It is not unusual to feel the urge to urinate at night. However, when this happens frequently, and you have to get up more than twice to go to the bathroom, it becomes a problem called Nocturia. As Carlos Hernández, head of the urology service at the Gregorio Marañón Hospital in Madrid explains: “Getting up three to six times a night to urinate poses many problems. The most common is the loss of quality of sleep, feeling tired when waking up, and even a weakened immune system.

“Nocturia is a symptom that causes a considerable decrease in the quality of sleep in people who suffer from it. One of the causes of Nocturia is prostate hyperplasia. This condition, generally benign, consists of an increase in the size of the prostate that partially obstructs the urethra, which prevents the emptying of the bladder”, explains the expert.

When someone with this problem urinates, they only release part of the accumulated fluid, one third or two thirds, depending on each patient. This insufficient emptying causes the bladder to refill after a short period of time, forcing the patient to evacuate again.

Anyone can get Nocturia, but it is most common in those over 50. This benign prostatic hyperplasia caused by Nocturia affects most men to varying degrees throughout their lives. Between 80 and 95 per cent of men over 80 have it.

It is considered that the androgenic stimulus is what causes the proliferation of the prostate tissue and, therefore, the size of the prostate. The prostate begins to enlarge around the fourth decade of life, and over time, this enlargement and proliferation of tissues accelerate. The balance between estrogen and testosterone levels also appears to influence the development of benign prostatic hyperplasia. “Patients with Nocturia go to the urologist before patients with benign prostatic hyperplasia who do not suffer dysfunction. This fact shows how the symptom can be annoying for patients”, explains the specialist. In fact, how nighturia affects the quality of life was also measured, showing a notable decrease.

The possible consequences of this Nocturia can affect sleep or depression.

Impact on sleep

Hernández has shown that patients with nocturnal prostatic hyperplasia require more treatment than those without this symptom. “The therapy that has shown the greatest effectiveness are alpha-blockers, which relax the muscles of the prostate, allowing easier emptying of the bladder and reducing nocturnal symptoms.

If patients do not improve with alpha-blockers, they only have the option of surgery: “The surgical solution tries to reduce hyperplasia by reducing the size of the prostate to facilitate emptying.”

Hyperplasia is a progressive disease. Some patients stabilize; however, more than 50 per cent make their symptoms worse, increasing discomfort, a sense of urgency and the frequency of urination during the day, leading to urinary incontinence.

Depression

Knowing the number of awakenings is important to estimate how Nocturia affects: “The more there is, the greater the impact on the quality of life of the affected person,” explains Emmanuel Chartier-Kastler, professor of urology at The Pierre and Marie Curie. School, of the University of Paris, which advocates the need for an accurate evaluation of patients, including the number of nocturnal urination, their quantity and the periods of insomnia after nocturnal awakenings.

According to the World Health Organization, recommendations to prevent or control these symptoms may include the following:

• Eat a diet rich in vegetables (broccoli, cauliflower, cabbage, cabbage, watercress, tomatoes, radishes), fruits, legumes, soybeans and derivatives, and low in red meat, saturated fat, salt, sugar and calcium.
• Eat whole grains and fats of vegetable origin.
• Avoid being overweight and obese by doing sports.
• Lie down in a horizontal position.
• Avoid long trips that make us go a long time without urinating.