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Werlauff U, Handberg C, Kristensen B, Glerup S, Pharao AV, Strøm J, Jensen BT. HAP-PEE: A Danish National Study of Challenges Related to Urinating When Away from Home in Women with Neuromuscular Diseases, Impact on Activity and Participation and Prevalence of Lower Urinary Tract Symptoms. J Neuromuscul Dis 2024; 11:829-838. [PMID: 38820020 PMCID: PMC11307087 DOI: 10.3233/jnd-230241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/02/2024]
Abstract
Background Little is known about the challenges faced by women with a neuromuscular disease (NMD) when having to go to the toilet in other places than home; a topic that is highly important for participation and bladder health. Objective The aim was to investigate whether women with NMD have problems in going to the toilet when not at home, the problems' impact on their social activities, education, and working life, which strategies they use to manage the problems, and the prevalence of lower urinary tract symptoms (LUTS). Methods A national survey containing questions on type of NMD, mobility, impacts on social activities, education, working life, and bladder health was developed by women with NMD and researchers. LUTS were assessed by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS). Female patients≥12 years (n = 1617) registered at the Danish National Rehabilitation Centre for Neuromuscular Diseases were invited. Results 692 women (43%) accepted the invitation; 21% were non-ambulant. 25% of respondents avoided going to the toilet when not at home. One third of respondents experienced that problems in going to the toilet impacted their social life. 43% of respondents refrained from drinking to avoid voiding when not at home, 61% had a low frequency of urinating, 17% had experienced urinary tract infections, and 35% had experienced urine incontinence. Problems were seldom discussed with professionals, only 5% of participants had been referred to neuro-urological evaluation. Conclusion The results highlight the difficulties in urinating faced by women with NMD when not at home and how these difficulties impact functioning, participation, and bladder health. The study illustrates a lack of awareness of the problems in the neuro-urological clinic. It is necessary to address this in clinical practice to provide supportive treatment and solutions that will enable participation for women with NMD.
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Affiliation(s)
- Ulla Werlauff
- National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
| | - Charlotte Handberg
- National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Bente Kristensen
- National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
| | | | | | | | - Bente Thoft Jensen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Mueller ER, Weiss JP, Bosch JLHR, Chughtai B, Rosenberg MT, Bacci ED, Simeone JC, Andersson FL, Juul K, Coyne KS, Chapple CR. Nocturnal polyuria in women: results from the EpiNP study. Int Urogynecol J 2023; 34:1743-1751. [PMID: 36708403 DOI: 10.1007/s00192-022-05432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/22/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Data from a large US population-based, cross-sectional, epidemiological study (the EpiNP Study) were used to assess the symptoms and bother experienced by women with nocturnal polyuria (NP). METHODS Consenting participants recruited from an online panel completed the baseline EpiNP survey online (Lower Urinary Tract Symptoms Tool and urological comorbidities). All reporting ≥2 voids/night and a random sample of 100 respondents, each reporting 0 or 1 void/night were asked to complete a 3-day web-based bladder diary recording time, volume, and urgency rating of each void. NP was calculated by the proportion of urine production that occurred during nocturnal hours using a Nocturnal Polyuria Index (NPI33) threshold of >0.33 or nocturnal urine production of >90 ml/h (NUP90). The frequency of participants reporting LUTS and bother was determined by age and NP: idiopathic NP, NP associated with overactive bladder (NPOAB), NP associated with comorbidities (NPCom), and no NP (did not meet NP criteria). RESULTS A total of 5,290 women completed the baseline survey. Mean age (range) was 54.9 (30-95) years; 1,841 (34.8%) reported ≥2 nocturnal voids. The prevalence of LUTS increased across the lifespan; however, bother associated with each LUTS decreased with increasing age. The percentage of women rating bother by nocturia episodes ≥2 "> somewhat" ranged from 40.3% to 68.3%, with bother ratings highest in the NPOAB and No NP groups. CONCLUSIONS NP is prevalent in women with considerable bother and is often associated with other urinary symptoms. Multifactorial causes and potential treatments of NP should be considered, particularly at a later age.
