If you're frequently bothered by waking in the middle of the night to empty your bladder, there may be some simple and drug-free lifestyle adjustments that can help, a small study suggests.

So-called nocturia is the complaint of getting up at least once a night to urinate -- either due to a heightened production of urine or the inability of the bladder to hold it, sometimes as a result of an underlying medical problem. The condition can contribute to fatigue and depression, and raise the risk of heart disease and gastrointestinal disorders.

However, as experts note, nocturia is also very normal, especially as people age. And not everyone affected is bothered by it.

The standard treatments for frequent nighttime urination include medical therapy as well as lifestyle modifications such as fluid restrictions, senior researcher Dr. Koji Yoshimura of Kyoto University Graduate School of Medicine in Kyoto, Japan, told Reuters Health in an email. However, the efficacy of the lifestyle therapy has not been established so far.

Yoshimura and his colleagues studied 56 people complaining of nocturia who were about 75 years old, on average. They tested the effects of four easy lifestyle changes: fluid restriction, limiting any excess hours in bed, moderate daily exercise and keeping warm while sleeping.

Each patient was advised of the benefits of each modification, including a recommendation to limit their fluid intake to about 2 percent of their body weight during the day -- avoiding too much in the evening. This translates to about one and a half quarts of water for a 165-pound person.

After four weeks, the participants' average number of nighttime bathroom trips dropped. More than half of the patients experienced an improvement of more than one episode a night, Yoshimura and colleagues report in The Journal of Urology. Total urine volume also decreased (from 923 to 768 milliliters).

Dr. Serge Marinkovic of St. Francis Hospital, in Indianapolis, who was not involved in the study, noted that the effectiveness of the lifestyle changes was comparable to that of drug interventions.

Current medication options for nocturia include a synthetic version of a hormone that keeps the body from making urine at night, a drug that blocks the ability of the bladder muscles to contract, and antidepressants that make it harder to urinate by increasing tension at the bladder neck, he told Reuters Health.

None of these medications are a great cure, and all have side effects, including dry mouth, constipation and heartburn, Marinkovic said. They're significant enough for up to 70 percent of patients to stop using the drug within 6 months.

A limitation of the current study, Marinkovic noted, is the fact that patients were not monitored to determine how well they actually adhered to each of the behavior modifications. Another limitation is the lack of an untreated control group, which means a placebo effect can't be ruled out.

In his practice, Marinkovic typically starts off with his nocturia patients by going over a medical history to rule out underlying conditions such as diabetes or renal problems. Then he has them keep a diary of fluid intake and nighttime symptoms, which helps him prescribe behavioral changes such as fluid restriction. On top of this, he often adds medications, he said.

But again, not everyone is bothered by frequent trips to the bathroom during the night, Marinkovic emphasized.

I saw a guy two weeks ago who gets up four times a night, and it's not a problem for him, he said. He told me he does some of his best thinking when he's walking to the bathroom.

SOURCE: link.reuters.com/nuc57n The Journal of Urology, September 2010.

Japan Medicine