Nocturia is defined as waking up at night to urinate. This is different from nocturnal enuresis, which is urinary leakage while asleep. It is a common problem, and occurrence increases with increasing age at an equal rate between men and women. Nocturia can be very distressing, contributing to disturbed sleep which can impact quality of life; it can also increase one’s risk of falls, which is especially concerning for the elderly. Often thought of as an inevitable consequence of aging, it can arise from several different factors, and can be treated quite effectively.
Nocturia can occur on its own, but is often a sign or symptom of underlying issues, so a medical examination is highly recommended.
One common cause is an overproduction of urine overnight, called nocturnal polyuria; this can have several causes:
- Increased fluid/caffeine consumption at night
- Timing of medications, especially diuretics
- Sleep apnea
- CHF, venous insufficiency or kidney issues which cause fluid buildup in the legs
Another cause is general overproduction of urine, called diurnal polyuria, which is most often related to diabetes.
Finally, nocturia can be caused when urine production exceeds what the bladder is able to hold. Reduced bladder capacity can be due to structural changes in the bladder or urethra, by irritation within the bladder itself, or by a condition called overactive bladder.
So what to do if you are waking several times a night to pee? First, call your doctor; a medical examination is important to rule out significant contributors such as cancer or diabetes. Further, a urological examination to determine your bladder capacity can also be helpful. Finally, consider physical therapy! A recent study showed that behavioral training, including urge suppression and pelvic floor muscle training, reduced nocturia episodes in men to a greater degree when combined with pharmacological management, than drugs alone.
In the meantime, try these tips to see if they are helpful:
- Avoid drinking significant amounts of fluid, especially caffeine, 2 hours before bed
- When you wake up with an urge to pee, take 3 deep breaths, think about something else, and try to return to sleep without getting up
Remember: nocturia is common, but it is not normal. You are not alone, and you have options! Give us a call if you have questions!
Appell, R. and Sand, P., 2007. Nocturia: Etiology, diagnosis, and treatment. Neurourology and Urodynamics, 27(1), pp.34-39.
Johnson, T., Markland, A., Goode, P., Vaughan, C., Colli, J., Ouslander, J., Redden, D., McGwin, G. and Burgio, K., 2013. Efficacy of adding behavioural treatment or antimuscarinic drug therapy to α-blocker therapy in men with nocturia. BJU International, 112(1), pp.100-108.