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Affiliation(s)
| | - Jeffrey P Weiss
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | | | | | | | | | | | | | - Karin S Coyne
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
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Ramsay S, Zagorodnyuk V. Role of circadian rhythms and melatonin in bladder function in heath and diseases. Auton Neurosci 2023; 246:103083. [PMID: 36871511 DOI: 10.1016/j.autneu.2023.103083] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
The circadian system modulates all visceral organ physiological processes including urine storage and voiding. The "master clock" of the circadian system lies within suprachiasmatic nucleus of the hypothalamus while "peripheral clocks" are found in most peripheral tissue and organs, including the urinary bladder. Disruptions of circadian rhythms can cause organ malfunction and disorder or exacerbate pre-existing ones. It has been suggested that nocturia, which develops mostly in the elderly, could be a circadian-related disorder of the bladder. In the bladder, many types of gap junctions and ion channels in the detrusor, urothelium and sensory nerves are likely under strict local peripheral circadian control. The pineal hormone, melatonin, is a circadian rhythm synchroniser capable of controlling a variety of physiological processes in the body. Melatonin predominantly acts via the melatonin 1 and melatonin 2 G-protein coupled receptors expressed in the central nervous system, and many peripheral organs and tissues. Melatonin could be beneficial in the treatment of nocturia and other common bladder disorders. The ameliorating action of melatonin on bladder function is likely due to multiple mechanisms which include central effects on voiding and peripheral effects on the detrusor and bladder afferents. More studies are warranted to determine the precise mechanisms of circadian rhythm coordination of the bladder function and melatonin influences on the bladder in health and diseases.
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Affiliation(s)
- Stewart Ramsay
- Discipline of Human Physiology, Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Vladimir Zagorodnyuk
- Discipline of Human Physiology, Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, South Australia, Australia.
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Aucar N, Fagalde I, Zanella A, Capalbo O, Aroca-Martinez G, Favre G, Musso CG. Nocturia: its characteristics, diagnostic algorithm and treatment. Int Urol Nephrol 2023; 55:107-114. [PMID: 35945304 DOI: 10.1007/s11255-022-03317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/25/2022] [Indexed: 01/05/2023]
Abstract
Nocturia is the complaint that an individual has to wake up at night one or more times to urinate. It is a frequent condition among older adults and entails detrimental effects with regard to sleeping, sexual activity, comfort, depression, mental function and vitality. It is clinically important to distinguish it from global polyuria, defined as a urinary rate ≥ 125 ml/h (3000 ml/day), as well as from nocturnal polyuria, which is an abnormally large volume of urine during sleep associated with a decreased daytime urine production. A Frequency Volume Chart (FVC), overnight water deprivation test with renal concentrating capacity test, and the nocturnal bladder capacity index are some of the methods that help establish the underlying pathology of this condition and hence define an adequate treatment plan.
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Affiliation(s)
- Nahir Aucar
- Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ines Fagalde
- Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Akemi Zanella
- Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Olivia Capalbo
- Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo Aroca-Martinez
- Universidad del Norte, Barranquilla, Colombia.,Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia
| | - Gabriel Favre
- Urology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carlos G Musso
- Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. .,Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia.
