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NOCTURIA- If you are having to get up at night to pee more than you usually do, here is an article for you!

A frequent need to get up to urinate at night is called nocturia. To get up once to urinate is said to be normal. However, if a person has to 2 or more than 2 times in one night (6-8 hours of sleep), nocturia is suspected.

Nocturia is seldom a disease in itself, it is often a symptom of other underlying causes which include certain lifestyle habits or medical conditions.

Causes of Nocturia-

1. Drinking too much or too close to bedtime is one of the most common causes of nocturia.
2. Having alcohol or caffeine late in the day.
3. A urinary tract infection (UTI) triggers a need to pee more during the day and at night but is seldom the only symptom and may be accompanied with pain, burning during the passage of urine or lower abdominal pain, fever.
4. Older age too is related to nocturia. As we age, our body produces less of a hormone that helps concentrate urine which helps us hold urine till morning and thus there is a need to get up to pee at night.
5. Pregnancy and childbirth weaken the bladder and pelvic floor muscles and cause frequent night time and day time urination in women.
6. Certain medications which are given for other health problems, such as hypertension may cause one to pee more especially if taken close to bedtime. 
7. Other medical conditions such as diabetes, prostate issues, neurological issues, and ongoing pregnancy.

Diagnosis of Nocturia-

Diagnosing the cause of nocturia can be tricky and needs a variety of investigations and a detailed questionnaire from your doctor is to be expected. It is therefore very important to maintain a diary if you have been having the problem of excessive nighttime urination for quite some time. The important point to keep noting in the diary is what you drink and how much, how often you need to urinate.

Few of the questions to be expected by your doctor are-

1. When did the nocturia start?
2. How many times do you have to urinate every night?
3. Are you producing less urine than you did before?
4. Do you have accidents or have you wet the bed?
5. Does anything make the problem worse?
6. Do you have any other symptoms?
7. What medications are you taking?
8. Do you have a family history of bladder problems or diabetes?

It is, therefore, an important thing to be prepared with information to the above questions beforehand. A few of the common tests done to rule out the causes of nocturia are- urinalysis and urine culture, blood sugar test to check for diabetes, other blood tests for blood counts and blood chemistry, imaging tests, such as ultrasounds or CT scans.

Tips to deal with nocturia-

Treatment for night time urination majorly depends on its cause and it usually resolves once its underlying cause is found out and treated.

Here are a few tips to deal with night time urination-

1. Drink your normal amount of liquid but do so earlier in the day. Reducing the amount you drink 2 to 4 hours before bedtime can help prevent you from needing to urinate at night.
2. Cut down on any drinks in the last two hours before you go to bed – especially alcohol, coffee or tea as these stimulate urine production. 
3. Keep a diary of how much you drink, what you drink, and when. This may be helpful in identifying the factors or situations which cause or worsen the nocturia.
4. Some food items can be bladder irritants, such as chocolate, spicy foods, acidic foods, and artificial sweeteners. Avoid them.
5. Kegel exercises and pelvic floor physical therapy can help strengthen your pelvic muscles and improve bladder control.
6. Paying attention to what worsens the symptoms is important so that you can try to modify your habits accordingly. 
7. Take an afternoon nap- if you have been getting up frequently due to nocturia, a nap can help you feel better during the day.
8. Avoid setting excessively low temperatures on the Air conditioner at night to avoid cold-induced diuresis.

By

Dr. Afroze Fatima

References

https://www.healthline.com/symptom/night-time-urination

https://www.webmd.com/urinary-incontinence-oab/nocturia-pee-night

https://www.sleepfoundation.org/articles/nocturia-or-frequent-urination-night

https://www.healthline.com/health/urination-excessive-at-night

https://my.clevelandclinic.org/health/diseases/14510-nocturia

 

Even though it is very common during childhood, it should be evaluated further in case of prolonged bed wetting even after 5 years. Bed wetting occurs more commonly in boys aged 4-11 years than girls. Most of the parents think that bedwetting is due to laziness which is not the actual cause.

