Use of compression stockings during daytime may improve symptoms of nocturia

JAPAN: A recent study published in the Cureus has investigated the effectiveness of compression stockings used during the daytime and described it as effective, satisfactory, safe, and painless treatment option in patients with nocturia.

Nocturia is increased urinary frequency, reduced bladder storage function, and sleep disorders. The causes of nocturia include congestive heart failure, edema of lower extremities, drugs, alcohol, diabetes, sodium-rich diet, bladder obstruction, prostate hyperplasia, etc.

Lifestyle interventions, bladder training, and pelvic floor muscle training are conservative treatment approaches for lower urinary tract symptoms. They are generally preferred due to their non-invasiveness and cost-effectiveness. Compression stockings, limiting night-time drinking, avoiding caffeine and alcohol, etc., are some of the additional lifestyle interventions for the management of nocturia. Compression stockings are used for deep vein thrombosis (25 and 35 mmHg), venous ulceration (18 and 35mm Hg), varix, lymphedema, and orthostatic hypotension. Compression stockings with the legs elevated reduce fluid build-up and alleviate nocturnal polyuria. This reduces edema of the lower extremities. These are safe and more effective during day time. But data supporting its use remains limited and controversial.

Against the above background, a study was conducted by Kaga et al. and the team from the Department of Urology at Chiba Prefectural Sawara Hospital to add data related to daytime usage of compression stockings in nocturia patients. The study was a single-arm prospective and was investigated for four weeks. A baseline and four-week questionnaire, a frequency volume chart, and treatment feedback were recorded. The primary endpoint recorded changes in night-time frequency from the baseline to the end of treatment.

The key points of the study are:

• Thirty-four patients were included in the study, including 19 men and 15 women aged 72.3 ± 12.6 years. Two patients dropped out from the study as they experienced pain wearing compression stockings, and one refused to wear stockings every day, so a total of 31 patients were analyzed in the study.

• The pilot study used compression stockings with a pressure range between 15 and 20 mmHg.

• The night-time and 24-hour frequencies were significantly decreased in the frequency-volume chart by 0.5 and 1.1 episodes with P values of 0.004 and 0.035, respectively.

• There was a significant increase in the hours of undisturbed sleep by 0.8 h with a P value of 0.013

• No recorded significant differences in nocturnal or 24-h urine volumes, the number of urinary incontinence episodes, the mean voided volume, the nocturnal polyuria index, or the first night-time voided volume.

• There was a significant decrease in the total overactive bladder symptom score with a P value of 0.006.

• All overactive bladder symptom score subscores were significantly reduced except for the daytime frequency score.

• The ankle and calf circumferences decreased by 0.7 and 1.2 cm, respectively.

Dr. Tomonori Yamanishi from the Department of Urology, Continence Center at Dokkyo Medical University Hospital said, "We reported patient satisfaction levels after four weeks of the treatment as "satisfied" (16.1%), "somewhat satisfied" (48.4%), "dissatisfied" (9.7%), and "unanswered" (25.8%) and believe that it is worth to consider compression stockings in the treatment for nocturia."

Desmopressin use is not recommended in some countries for the treatment of nocturia in women, and therefore wearing compression stockings is a good treatment option to consider in such cases.

The researchers mentioned that our study had no controls and was a pilot study. So more Comparative studies are warranted with large sample size. Further studies are required to examine the association between the pressure exerted by compression stockings and the outcomes of nocturia.

References :

Kaga K, Yamanishi T, Shibata C, Kamasako T, Kaga M, Fuse M. The Efficacy of Compression Stockings on Patients With Nocturia: A Single-Arm Pilot Study. Cureus. 2022 Aug 30;14(8):e28603.