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Singer J, O'Connell KA. Relationship of cue-induced urinary urges to nocturia in women ages 18 to 40 years. Neurourol Urodyn 2019; 38:1378-1383. [PMID: 30939224 DOI: 10.1002/nau.23996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/16/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022]
Abstract
AIMS Although physiological factors have a role in nocturia, research suggests that behavioral processes, especially classical conditioning may also play an important role in nocturia and other lower urinary tract symptoms. The study aimed to assess the relationship of stimulus-associated urges during the day to nocturia in a sample of women aged 18 to 40, after controlling for physiological symptoms (eg, overactive bladder [OAB]; daytime frequency). METHODS An online study was conducted using a panel of 356 female participants between the ages of 18 to 40. One-third of the participants self-reported an OAB diagnosis as determined by their physician. Almost 80% of participants reported having at least one nocturnal voiding per night. Participants completed the Urinary Cues Questionnaire, which assessed the frequency with which respondents experienced the urge to urinate in the presence of a variety of cues and the Overactive Bladder Screening Scale (OABSS), which assesses symptoms of OAB syndrome. RESULTS Controlling for OABSS scores and daytime urinary frequency, the Situational Cues Subscale had a significant relationship with nocturia such that with each unit increase in the subscale, the probability of nocturia increased by 12% to 14% depending on the definition of nocturia. DISCUSSION Behavioral techniques, such as habituation to decrease the association between awakening at night and feeling an urge to urinate, may be an appropriate intervention to mitigate nocturnal urination. Theoretically, this would translate to decreasing this disorder throughout the lifespan, if behavioral techniques could be effectively utilized in early adulthood.
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Affiliation(s)
- Jonathan Singer
- Department of Clinical Psychology, University of Nevada, Reno, Nevada
| | - Kathleen A O'Connell
- Department of Health and Behavior Studies, Teachers College Columbia University, New York City, New York
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Effects of two nonpharmacological treatments on the sleep quality of women with nocturia: a randomized controlled clinical trial. Int Urogynecol J 2018; 30:279-286. [DOI: 10.1007/s00192-018-3584-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/27/2018] [Indexed: 01/26/2023]
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Bower WF, Rose GE, Ervin CF, Goldin J, Whishaw DM, Khan F. TANGO - a screening tool to identify comorbidities on the causal pathway of nocturia. BJU Int 2017; 119:933-941. [PMID: 28075514 DOI: 10.1111/bju.13774] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop a robust screening metric for use in identifying non-lower urinary tract comorbidities pertinent to the multidisciplinary assessment of patients with nocturia. METHODS Variables having a significant risk association with nocturia of greater than once per night were identified. Discriminating items from validated and reliable tools measuring these comorbidities were identified. A self-completed 57-item questionnaire was developed and a medical checklist and pertinent clinical measures added. Pre-determined criteria were applied to retain or remove items in the development of the Short-Form (SF) screening tool. The tool was administered to 252 individuals with nocturia who were attending either a tertiary level Sleep, Continence, Falls or Rehabilitation service for routine care. Data collected were subjected to descriptive analysis; criteria were applied to reduce the number of items. Using pre-determined domains, a nocturia screening metric, entitled TANGO, was generated. The acronym TANGO stands for Targeting the individual's Aetiology of Nocturia to Guide Outcomes. RESULTS The demographic characteristics of the sample are described, along with item endorsement levels. The statistical and structural framework to justify deleting or retaining of items from the TANGO Long-Form to the SF is presented. The resultant TANGO-SF patient-completed nocturia screening tool is reported. CONCLUSIONS A novel all-cause diagnostic metric for identifying co-existing morbidities of clinical relevance to nocturia in patients who present across disciplines and medical specialties has been developed. TANGO has the potential to improve practice and smooth inequalities associated with a siloed approach to assessment and subsequent care of patients with nocturia.
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Affiliation(s)
- Wendy F Bower
- Department of Rehabilitation, Royal Melbourne Hospital, Parville, Vic., Australia
- Sub-Acute Community Services, Royal Melbourne Hospital, Parville, Vic., Australia
| | - Georgie E Rose
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parville, Vic., Australia
| | - Claire F Ervin
- Sub-Acute Community Services, Royal Melbourne Hospital, Parville, Vic., Australia
| | - Jeremy Goldin
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parville, Vic., Australia
| | - David M Whishaw
- Department of Aged Care, Royal Melbourne Hospital, Parville, Vic., Australia
- Department of Urology, Royal Melbourne Hospital, Parville, Vic., Australia
| | - Fary Khan
- Department of Rehabilitation, Royal Melbourne Hospital, Parville, Vic., Australia
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Abstract
Nocturia is a common but overlooked lower urinary tract symptom that substantially reduces patient health and quality of life. Though traditionally viewed as occurring predominantly in males, nocturia has been found to be equally as prevalent in females. The recent emphasis on the importance of nocturia has resulted in a surge of research studies, providing a foundation for current and future management decisions. In this review, we describe the current recommendations for the female patient in light of the most recently published studies, including a unique interest in predicting treatment response.
