, the coordination of the autonomic and somatic nerves to the bladder and urethra is important not only in micturition, but also in incontinence and Nocturia.

The points that are most commonly used in acupuncture are BL31, BL32 and BL33, which are located above the first, second and third sacral foramina, which lie over the first, second and third sacral nerve roots, respectively. These points are frequently used, due to the fact that they correspond with the segmental innervation of the parasympathetic nerve supply to the bladder.

The acupuncture points that are known to affect the micturition center and parasympathetic innervation to the urinary system include BL23, BL28 and several points on one of the eight extra meridians in the lower abdomen. BL23 is located at the L2 level, BL28 is located paravertebrally from the second sacral foramina and points three, four and six on the CV are located in between the pubic and the umbilical cord

ACUPUNCTURE FOR NOCTURIA

In Korean Medicine, acupoints SP6, ST36 and KI3, located on the legs, are also considered to assist bladder function by invigorating energy. Furthermore, these acupoints on the legs correspond to the skin dermatomes from L4-S2 innervation, which means that stimulation of these points may influence bladder function and reduce the symptoms of frequent urination at night. Similarly, points three, four and six on the CV correspond to the skin dermatomes from T11-L1.

Since the afferent and efferent innervations of the bladder are affected by the sympathetic nerves originating at T11-L2, as well as the parasympathetic and somatic nerves originating at S2-4, these acupoints appear to be strongly organized segmentally.

The locations of BL31, BL32 and BL33 correspond with the origin of the somatic fibers of the pudendal nerve, which provide excitatory innervation to the pelvic floor muscles and the sphincter so that they are able to remain in a contracted state.

Acupoint ST36 activated the neural brainstem-thalamus-cortex reticular system and increased the neurotransmitter concentrations. It is for this reason that acupuncture has been proposed to affect Nocturia or frequent urination at night through the descending serotonergic system. At present, there are numerous experimental and clinical data supporting the theory that the serotonergic input facilitates glutamate-induced activation of the pudendal nerve, and thereby helps to maintain the external urethral sphincter in a closed state. However, there are also physiological similarities between muscle training and acupuncture, and there have been suggestions that acupuncture may be regarded as an artificial method of muscle training. With regard to the insertion depth of the acupuncture needles, it has been observed that the majority of the studies concerning acupuncture have focused on the efficacy of the acupoint itself.

RELIEF FOR NOCTURIA

The area of acupuncture that is predominantly focused upon is its analgesic effect on pain, and therefore most of the studies or trials concerning the depth of acupuncture have been restricted to its pain relieving effects . Furthermore, it has been demonstrated that, with regard to analgesic effects, the insertion of acupuncture needles into the muscles affects the nociceptors thereby giving relief for frequent urination at night.

For the purpose of skin dermatome stimulation, the acupuncture needle has to be inserted shallowly, so that it only penetrates the skin. With regard to urinary dysfunction, the acupoints on the limbs are associated with the skin dermatomes from the spinal innervation that influence bladder function, as are the acupoints on the lower abdomen (CV 3, 4 and 6). Therefore, when acupuncture is applied to these acupoints, in order to influence bladder function, it is necessary for the depth of insertion to be no deeper than the skin. However, if the purpose is to stimulate the muscle or nerve, a deeper insertion is required. Therefore, it is necessary for the needles at the acupoints on the spinal part of the BL meridian to be inserted deeper than those at other BL points to give the best remedy for frequent urination at night. In addition, it is necessary that the application of acupuncture to strengthen the muscle that assists the act of urination has a penetration that is sufficiently deep for the muscle to be reached

Studies have shown that acupuncture is effective for relieving the symptoms of Overactive Bladder symptoms or frequent urination at night.Therefore, aside from the acupuncture point itself, there is a requirement for the insertion depth of the acupuncture needle to differ according to the intention of the stimulation.

BEST CURE FOR NOCTURIA

Looking for the best relief for Nocturia or frequent urination at night in Chennai, here’s why you should reach out to the expert Acupuncturist. A. Shaji Bharath from the best rated clinic Dr.Bharath’s Acu Heal. He is currently treating patients for a wide range of conditions. As a best acupuncture practitioner with 15 years of experience, and having worked with several Urologists,Neurologists and Otolaryngologists, Acupuncturist. A. Shaji Bharath can create the treatment plan for the best cure for Nocturia or frequent urination at night to manage the condition that's tailored to your needs, which can break a cycle of repeated urination. As the top acupuncture doctor for Nocturia or frequent urination at night in Chennai, he has witnessed acupuncture doing wonders on people suffering from Nocturia or frequent urination at night. The effectiveness rate increases several times just with one course of Acupuncture and a specialized expertise in Urology and other nephrology disorders are warranted. So, take some time to find the right pain management and best remedy for acupuncture approach that suits you. Most of the people swear by acupuncture, citing it as a best cure and a ‘miracle’ to improving their quality of life.

Dial: +91 9884746916 or Visit: drbharathsacuheal.com for more details on treating frequent urination at night using Acupuncture, by contacting the top acupuncture doctor in Chennai.

TREAT NOCTURIA WITHOUT SURGERY

All surgery comes with risks, including

• infection
• accidental injury
• bleeding
• pain
• problems with anesthesia

Post-surgical risks of bladder surgery include:

• issues with the tube that remains outside your body
• issues with skin at the surgical site
• urine leakage

Frequent urination at night can be treated without surgery. Acupuncture can offer a holistic approach in treating Nocturia or frequent urination at night. Several studies support acupuncture as a potentially useful option.

