What Is Nocturia? Why Getting Up to Pee Multiple Times a Night May Signal a Problem
You wake up at 2 a.m. from a deep sleep, confused about everything except for the fact that you need to pee...right now. It's not an uncommon scenario: everyone has been roused from bed by the urge to hurry down the hall to the bathroom before. Maybe you overdid it with the wine at dinner or slacked off on your daytime hydration, finding yourself chugging water at bedtime to catch up.
When it happens once in a while, it's no big deal, but at what point do your nightly bathroom trips signal a larger problem?
If your sleep is chronically disturbed by the urge to urinate, it's worth investigating; not only can frequent urination at night leave you groggy and sluggish in the morning, it could also be your body's way of telling you something else—like your bladder, heart, kidney, or prostate—is performing at less-than-optimal levels.
Here's everything you need to know about waking nightly to urinate, aka nocturia, and what you should do if you think you're suffering from it.
What is nocturia?
In medical terms, nocturia is excessive urination in the evening; in layman's terms, it simply means waking up at night with the urge to urinate multiple times, says S. Adam Ramin, MD, urologist and medical director of Urology Cancer Specialists in Los Angeles.
However, Dr. Ramin notes that while it may feel as if your bladder is about to burst, nocturia doesn't always mean you're producing an excessive amount of urine.
"With nocturia, it's not necessarily true that the bladder has reached its maximum capacity," he explains. "Even with just a little amount of urine in your bladder, you might feel like you need to go urgently."
This sets nocturia apart from a similar-but-different condition known as polyuria, where your body actually produces an abnormal amount of urine, explains the diabetes research foundation JDFR. People with nocturia may or may not also have an increased need for bathroom trips during the daytime, too, per Cleveland Clinic.
What causes nocturia?
Nocturia can be caused by a number of different conditions. Men with enlarged prostates, women with bladder dysfunction or overactive bladder, people with kidney infections or UTIs, or people who have a malfunctioning central nervous system due to spinal injury or stroke are all at risk.
Again, these risk factors don't create excess urine production, says Dr. Ramin, but they do interfere with the body's signals—so you might get the message that you need to urinate frequently, even if there's very little urine in your bladder.
In some cases, you may not be fully emptying your bladder with each void, as the Cleveland Clinic points out, so it's filling up again quickly and causing the urge to go.
You're also more likely to develop nocturia as you get older.
"Approximately 50% of adults between the ages of 50 and 79 have nocturia," says Mark Ellerkmann, MD, director of the Urogynecology Center at Mercy in Baltimore. "Younger women tend to experience nocturia sooner in life than [men], but this sex ratio reverses after the age of 50, with nocturia becoming more prevalent in men."
He notes that studies also suggest nocturia is more common among Black and Hispanic people, and that, of course, pregnant women commonly have nocturia because of all the changes happening to their bodies during pregnancy.
While you can't do anything about your age or ethnicity, there are a few risk factors that Dr. Ellerkmann says can sometimes be modified or better managed to reduce your risk of developing nocturia, including:
What are the symptoms of nocturia?
It's important to note that nocturia is a symptom itself, per Dr. Ellerkmann, and not a standalone condition or disease. For example, waking up at night with the urge to urinate is often a symptom of overactive bladder or an enlarged prostate.
That said, there are still ways to tell if what you're experiencing is nocturia. According to Dr. Ellerkmann, the timing and frequency of the episodes is important to defining nocturia in medical terms: if you're waking up at night to void in the middle of sleep (i.e. your episodes are preceded and followed by sleep) and this is happening two or more times per night, it could be nocturia.
How is nocturia diagnosed?
Because nocturia can be caused by a combination of factors and you could have both nocturia and polyuria, it can be hard to figure out what the cause of your frequent nighttime urination really is.
According to Dr. Ramin, the first step is to take a thorough medical history and identify potential causes of polyuria, like heart disease or diabetes, which can rule out nocturia. Some medications can cause nocturia, like diuretics, certain heart medications, and lithium, reports the American Urological Association, so make sure you tell your doctor about any OTC or prescription drugs you're taking.
Dr. Ellerkmann says most doctors will also ask you how many times you get up to use the bathroom at night, if you drink a lot of liquids before bedtime, and what your alcohol and caffeine habits are like.
From there, you'll probably spend a few days keeping a "void log," or record of how many times you use the bathroom and how much you urinate when you go.
"As far as diagnostic testing, one of the first things we do is perform a urination log for 72 hours, tracking each bathroom trip and measuring the units of urine each time," says Dr. Ramin. "That way we can see the volume of urine at night versus daytime."
Dr. Ramin says you may also undergo a series of other tests, namely ones that check your prostate and your bladder, since problems with either of those organs can cause nocturia; these include various types of blood work, urinalysis, ultrasounds, cystoscopy, and other kinds of urodynamic testing, per the Cleveland Clinic.
How is nocturia treated?
It's important not to neglect signs of nocturia, because it often points to a bigger condition (like an enlarged prostate) and can, sometimes, lead to other problems. Depending on how many times your nocturia is waking you up, it could affects your sleep quality and mental health, says Dr. Ellerkmann. A 2014 study in the Journal of Urology suggests a strong association between nocturia and depression because of how severely nocturia can impact quality of life.
"Nocturia has been associated with an increased risk of depression and work absenteeism," says Dr. Ellerkmann, "and, in older patients, it has been associated with falls and resulting fracture risk."
At the same time, if you don't have an underlying medical condition and your nocturia isn't causing daytime issues, Dr. Ellerkmann says you don't necessarily need treatment—although your goal may still be to reduce the number of episodes you have each night. You can do so by:
- Reducing your overall fluid intake, especially in the evening
- Cutting back on sodium, which acts as a diuretic and prompts more frequent urination
- Avoiding diuretics in the evening, whether it's medication or beverages like alcohol and caffeine
- Wearing compression stockings at night
- Elevating your legs in bed
- Improving bladder control with pelvic floor exercises
- Maintaining a comfortable sleep environment to reduce nighttime wakings
- Practicing "double voiding" before bedtime, a strategy Dr. Ellerkmann says involves trying to void twice within 30 to 60 seconds
There are also some medications that can reduce nocturia episodes. These include:
- Drugs like desmopressin, to control urine output, per the US National Library of Medicine.
- Anticholinergic drugs or medications for overactive bladder, which Dr. Ellerkmann says "can help reduce nocturia by increasing bladder capacity and decreasing urge-associated voiding."
- Hypertension drugs that reduce symptoms of benign prostatic hyperplasia, according to Johns Hopkins Medicine.
Doctors say if you do have an underlying medical condition, it's important to manage it; this will not only reduce your nocturia, but help you maintain your overall health. Conditions like gastroesophageal reflux and restless legs syndrome can often be improved with OTC or prescription medications, for example, while people with diabetes might have less nocturia episodes if they work to avoid hyperglycemia in the evening hours.
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