Treatment of Nocturnal Urinary Incontinence in Adults
Initial Diagnostic Evaluation
- The American Urological Association recommends performing a careful history, physical examination, and urinalysis to exclude urinary tract infection and other pathology in patients with nocturnal urinary incontinence 1, 2
- Obtaining a voiding diary is essential to reliably measure urinary frequency, incontinence episodes, and voided volumes in patients with nocturnal urinary incontinence 2, 3
- Differentiating between urgency urinary incontinence and nocturnal polyuria is crucial, with nocturnal polyuria characterized by normal or large volume voids representing >20-33% of 24-hour urine output, age-dependent 2, 3, 4
- Assessing for comorbid conditions, including sleep apnea, vascular/cardiac disease, neurologic disorders, and diabetes, is necessary as they commonly cause nocturnal polyuria 2, 5
First-Line Treatment: Behavioral Interventions
- The American Urological Association recommends initiating behavioral treatments first, with consideration of adding antimuscarinic therapy if partially effective, for patients with nocturnal urinary incontinence 1
- Establishing treatment goals collaboratively with the patient and discussing normal urinary tract function along with benefits/risks of treatment alternatives is essential 1, 2
Second-Line Treatment: Antimuscarinic Medications
- The American Urological Association recommends adding antimuscarinic medications with active management of adverse events if behavioral treatments are insufficient or only partially effective for patients with nocturnal urinary incontinence 1
- Actively managing common adverse events, including dry mouth and constipation, through dose modification or switching to an alternate antimuscarinic is necessary if effective but intolerable 1
Targeted Treatment for Nocturnal Polyuria
- Addressing underlying cardiovascular, renal, or sleep disorders contributing to nocturnal polyuria is crucial for patients with nocturnal polyuria 2, 5
Critical Pitfalls to Avoid
- The American Urological Association emphasizes the importance of not failing to distinguish between mixed incontinence subtypes, as this leads to inappropriate treatment selection 2, 5
- Not neglecting follow-up for treatment efficacy and adverse event management is essential for optimizing outcomes in patients with nocturnal urinary incontinence 1