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The causal pathway of nocturia is multi\u2010factorial and differs between patients. There is currently no symptom\u2010specific clinical algorithm for all\u2010cause diagnosis of nocturia. The aim of this study was to investigate the interrelationships between causes of nocturia in order to inform the development of a comprehensive multidisciplinary assessment metric.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A PubMed search that identified studies reporting relationships between nocturia and a priori aetiological factors was conducted by cross referencing the term \u201cnocturia\u201d with \u201cpolyuria, postural hypotension, hypertension, cardiac function, heart failure, depression, anxiety, polypharmacy, sleep disturbance, sleep disorder, apnoea, and lower urinary tract symptoms.\u201d Directed acyclic graphs (DAGS) were constructed to visually represent causal assumptions and to identify underlying relationships.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study confirmed that causality of nocturia can be expressed in a directed acyclic graph, with the key variables being cardiovascular dysfunction, polyuria, sleep disturbance, mental health, metabolic and inflammatory changes, health status and lower urinary tract symptoms. None of the variables were independently a sufficient or necessary direct cause of nocturia and multiple backdoor pathways exist to nocturnal voiding. Polypharmacy, increasing age and BMI all have confounding effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There are significant interactions between voiding at night and metabolic, cardiovascular, hormonal, mental health, sleep and inflammatory changes that flag nocturia as a likely marker of co\u2010morbid poor health. Patients should be comprehensively evaluated for all\u2010causes of nocturia since multiple aetiologies commonly co\u2010exist. <jats:italic>Neurourol. 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