Lower Urinary Tract Dysfunction
Initial management of nocturia

Leonie (55 years old)

Leonie, a 55-year-old part-time column writer, has often to visit the bathroom to void during the night. This results in tiredness during the day and sometimes sick leave. She also has a longstanding history of stress urinary incontinence. She occasionally performs pelvic floor muscle exercises. She complains of leakage, particularly when changing position. She struggles with pads because of perineal rash.


Medical history: Total abdominal hysterectomy. Poorly controlled epilepsy (carbamazepine, pregabalin). Obstructive sleep apnoea (use of nasal prongs but difficult to keep them in).
Clinical examination: Overweight (BMI 35).
Urine dipstick: Normal.
Bladder diary (1 week): Frequency: day 4-5x, night 1-3x. Voided volumes: 120-480 ml. Average 24h diuresis: 1,750 ml (35% during the night, range 7-53%). Normal fluid intake.

Considering her nocturia complaints, what would be the most appropriate next step?