Nocturia is the need to wake up during the night to empty your bladder. It can be common in multiple sclerosis, particularly if you need to use the toilet often during the day (urinary frequency) or if you have difficulty emptying your bladder completely. There are also a number of other possible causes, so it is important that you get nocturia investigated if it something you experience.
The sleep disturbance that nocturia causes can lead to tiredness during the day and contribute to MS fatigue. As such, nocturia can have a significant effect on quality of life.
What is nocturia?
Nocturia is the need to get up at night to pass urine. It is normal to get up once a night, but getting up twice or more may cause daytime tiredness. People with severe nocturia may get up five or six times during the night.
What causes nocturia?
In MS you are more likely to experience nocturia if you usually need to use the toilet often during the day (urinary frequency) or if you have difficulty emptying your bladder. Urinary tract infections can also increase the need to urinate, including at night. As with the general population, drinking caffeinated drinks or alcohol before bedtime and other poor sleep patterns can result in nocturia.
Nocturia can also be caused by health problems such as diabetes, so do get it checked out by health professionals.
How many people have nocturia?
Studies have shown that needing the toilet at night is common in MS and affects around seven out of ten people with MS. Despite being a frequent issue, nocturia is often under-treated. Some people with MS may put up with sleep disruption and fatigue when nocturia can be treated.
What can I do if I have nocturia?
Talk to a health professional if you find that you are getting up more than once or twice at night to make trips to the toilet. This could be your MS specialist nurse, GP or continence advisor. Many people feel a sense of shame and embarrassment about bladder problems and feel awkward raising them with health professionals. All health professionals should understand that MS has an impact on how the bladder works so don't be shy in raising this.
Reduce the amount you drink before bedtime, ensure that you still drink the recommended daily amount of six to eight cups of fluid, but having your last drink before 8pm can help.
Drink less caffeinated drinks as these can irritate your bladder and change your sleep patterns.
Determine if there is anything else that is disturbing your sleep. Other MS symptoms such as spasms, anxiety, depression or neuropathic pain may disturb your sleep and you are more likely to need to urinate if you are awake. Some medications have side effects that include increasing urinary frequency. Talk to your health professionals about managing these symptoms and the possibility of substituting any medications which may be causing your nocturia.
How is nocturia treated?
Treatments for nocturia also include treatment for bladder frequency as reducing the general need to urinate throughout the day can help to reduce the need to get up in the night to urinate.
Drug treatments include antimuscarinic medications, which can reduce the feeling of urgency, and cut down the night time visits to the bathroom. A medication called desmopressin may also be used to treat nocturia. This acts by reducing the amount of urine produced by the kidneys for six to eight hours. It is not available for people who are over 65, diabetic or on blood pressure medication.
Physiotherapy is a possible treatment for nocturia and bladder frequency, particularly where it results in bladder incontinence. The aim is to increase the muscle tone of the pelvic floor with exercises.
Botox (Botulism toxin) can be used to reduce the activity of the bladder muscles. This can be very effective, but wears off after a few months, so may need to be repeated.
Nerve stimulation - stimulating the tibial nerve in the leg can in some cases interfere with the nerve signals going to the bladder. This can reduce the need to urinate.
A study of sativex on urinary problems in MS found small, but not statistically significant, improvements in nocturia.
There is a study of the effects of melatonin on nocturia in MS currently under way.
- Journal of Urology. 2017 Feb;197(2):432-437 Summary Nocturnal Urinary Disorders and Multiple Sclerosis: Clinical and Urodynamic Study of 309 Patients.
- Neurology 2004;63(11 Suppl 5):S12-18. Summary A multimodal approach to managing the symptoms of multiples sclerosis.
- Sleep Medicine 2014;15(1):5-14. Summary Sleep disorders in multiple sclerosis and their relationship to fatigue.
- J Phys Ther Sci. 2017 Jul; 29(7): 1259–1263. Full article Effects of physiotherapy treatment for urinary incontinence in patient with multiple sclerosis
- BMC Neurol. 2017 Mar 27;17(1):63. Full article Protocol for a randomized, double blind, placebo controlled, crossover trial of Melatonin for treatment of Nocturia in adults with Multiple Sclerosis (MeNiMS).
Bladder problems are common symptoms in multiple sclerosis but successful treatment is available and lifestyle changes can make a real difference.
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