Surely, at some point, you have woken up in the night to go to the bathroom. Pregnancy, drinking too much water before bed, or certain conditions that tend to be more common with age can make nighttime bathroom visits more frequent.
In general, occasionally waking up at night with the urge to urinate, known as nocturia, is usually not a problem. However, if it occurs frequently more than twice a night or interferes with sleep, doctors may recommend simple lifestyle changes or, if necessary, medication.
“The need to see a doctor depends largely on the severity of the discomfort,” said Jeffrey P. Weiss, professor and chair of the department of urology at SUNY Downstate University of Health Sciences, who has been studying nocturia for 30 years. In other words, if it happens often enough to be bothersome, it may be time to get a checkup.
Who suffers from nocturia and why?
Nocturia is common, affecting approximately one in three adults over 30 years of age. Its prevalence increases with age, reaching up to 60 percent of older people to suffer from it, according to a widely cited study.
Generally speaking, there are three main causes. It can occur when there is excessive urine production, when the bladder cannot hold as much urine as before, or when there are underlying conditions that affect sleep, according to experts.
Below, we analyze some of the determining factors in more detail:
Excessive urine production: In some cases, the body may produce excessive amounts of urine, a symptom known as polyuria. This may be due to medical conditions such as kidney disease and diabetes, or medications such as diuretics, which remove excess water from the body.
Nocturnal polyuria, characterized by an unusually large amount of urine produced during the night, usually occurs when too many fluids are consumed before bedtime, especially alcohol or caffeinated beverages. It can also be due to underlying conditions, such as heart disease and sleep apnea, among others, according to Camille Vaughan, professor and director of geriatrics and gerontology at Emory University School of Medicine.
Cardiovascular disease can cause fluid to build up in the lower extremities throughout the day, and when this fluid returns to the bloodstream when you go to bed at night, it can increase urine production during sleep.
Similarly, untreated obstructive sleep apnea, a condition in which the airways collapse during sleep, reducing or temporarily stopping airflow, can overwhelm the heart. This causes the heart to release a hormone that tells the kidneys to eliminate more sodium and water, resulting in more urine production, Vaughan explained. (Using a continuous positive airway pressure, or CPAP, machine, which blows air into your airways to keep them open during sleep, can help treat nocturia caused by sleep apnea.)
Decreased bladder capacity: Urinary tract infections (UTIs) are a common cause of urgency, frequency, and pain when urinating.
However, there are many other causes of urinary urgency that can cause nocturia. An overactive bladder, at any age, can reduce the amount of urine the bladder can hold by causing involuntary muscle contractions that cause urination before the bladder is full. Symptoms of an overactive bladder may be due to underlying medical problems such as diabetes or neurological conditions, including multiple sclerosis, Parkinson’s disease and stroke, Weiss explained.
Additionally, pregnancy, an enlarged prostate, tumors, or even constipation can put pressure on the bladder or other parts of the urinary system, causing symptoms, Weiss explained.
Some people experience both reduced bladder capacity and excessive urine production, “a double whammy,” he said.
Underlying sleep disorders: Conditions that make it difficult to fall or stay asleep, or cause people to wake up during the night, such as insomnia, restless legs syndrome, and chronic pain, may contribute to nocturia because people are more likely to notice even a mild urge to urinate when they are awake, Vaughan said.
“The coexistence of insomnia and nocturia is quite common,” especially among older adults, he said.
Does nocturia pose health risks?
Nocturia alone is not usually harmful, but the sleep disturbance it causes may be associated with daytime fatigue, mental confusion, and decreased cognitive performance, among other problems.
It can also pose security risks. Repeatedly going to the bathroom when you are sleepy and in the dark can cause falls. An analysis of studies on nocturia and falls suggests that people who wake up at night to urinate may have a 20% higher risk of falls and a 30% higher risk of fractures compared to those without nocturia.
Weiss suggested that people use nightlights to illuminate the way to the bathroom or keep a toilet or urinal handy next to their bed if they know or suspect they may be at higher risk for falls.
How is nocturia treated?
When nocturia is bothersome enough to require treatment, it can be controlled with lifestyle changes or, in some cases, medications.
First-line treatment—behavioral changes such as small adjustments to diet or fluid consumption habits—can help reduce nighttime urination. If the cause is drinking too much fluid, for example, limit your water intake—and avoid alcohol and caffeine—before bed, and don’t leave a glass of water on the nightstand, Vaughan explained.
People with cardiovascular disease may benefit from limiting sodium intake. In one study, Weiss and colleagues found that advice on dietary sodium restriction appeared to reduce nocturnal urination in cardiology patients with nocturia.
Varicose veins, which are swollen or dilated veins, usually in the legs, occur when weakened or damaged valves cause blood to pool. This can also contribute to fluid buildup in the lower extremities. When you go to bed at night, the body reabsorbs this fluid, causing the kidneys to produce more urine. Wearing compression stockings during the day and elevating your legs when possible can help decrease excessive urine production at night, Weiss explained.
Additionally, Vaughan said that, under close supervision by a doctor, the timing of some medications that can increase urination, such as diuretics, can be adjusted so that they are taken earlier in the day to reduce excessive urine production at night.
According to Weiss, medications should not be considered without “understanding the underlying causes of nocturia, since as one ages, there are generally more and more factors that contribute to this symptom.”
When medications are needed, desmopressin, approved by the Food and Drug Administration (FDA) to treat nocturia, can reduce urine production. However, it comes with an important warning, as it can occasionally cause dangerously low levels of sodium in the blood, which can be fatal in severe cases.
Medications that target an enlarged prostate or relax the bladder muscles may also be effective, but could cause side effects. Benign prostatic hyperplasia (BPH), an enlargement of the prostate gland, can be treated with lasers and other methods to remove excess prostate tissue that is blocking the flow of urine.
In most cases, however, experts agreed that nocturia can be controlled without medications.
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“Getting up frequently at night to urinate, especially if it’s bothersome, is something we can often improve, so people don’t have to feel like it’s an inevitable part of aging or that they have to suffer in silence,” Vaughan said. “Nocturia has multiple causes. It’s not just about the bladder.”