Nocturia issues -- suggestions?

[Jmac]

My mom, who is walking down the dementia/AD path, is waking up numerous times at night to urinate. Went to a urologist who prescribed Mybertric, max dosage -- has maybe helped a bit during the day but not at night even though we had Mom start taking closer to bedtime. Not happy with the urologist as it's "well, try moving it to the nighttime and come back to see me in 3 months".

I'm going to make her an herbal tea with a few things that are supposed to help (buchu, echinacea, saw palmetto, cinnamon), add pumpkin seeds to her diet along with walnuts, chick peas, and more grass-fed meat. Those are some things I found on-line that may or may not help. Can't hurt, although drinking tea is not the best thing to do before bed so will have her drink it with dinner I suppose. Or maybe even lunch.

Is there such a thing as a urologist who specializes in elderly bladder issues? Mom is not going to respond to exercise or mental training, even though both would help. She is so fearful about having to use the bathroom that she doesn't want to drink anything, doesn't want to go anywhere and it's getting worse.

I did a search on nocturia, found a few mentions. She doesn't have incontinence issues, just frequent trips...

[NF52]

My mom, who is walking down the dementia/AD path, is waking up numerous times at night to urinate. Went to a urologist who prescribed Mybertric, max dosage -- has maybe helped a bit during the day but not at night even though we had Mom start taking closer to bedtime. Not happy with the urologist as it's "well, try moving it to the nighttime and come back to see me in 3 months". ..Is there such a thing as a urologist who specializes in elderly bladder issues? Mom is not going to respond to exercise or mental training, even though both would help. She is so fearful about having to use the bathroom that she doesn't want to drink anything, doesn't want to go anywhere and it's getting worse.

I did a search on nocturia, found a few mentions. She doesn't have incontinence issues, just frequent trips...

Hi Jmac, As someone who has had the experience of having to find a new doctor after the first specialist basically said "who knows? see me in 3 months", and having also found a wonderful specialist in gynecological urology years ago for chronic UTIs, trust me, there is a better doctor for your mom out there!

Here are two articles that may be of interest:
The first, from 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807446/ includes a mention of Mybertric, generic name mirabegron, for use in over-active bladder (OAB), which refers to the daytime issue, and as a secondary target, nocturia:

Data from a phase 2 dose-ranging study of mirabegron in a mixed population with OAB, where nocturia was evaluated as a secondary parameter, showed that mirabegron 50 mg reduced significantly the number of nocturia episodes by 0.6 from baseline vs 0.22 on placebo.

A difference of .38 episodes of nocturia (night-time urination) between Mybetric and placebo seems like an example of "statistically significant doesn't always mean clinically significant". I did find a patient forum where guys with prostate cancer reported relief from Mybertric, but your mom isn't a guy with prostate issues!

Here's a more promising note about DDAVP (desmopressin) from the same article:

Desmopressin is the only therapeutic agent to be highly recommended for treating nocturnal polyuria by the International Consultation on Incontinence (ICI) committee..in 2017, FDA approved desmopressin nasal spray (NoctivaR, desmopressin acetate) for the “treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void.” An oral desmopressin lyophilisate formulation (NocdurnaR) requiring no concomitant fluid intake is currently the most widely used DDAVP preparation.

DDAVP has shown efficacy in nocturia due to nocturnal polyuria as evident from numerous reviews. In a double-blind, randomized, proof-of-concept study, Rovner et al....enrolled female 106 patients (≥ 18 years), with overactive bladder (OAB) and nocturia, with ≥ 2 nocturnal voids, receiving a 3-month once-daily combination (desmopressin 25 μg, orally disintegrating tablets [ODT]/tolterodine 4 mg [Detrol® LA]; n = 49) or monotherapy (tolterodine 4 mg/placebo ODT; n = 57)...It was concluded that low-dose desmopressin could be safely combined with tolterodine for treating nocturia in women with OAB... There is a medical need for new, approved drugs for treatments for patients with nocturia. However, using current available agents, effective, personalized treatment may be designed taking into account gender, co-morbidities, and identified etiological factors.

It's important to note that for women, 25 μg is the optimal dose, while men typically have twice that dose.

And this seems like a good overview of the issues involved in Nocturia in the elderly: A wake-up call with some helpful suggestions including use of compression socks and foot elevation during the day, as well as possibly a gynecology evaluation to determine if other issues (prolapsed uterus, cysts, etc) are contributing.

If you have a gastroenterologist you've liked for colonoscopies, or your OB-GYN, you may want to ask that person who they'd recommend for your mom. Both work in the same "neighborhood" and may be able to be very helpful. You can also check for doctors online whose profiles mention female urology, and schedule a consult/second opinion, which Medicare covers at little to no cost. The doctor we found out of frustration spent 45 minutes just on the consultation and gave us more information and advice than we'd had in the previous year! Needless to say, we switched immediately!

[Plumster]

It sounds like you are on top of things and the cause is likely something else, but just wanted to point out that frequent urination can be a sign of mycotoxin exposure. I've been through it myself.