Acupuncture involves extremely fine-tipped needles. These needles are inserted in very specific areas of the body. The objective of acupuncture is to improve the flow of “qi” (energy) throughout the body. Treatment can be done once or twice a week for about 12 sessions, or until symptoms improve.The best doctor likely will try non invasive treatments. They may recommend fluid and dietary changes and pelvic muscle exercises.

In Acupuncture treatment, people are able to retrain their bladders to function better. In bladder training, you practice delaying urination to build longer time intervals, or schedule urination for appropriate intervals

BEST ACUPUNCTURE DOCTOR NEAR ME

To choose the Best doctor for Acupuncture, it's important that the Acupuncturist should have a decade of experience and treated at least 1000 to 2000 patients.

You can also search for the Best Acupuncture Doctor near me or ask your primary care physician to refer an experienced Acupuncturist nearby. Once you find the Best Acupuncture Doctor in Chennai, you may go through their google reviews first and then fix an appointment with the doctor only when you are satisfied with the reviews.

The Best Acupuncture Doctor should address your concerns and help you feel more comfortable before your first session. Acupuncture usually takes numerous sessions or several weeks to get a complete cure in any ailment but within 3 or 4 sessions the patients will experience positive differences.

BEST ACUPUNCTURE CLINIC NEAR ME

Owing to the demand for the treatment, there are numerous clinics popping up and it is sometimes skeptical to choose the best or even the safe one. To address such concerns, you can look into the following points to choose the best acupuncture clinic for Overactive bladder or frequent urination at night. Acupuncture is also offered in hospital pain clinics and by healthcare organizations but it is ideal to visit the best Acupuncture Clinic for Nocturia or frequent urination at night. If you are not sure, it would be a good idea to contact your local doctor to see if they would be prepared to refer to the best rated acupuncture clinics. For example in cases where a patient specifically requests acupuncture for Nocturia or frequent urination at night, or where it is felt that acupuncture would complement conventional treatment. In some cases acupuncture is offered in top rated acupuncture clinics near me because conventional treatment has failed or produces unacceptable side effects.

Most of the best acupuncture clinics for Overactive Bladder symptoms or will spell out very clearly

• what type of acupuncture they practice
• how much they charge
• how professional they are - at present anyone can set themselves up as an acupuncturist but reputable practitioners will belong to an organization
• whether the premises are hygienic and smart
• what other therapies they offer

So while you are filtering the best clinics for acupuncture that treats Nocturia or frequent urination at night, you can look out for these factors

We have been rewarded a 5-star rating from Google & Practo. You can also check the reviews there.

THE BOTTOM LINE

If you have recurring Overactive Bladder or are looking to try alternative treatments, acupuncture may be worth a shot. Just make sure you see a licensed acupuncturist and keep up with any prescribed treatments.

SCIENTIFIC REFERENCES:

• E.A. Gormley, D.J. Lightner, K.L. Burgio, T.C. Chai, J.Q. Clemens, D.J. Culkin, A.K. Das, H.E. Foster Jr., H.M. Scarpero, C.D. Tessier, S.P. Vasavada
  Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline
  J. Urol., 188 (6 Suppl) (2012), pp. 2455-2463
• B.T. Haylen, D. de Ridder, R.M. Freeman, S.E. Swift, B. Berghmans, J. Lee, A. Monga, E. Petri, D.E. Rizk, P.K. Sand, G.N. Schaer
  An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction
  Neurourol. Urodyn., 29 (1) (2010), pp. 4-20
• P. Abrams, L. Cardozo, M. Fall, D. Griffiths, P. Rosier, U. Ulmsten, P. Van Kerrebroeck, A. Victor, A. Wein
  The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society
  Urology, 61 (1) (2003), pp. 37-49

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FAQ:

What are the services provided for nocturia by Dr. Bharath’s Acu Heal?

Nocturia describes needing to wake up at night in order to urinate. If you wake up more than one time each night to go to the bathroom, you may have nocturia. Sleep disruption from having to urinate during the night can impact your quality of life. About 1 in 3 adults over the age of 30 experience nocturia. The rate of people affected increases with age .Nocturia is a common symptom in the elderly. It can be caused by a lifestyle habit or an underlying health problem.

Underlying health conditions can cause nocturia. For example: diabetes, aging, high blood pressure, heart disease, vascular disease or congestive heart failure, overactive bladder symptoms, prostate obstruction, vaginal prolapse, uterine prolapse etc.

After a thorough investigation by pulse and tongue diagnosis, condition of the disease is understood by the Acupuncturist .

The treatment will be given based on the disease’s chronicity and acuteness. In the first few sessions, positive changes in symptoms may be experienced and after several more sessions there are 90 to 100% chance that the patient be cured of the disease .

This treatment will help in inducing sound sleep which will help and play a vital role in reversing this disease. Simultaneously the patient will be advised on a diet and exercise regime.

What are the benefits of acupuncture for nocturia?

This is a drugless therapy and there are no side effects. During or after completing the course of treatment any form of medication if any can be stopped.

How many sessions do you need for nocturia?

It takes around 20 to 30 sessions in a period of 2 to 4 months.