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Affiliation(s)
- Andrew Chang
- Medical Scientist Training Program, Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA,
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Excessive daytime sleepiness and nocturia in women. Sleep Med 2014; 15:677-80. [DOI: 10.1016/j.sleep.2014.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
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10
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Presence of multiple peripheral circadian oscillators in the tissues controlling voiding function in mice. Exp Mol Med 2014; 46:e81. [PMID: 24603368 PMCID: PMC3972783 DOI: 10.1038/emm.2013.153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/28/2013] [Accepted: 11/08/2013] [Indexed: 01/23/2023] Open
Abstract
Circadian clocks are the endogenous oscillators that harmonize a variety of physiological processes within the body. Although many urinary functions exhibit clear daily or circadian variation in diurnal humans and nocturnal rodents, the precise mechanisms of these variations are as yet unclear. In the present study, we demonstrate that Per2 promoter activity clearly oscillates in neonate and adult bladders cultured ex vivo from Per2::Luc knock-in mice. In subsequent experiments, we show that multiple local oscillators are operating in all the bladder tissues (detrusor, sphincter and urothelim) and the lumbar spinal cord (L4–5) but not in the pontine micturition center or the ventrolateral periaqueductal gray of the brain. Accordingly, the water intake and urine volume exhibited daily and circadian variations in young adult wild-type mice but not in Per1−/−Per2−/− mice, suggesting a functional clock-dependent nature of the micturition rhythm. Particularly in PDK mice, the water intake and urinary excretion displayed an arrhythmic pattern under constant darkness, and the amount of water consumed and excreted significantly increased compared with those of WT mice. These results suggest that local circadian clocks reside in three types of bladder tissue and the lumbar spinal cord and may have important roles in the circadian control of micturition function.
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Kim SC. Editorial comment to Nocturnal polyuria and decreased serum testosterone: is there an association in men with lower urinary tract symptoms? Int J Urol 2013; 21:524. [PMID: 24286555 DOI: 10.1111/iju.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sae Chul Kim
- Department of Urology, Myongji Hospital, Goyang, Gyeonggi-do, Korea.
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Nocturia Now. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-012-0163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Relations between Enuresis in Childhood and Nocturnal Polyuria Syndrome in Adult Life. Int Neurourol J 2012; 16:37-40. [PMID: 22500252 PMCID: PMC3321402 DOI: 10.5213/inj.2012.16.1.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 03/13/2012] [Indexed: 11/08/2022] Open
Abstract
Purpose The aim of this study, to investigate whether there is any association between enuresis in childhood and nocturnal polyuria syndrome (NPS) in adult life. Methods The study consisted of thirty five patients with nocturnal polyuria, and thirty five healthy people without nocturnal polyuria in adult life, were asked to assess their enuresis in childhood. Results There was a history of enuresis in childhood in 18 (51.42%) of 35 of men with nocturnal polyuria and in 4 (11.42%) of 35 without nocturnal polyuria. Enuresis in childhood was significantly more common in men with nocturnal polyuria than without nocturnal polyuria. The difference was significant (P<0.0001). The prevalence of enuresis in the nocturnal polyuria (51.42%) was more than two-fold higher than reported prevalence in general populations. Conclusions The results of this study suggest that the history of enuresis in childhood seems to increase the risk of having NPS in adult life. This relationship should be taken into account in the evaluation of men with complaints from NPS in adult life and the possible common pathophysiology should be considered in the treatment planning.
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