Adverse Event reporting information can be found in footer

Request a Meeting


Nocturnal polyuria (NP) is a common underlying condition of nocturia1




Nocturia has been traditionally regarded by urologists as a urine storage symptom associated with benign prostatic hyperplasia (BPH) and/or overactive bladder (OAB).1 BPH can result in bladder outlet obstruction (BOO) causing nocturia symptoms.1 Studies show that NP presents in 76-88% of reported nocturia cases -the majority of patients suffering from nocturia.1 More importantly, patients who suffer from OAB or BOO with persistent nocturia despite treatment may have underlying nocturnal polyuria as well.1 These findings are consistent regardless of gender, age, ethnicity and/or country;1 this discovery suggests NP can have its own pathology.1 A fuller understanding of the underlying causes of nocturia and correct diagnosis of patients suffering from nocturnal polyuria will help clinicians provide better patient care.


Common nocturia causes


Causes of nocturia can be simplified to its pathology:6

1. Increased nocturnal urine production

2. Reduced urine volume

3. Increased 24-hour urine volume

These three pathways can lead to nocturia symptoms via different mechanisms6



Adapted from: Van Karrebroeck of al. Neurourol Urodyn 2002;21:179-183.6 Copyright © 2002.


For more information, download our differentiation guide for further guidance in correctly diagnosis the aetiology of nocturia symptoms in your patients.


Nocturnal polyuria is an important contributing factor to nocturia



Common conditions causing nocturia7,8
Overactive bladder (OAB)9–12 Bladder outlet obstruction (BOO)1,12–16 Nocturnal polyuria (NP)1,6,12,17,18
Description Muscles of bladder start to contract involuntarily even when volume of urine in bladder is low Blockage to the base of the bladder, reducing or stopping the flow of urine into the urethra Passing of large volumes of urine at night due to absence of diurnal rhythm of antidiuretic hormone (ADH) system

24-hour urine output is normal or only moderately increased

Gender Female & male Male > female Female = male
Symptoms Nocturia, urinary incontinence, urinary urgency, increased frequency of urination, sleep disturbance, fatigue Abdominal pain, frequent urination, dysuria, hesitancy, poor stream, intermittent stream, terminal dribbling, nocturia, urinary tract infection, sleep disturbance Nocturia, sleep disturbance
Causes Multifactorial

Specific cause of OAB is still unknown

Large prevalence due to benign prostatic hyperplasia among men

Can be idiopathic

Risk factors for development Elderly patients with cognitive decline Largely dependent on cause Largely dependent on cause
Diagnosis Medical history

Physical exam

Urine sample

Neurological exam

Fluid and bladder diary

Physical exam

Digital rectal exam

Blood chemistries

Prostate-specific antigen testing

Cystoscopy and retrograde urethrogram


Urodynamic testing


Urinalysis / urine culture

Medical history

3-day bladder diary

ADH levels

Treatment Behavioural strategies such as pelvic floor exercises or scheduled toilet trips

Lifestyle modifications such as fluid restriction



Bladder injections (e.g. botox)

Invasive/non-invasive nerve stimulation

Surgery (last resort)

Largely dependent on cause

Urinary catheterisation


  • 5-alpha reductase inhibitors
  • Alpha-1-adrenoreceptor antagonists
  • Trans-urethral resection of prostate (TURP)
  • Laser prostatectomy
Largely dependent on cause

Fluid restriction

Lifestyle modification

ADH analogues (desmopressin)

  1. Weiss JP et al. J Urol 2011;186:1358–1363.
  2. Chang SC et al. Urology 2006;67:541–544.
  3. Young H et al. Med J Malaysia 2005;60(3):294–296.
  4. Kurtzman J et al. Curr Opin Urol 2016;26:315–320.
  5. Irwin DE et al. BJU Int 2008;101:1381–1387.
  6. van Kerrebroeck P et al. Neurourol Urodyn 2002;21:179–183.
  7. Henderson R. Patient. September 2016. Nocturia – Clinical Reference. Available at: Date accessed: September 2017.
  8. Guy’s and St Thomas NHS Foundation Trust. Nocturia (getting up at night to pass urine). January 2017. Available at: Date accessed: September 2017.
  9. Mayo Clinic. Aug 2017. Overactive Bladder. Available at: Date accessed: September 2017.
  10. Ge TJ. et al. Urology. 2017 Nov;109:67-73.
  11. National Institute for Health and Care Excellence (NICE). June 2015. Incontinence – urinary, in women. Available at: Date accessed: September 2017.
  12. Ellis ME. Healthline. December 2016. How to Treat an Overactive Bladder at Night. Available at: Date accessed: September 2017.
  13. Dawson C and Whitfield H. BMJ 1996;312:767.
  14. Sobol J. MedlinePlus. April 2016. Bladder outlet obstruction. Available at: Date accessed: September 2017.
  15. Policastro MA et al. February 2016. Urinary Obstruction Medication. Available at: Date accessed: September 2017.
  16. Dmochowski RR. Rev Urol 2005;7(Suppl 6):S3–13.
  17. Asplund R. Gen Pharmacol. 1995;26(6):1203–1209.
  18. Everaert K et al. in Practical Functional Urology, Springer 2016. Edited by Heesakkers, et al. pp 377–392.
  19. Sand PK et al. J Urol 2013;190:958–964.
  20. Weiss JP et al. J Urol 2013;190:965–972
  21. Noqdirna Summary of Product Characteristics. May 2016. Available at: Date accessed: September 2017.

Job Code: UK-NOQD-2000015 - Date of preparation: January 2023


Our use of cookies

We use cookies (including third party cookies) to collect data while you use this website in order to make it work, keep it secure and comply with regulations. We’d also like your consent to use cookies so we can provide you with tailored content and advertising and analyse how you and other people use the website.

Select “On” to consent to our use of these cookies and continue to the website, or select “Off” to control which types of cookies we use. You can read more about cookies in our Privacy Policy.

Necessary cookies

Necessary cookies enable core functionality such as security, network management, and accessibility. You may disable these by changing your browser settings, but this may affect how the website functions.

Analytics cookies

We’d like to set Google Analytics cookies to help us to improve our website by collecting and reporting information on how you use it. The cookies collect information in away that does not directly identify anyone. For more information on how these cookies work, please see our Privacy Policy.