Causes:

Cause can be due to physical or psychosocial factors. If the child spends all day under strong pressures whether from parents or from school. Major reasons include:

1. Stressful homelife and conflict between parents
2. Poor daytime toilet habits
3. Urinary tract infection
4. Diabetes
5. Down’s syndrome
6. Attention deficit hyperactivity disorder
7. Deep sleep and arousal disorder
8. Congenital malformations of genitourinary tract
9. Chronic constipation in which full bowel will put pressure on bladder
10. Slow development of bladder control

Laboratory tests:

• Urine analysis is the first step in which we check the pus cells, protein, casts and glucose to rule out urinary tract infections and renal disease.
• Random blood sugars are checked to rule out diabetes.
• Urine culture is based on the urine analysis report.
• Children with complicated enuresis may need further evaluation with renal ultrasound and voiding cystourethrogram.

Treatment:

• Reassurance is the best approach for both the child and parents.
• Avoid punitive measures that can affect child’s psychological development adversely.
• Fluid intake should be restricted to 60ml after 6-7pm.
• Parents should be certain that the child voids at bedtime.
• Avoiding sugars and caffeine after 4pm can also be helpful.
• Waking children few hours after they go to sleep can help them to wake up dry.
• The child should not be blamed for bed wetting.
• Praise the child and give them a star if they wake up dry.
• Some pharmacological measures are there to give short term relief but  can be only advised by doctors, if the above measures do not work.
• If there is any underlying cause like diabetes or structural abnormalities, treatment is given to treat that first.

References:

https://www.webmd.com/urinary-incontinence-oab/bed-wetting-in-adults

https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685
By,

Dr.Y. Alekhya.

 

Constipation refers to bowel movements that are infrequent or hard to pass and often hard and dry. The most common symptoms associated with constipation are generalised abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement.

Everyone experiences occasional episodes of constipation. Constipation can be bothersome if one doesn’t know how to relieve the condition.

 Here are a few suggestions to prevent, relieve constipation and to promote regular bowel movements.

• Drink more liquids: Drinking enough water and other liquids helps to keep stools soft so they can move more easily through the intestines. When you don’t drink enough, the stool can get hard and dry, and you might get stopped up.
• Eat more fiber: Eating high-fiber foods, like fruits, vegetables can help to prevent constipation. Avoid diet which contains more fat, sugary, or starchy foods. To get more fiber in your diet, try fresh fruits like pears, apples (with the skin), oranges, and ripe bananas, or dried fruits like prunes. Other high-fiber foods include beans, oatmeal, whole-grain slices of bread, and popcorn.
  
• Make sure you get enough exercise: Physical activity helps move food through the digestive system and nudges the bowels into action, so be sure to get plenty of exercises. It can be as simple as playing catch, cycling, or shooting a few hoops.
• Set a regular meal schedule: Regular meals may help you develop routine bowel habits.
  
• Disturbed sleep: Could have an adverse effect on bowel functions, hence try to have ample amount of the sleep (about 6 to 8 hours)
  
• Get into the habit of going: Like if you don’t want to use the bathroom at school, or college ignoring your body’s signals that it’s time to go, can make it harder to go later on.

Written by-

Dr. Krishna Priya

References:
https://www.medicinenet.com/constipation/article.htm

Migraine is a recurrent type of headache that has a throbbing or pulsating nature. It most often affects one side of the head but may also be seen on both sides. It is known to affect three times as many women as men.

Here are some tips to prevent migraine attacks-

1. Learn about your triggers and find out ways to manage them. 
2. Loud noises, flashing lights (for example, strobe lights), and sensory stimulation are common triggers for migraine headaches
3. Take breaks from the TV or computer screen to rest your eyes, and adjust the brightness levels on digital screens.
4. Learn to make note of foods that trigger an attack and avoid consuming them.
5. Identify the activities that trigger migraine attack- for some people, too much exercise or a lack of exercise can be a cause. Moderation is the key.
6. Lack of sleep or irregular sleeping habits may also lead to an attack in susceptible people. Make sure to have a regular sleep time table- sleep early and for at least a good 7 hours.
7. Stress is a known trigger for migraine headache-learning to manage them is important. Meditation, praying, spending time with people you love, and doing things you enjoy can really be wonderful stress busters. Counselling and stress management classes can also be tried.
8. Hunger lowers the blood sugar levels and may act as a trigger for headaches. It is therefore very important to manage your eating schedules if you are prone to headaches.
9. It is important to stay hydrated. Drink plenty of water and fluids to keep migraines at bay.
10. If you have more than 4 attacks in a month, then it would be advisable to talk to your doctor and keep ‘preventive medicine for migraine’ stocked at home.

 

Written by Dr. Afroze Fatima