A good night’s sleep helps you feel rested and refreshed in the morning. However, when you have the frequent urge to use the restroom at night, a good night’s sleep can be hard to achieve. If you find yourself waking up to urinate more than twice each night, you may have a condition called nocturia. This is most common in people over the age of 60. (NAFC)
Nighttime urination is not to be confused with a related condition called enuresis (bed-wetting), where you cannot control your need to urinate at night. While nighttime urination typically results in sleep loss, it can be a symptom of an underlying condition.
What Are the Symptoms of Nighttime Urination?
Most people can get a full six to eight hours’ rest without the need to urinate. However, nighttime urination causes you to get up several times at night to use the restroom. In its most severe forms, this condition causes you to get up between five to six times at night.
Symptoms associated with nighttime urination include:
- overproduction of urine (urinating more fluid than you do normally)
- urinating too frequently
- feeling the urgent need to urinate, yet little urine is produced
Nighttime urination can be problematic because you cannot feel rested when you are frequently using the restroom. Also, nighttime urination can increase the likelihood for falls and injury in the elderly.
What Causes Nighttime Urination?
Aging is one of the biggest contributing factors to nighttime urination. As we age, the body produces less of the anti-diuretic hormone that helps us retain fluid resulting in increased urine production—especially at night. Muscles in the bladder can also become weak over time, making it more difficult to hold urine in the bladder.
Aging is not the only contributing factor to nighttime urination. Other common causes include:
- chronic urinary tract infections
- drinking excess fluids (especially caffeinated and alcoholic ones) before bed
- bacterial infection in the bladder
- medications that encourage urination (diuretics)
Women may experience frequent urination as a result of pregnancy and childbirth, which can weaken the bladder and pelvic floor muscles.
In some cases, nighttime urination is a symptom of an underlying medical condition. Disease and conditions associated with frequent urination include:
- chronic renal (kidney) failure
- congestive heart failure
- benign prostatic hypertrophy (enlarged prostate)
- sleep disorders, such as obstructive sleep apnea, insomnia or restless leg syndrome
When to See A Doctor
Your doctor will diagnose your nighttime urination by evaluating your symptoms and performing a physical examination. They may ask certain questions to determine potential causes for the condition. Questions may include how many times you get up to urinate at night, how long you have been experiencing nighttime urination, and questions about your regular activities before bed. For example, if you are drinking lots of fluids or taking diuretics before bedtime, these can lead to nighttime urination. Certain tests may be ordered to help determine the cause of frequent urination, such as:
- urinalysis (looks at the chemical compounds present in urine)
- urine concentration (determines if the kidneys are properly excreting water and waste products)
- urine culture
- post-void residual urine measurements—this test involves taking an ultrasound of pelvic area to see how much urine remains in the bladder after urination
If your doctor suspects an underlying medical condition is causing nighttime urination, they may order further tests to make a diagnosis, such as:
- blood sugar
- blood urea nitrogen
- blood osmolality (measures the concentration of chemicals in the fluid part of the blood)
- creatinine clearance
- serum electrolytes
These tests can determine how well the kidneys are functioning and measure the concentration of certain chemical compounds in your blood. These tests can help identify if nighttime urination is a side effect of kidney disease, dehydration, or diabetes-related health complications.
What Treatments Are Used for Nighttime Urination?
Treatment for nighttime urination often depends upon its cause. For example, if you are drinking too much before bed, your physician may recommend restricting your fluids after a certain time.
Certain behaviors can also reduce the frequency of nighttime urination. In addition to reducing your fluid intake at night, you also may need to take afternoon naps to feel more rested. Keeping your legs elevated during the day and/or wearing compression stockings to encourage fluid circulation also can help to minimize nighttime urination. (NAFC)
Medications may also help reduce nighttime urination, but are not always a first line of treatment. Medications can alleviate symptoms, but cannot cure nighttime urination—once you stop taking them, your symptoms will return.
A class of drugs called anti-cholinergics are prescribed to relax muscle spasms in the bladder and reduce the need to urinate more frequently. If you also experience bed-wetting, some anti-cholinergics can reduce this occurrence. However, these medications can cause side effects such as dry mouth, dizziness, and blurred vision.
Some doctors recommend taking a diuretic that encourages urination earlier in the day to reduce the amount of urine in your bladder at night. For some people, taking a synthetic form of anti-diuretic hormone may help to reduce nighttime urination.