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March 19, 1997

Urinary Incontinence in Elderly Patients-Reply

Author Affiliations

Brigham and Women's Hospital Boston, Mass

JAMA. 1997;277(11):882. doi:10.1001/jama.1997.03540350032020

In Reply.  —Excess nocturnal urinary excretion is indeed common in older adults, particularly among institutionalized elderly persons and those who spend much time in bed, and as Dr Reyes-Ortiz points out, the causes are diverse. From a clinical standpoint, I find it easiest to divide the causes of nocturia into 3 categories: excessive urine output, sleep-related difficulties, and urinary tract dysfunction.1 These causes usually can be differentiated by using the voiding record to compare the volume of each nighttime void with the functional bladder capacity (the largest single volume voided). For instance, if the functional bladder capacity is 400 mL and each of 3 nightly voids is approximately 400 mL, nocturia is due to excessive nocturnal urine production. If the volume of nightly voids is smaller than normal bladder capacity, nocturia is due to either a sleep-related problem (patients void since they are awake anyway) or a problem with the lower