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Nocturia

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of nocturia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2025), the European Association of Urology (EAU 2025), the European Association of Urology (EAU/EAUN 2025), the Canadian Urological Association (CUA 2022), and the European Academy of Neurology (EAN 2020).
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2
3
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5
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Diagnostic investigations

History and physical examination
As per AAFP 2025 guidelines:
Obtain a complete assessment of bladder symptoms, fluid intake, sleep habits, medical history, and symptoms of obstructive sleep apnea in patients with nocturia.
B
Obtain a frequency-volume chart, including sleep and wake times, for 2 or 3 days in patients with only nighttime urinary symptoms and no obvious medical comorbidities contributing to increased urine output.
B
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  • Laboratory tests

  • Post-void residual volume

  • Urodynamic studies

  • Screening for obstructive sleep apnea

Diagnostic procedures

Cystoscopy: as per CUA 2022 guidelines, do not perform cystoscopy in patients with nocturia.
D

Medical management

General principles
As per AAFP 2025 guidelines:
Initiate conservative therapy and treat any contributing medical comorbidities as the initial approach for nocturia.
B
Consider initiating pharmacotherapy as an adjunct to lifestyle interventions for nocturia related to overactive bladder syndrome or BPH.
C

More topics in this section

  • Desmopressin

  • Anti-LUTS therapy

  • Diuretics

  • Imipramine

  • Vaginal estrogen

  • Melatonin

Nonpharmacologic interventions

Lifestyle modifications: as per EAU 2025 guidelines, discuss behavioral changes with the patient to reduce nocturnal urine volume and episodes of nocturia and improve sleep quality.
B

More topics in this section

  • Pelvic floor muscle training

Surgical interventions

Bariatric surgery: as per EAU/EAUN 2025 guidelines, inform female patients with overweight or obesity that bariatric surgery may result in a reduction in nocturia episodes.
B

Specific circumstances

Patients with multiple sclerosis: as per EAN 2020 guidelines, consider offering desmopressin intranasal spray for nocturia in patients with severe multiple sclerosis. Do not offer desmopressin intranasal spray in patients with uncontrolled hypertension, cardiovascular, and/or renal diseases.
C