Continence Physiotherapy Network of WA

Frequency / Nocturia

  • Screening Questions
  • Contributing Factors
  • Management

ICS Definitions:

  • Nocturia  is  the complaint of interruption of sleep one or more times because of the need to micturate. Each void is preceded and followed by sleep.

  • Urinary frequency is the complaint that voiding occurs more frequently during waking hours than previously deemed normal by the individual.  The degree of bother to the individual is considered more important than the actual number of voids.

Screening Questions: 

  • Waking at night one or more times due to the need to micturate?

  • Is extent of daytime voiding frequency considered greater than previously deemed normal?

  • Is extent of daytime voiding frequency considered bothersome?

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

  • Persistent or recurring urinary tract infections.

  • Dysuria, persisting bladder or urethral pain.

  • Haematuria, glycosuria or persistent proteinuria.

  • Inability to empty bladder or straining to empty.

  • Post void residual volume >200ml.

  • Nocturnal enuresis.

  • Rectal bleeding or unexplained vaginal bleeding.

  • Recent sudden alteration of bowel habits with no obvious explanation.

  • Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.

  • Pelvic organ prolapse (POP) past introitus causing difficulty emptying bladder.

  • Pelvic masses, unexplained weight loss or unremitting night pain.

  • Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.

  • Suspected urogenital fistulae.

 

  • UTI
  • Polyuria
  • Side Effect of Medication

Consideration:

  • Urinary frequency is a common symptom of a UTI.

Medical Intervention:

  • Assess for and treat UTI as required.

Considerations:

  • Large voided volumes both during the daytime and at night may be associated with diabetes and/or cardiac disease.

Medical Intervention:

  • Exclude likely cardiac, renal and metabolic causes and refer to specialist as appropriate.

Consideration:

  • Some medications may have side effects which lead to frequency and/or nocturia.

Medical Intervention:

  • Review medications with regard to type of medication and times of administration, especially when nocturia is present.

  • Consider alcohol consumption.

Initial Testing / Examination:

  •    Pelvic examination.

  •    Urinalysis.

  •   Diagnostic imaging may be appropriate to rule out outlet obstruction.

1st Line Treatment

Refer to an appropriate health professional:

  • Continence and Women's Health Physiotherapist:

    • 3 day bladder diary.

    • Bowel diary.

    • Lifestyle modifications: reduce caffeinated drinks, carbonated drinks and other bladder irritants.

    • Addressing urgency triggers/bladder calming/bladder re-training strategies.

    • Bowel management strategies and defaecation dynamics.

    • TENS to assist bladder training.

  • Continence Nurse Advisor.

  • In some cases it may be appropriate to refer to both Continence Nurse Advisor and Continence and Women's Health Physiotherapist. These roles may compliment and work together to help the patient achieve optimal management.

 2nd Line Treatment

Pharmacological management:

  • Beta-3 Agonist,.

  • Antimuscarinic.

 3rd Line Treatment

The following referral to medical specialty is appropriate if patient shows Red Flag signs or is non-responsive to conservative management:

  • Urologist/Urogynaecologist:

    • Urodynamic studies.

    • Botox (requires ability to self catheterize after treatment).

    • Neuromodulation.