Nocturia

Author: Jane Meijlink

Last Updated: June 2018

Current ICS Definition

2018:

Definition: Waking to pass urine during the main sleep period (FN1).

Symptom: Waking at night to pass urine.

Sign: The number of times an individual passes urine during their main sleep period. Should be quantified using a bladder diary.

The new definition reflects the fact that nocturia is firstly a symptom, which may or may not be a complaint (i.e. of an abnormality), with mixed and multiple etiologies.

(FN1): The first nocturia episode must be preceded by sleep. Subsequent nocturia episodes must be followed by the intention of getting back to sleep. The quality of life impact of nocturia is not an element in its definition but will be appropriately evaluated during its assessment by fully validated quality of life questionnaires.

Old ICS Definitions

2002: The complaint that the individual has to wake at night one or more times to void (2).

2010: Complaint of interruption of sleep one or more times because of the need to micturate (3). Each void is preceded and followed by sleep.

Controversies

The new 2018 standardisation document states that nocturia must be preceded by sleep and that “individuals who go to bed, with the intention of sleeping, but cannot sleep and need to void at least once before falling asleep will have increased daytime frequency”. This would be clarified by a voiding diary which must clearly state at what time the patient goes to bed with the intention of sleeping.

Since recording pre-sleep voiding as daytime frequency could give a wrong impression in conditions where night-time frequency is of particular importance with regard to diagnosis, what terminology should be used (for the time being) for patients with a painful or hypersensitive bladder who go to bed with the purpose of sleeping but are unable to fall asleep for hours due to pain, discomfort or other hypersensitivity sensation in the bladder with a persistent need to void? Should this be described as nocturnal frequency or night-time frequency since it cannot be described as nocturia since the patient has not woken from sleep?

It is to be hoped that this aspect relating to a specific group of patients will be clarified in a revision of lower urinary tract dysfunction standards.

References

  1. Hashim H, Blanker MH, Drake MJ, Djurhuus JC, Meijlink J, Morris V, Petros P, Wem JG, Wein A. An International Continence Society Report on the Terminology for Nocturia and Nocturnal Lower Urinary Tract Function. Neurourol Urodyn……………

  2. Van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, et al. The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):179-83.

  3. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20.

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