[Jmac]

Here are two articles that may be of interest:
The first, from 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807446/ includes a mention of Mybertric, generic name mirabegron, for use in over-active bladder (OAB), which refers to the daytime issue, and as a secondary target, nocturia:

Data from a phase 2 dose-ranging study of mirabegron in a mixed population with OAB, where nocturia was evaluated as a secondary parameter, showed that mirabegron 50 mg reduced significantly the number of nocturia episodes by 0.6 from baseline vs 0.22 on placebo.

A difference of .38 episodes of nocturia (night-time urination) between Mybetric and placebo seems like an example of "statistically significant doesn't always mean clinically significant". I did find a patient forum where guys with prostate cancer reported relief from Mybertric, but your mom isn't a guy with prostate issues!

Here's a more promising note about DDAVP (desmopressin) from the same article:

Desmopressin is the only therapeutic agent to be highly recommended for treating nocturnal polyuria by the International Consultation on Incontinence (ICI) committee..in 2017, FDA approved desmopressin nasal spray (NoctivaR, desmopressin acetate) for the “treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void.” An oral desmopressin lyophilisate formulation (NocdurnaR) requiring no concomitant fluid intake is currently the most widely used DDAVP preparation.

DDAVP has shown efficacy in nocturia due to nocturnal polyuria as evident from numerous reviews. In a double-blind, randomized, proof-of-concept study, Rovner et al....enrolled female 106 patients (≥ 18 years), with overactive bladder (OAB) and nocturia, with ≥ 2 nocturnal voids, receiving a 3-month once-daily combination (desmopressin 25 μg, orally disintegrating tablets [ODT]/tolterodine 4 mg [Detrol® LA]; n = 49) or monotherapy (tolterodine 4 mg/placebo ODT; n = 57)...It was concluded that low-dose desmopressin could be safely combined with tolterodine for treating nocturia in women with OAB... There is a medical need for new, approved drugs for treatments for patients with nocturia. However, using current available agents, effective, personalized treatment may be designed taking into account gender, co-morbidities, and identified etiological factors.

It's important to note that for women, 25 μg is the optimal dose, while men typically have twice that dose.

And this seems like a good overview of the issues involved in Nocturia in the elderly: A wake-up call with some helpful suggestions including use of compression socks and foot elevation during the day, as well as possibly a gynecology evaluation to determine if other issues (prolapsed uterus, cysts, etc) are contributing.

Thanks so much! I am passing along the info to her primary care (who we switched to & is not the one who referred us to the urologist --- her new primary has taken an extra special interest in Mom, which is really heartening!). And, I'm going to read the info myself. Heading up to stay the day with her...

[Jmac]

It sounds like you are on top of things and the cause is likely something else, but just wanted to point out that frequent urination can be a sign of mycotoxin exposure. I've been through it myself.

I will check into the mycotoxin exposure. Thank you!

[mike]

I will check into the mycotoxin exposure. Thank you!

Probably already looked into, but having to pee multiple times is also a symptom of diabetes.

[SusanJ]

Or look into electrolytes. If they are out of balance, any water (without electrolytes) just gets urinated out quickly to maintain balance. Many people are low in magnesium and potassium, probably more so for the elderly.

[Jmac]

Or look into electrolytes. If they are out of balance, any water (without electrolytes) just gets urinated out quickly to maintain balance. Many people are low in magnesium and potassium, probably more so for the elderly.

Potassium MAY be an issue --- will check on that one. She things potassium is metal and if she sees it on a label has a tendency to avoid. No what I show her, read, etc. she says it makes things TASTE list metal May switch her multi vitamin if it doesn't have enough. She takes 2 tsp Calm magnesium at night, plus it's in her multi so she's probably good there. But, then again, if I gave her an electolyte "drink" she'd probably go for it. Rambling, typing as I think Thanks.

[Jmac]

I will check into the mycotoxin exposure. Thank you!

Probably already looked into, but having to pee multiple times is also a symptom of diabetes.

Thanks --- she was pre-diabetic but she has that one under control. She is great when a doc tells her she has to take a pill --- she fixes her diet. Mainly 'cause she'll hear about a side effect from the drugs and decide she'll be the one to get liver problems or whatever. Love that part of all this with her! Although it can hurt at times as she won't take a supplement or eat something like walnuts...

[Jmac]

Or look into electrolytes. If they are out of balance, any water (without electrolytes) just gets urinated out quickly to maintain balance. Many people are low in magnesium and potassium, probably more so for the elderly.

Potassium MAY be an issue --- will check on that one. She thinks potassium is metal and if she sees it on a label has a tendency to avoid. No matter what I show her, read, etc. she then says it makes things TASTE list metal May switch her multi vitamin if it doesn't have enough. She takes 2 tsp Calm magnesium at night, plus it's in her multi so she's probably good there. But, then again, if I gave her an electolyte "drink" she'd probably go for it. Rambling, typing as I think Thanks.