BPH

Nocturia: Why Do I Urinate So Much At Night?

Have you ever been woken from a deep and dreamless sleep with the urgent need to run to the toilet?

Is this happening not once or twice, but frequently throughout the night? Then you may be experiencing nocturia.

Nocturia is a condition which causes you to wake during the night with the urge to urinate.

It’s a pretty common condition that can affect both men and women and 1 in 3 adults over the age of 30 make at least two trips to the bathroom on a nightly basis.

Although the majority of those who are dealing with nocturia are usually older adults, over the age of 60, it can happen at any age.

What is Nocturia?

Simply put, nocturia is a medical term for excessive urination. When we sleep, the body produces less urine, and typically people do not need to wake up during the night for a toilet visit.

However, for some people, this is not the case, and they are woken with the need to urinate. This can disrupt sleep patterns and may even be a sign of an underlying health problem.

What Causes Nocturia?

There is no single identifiable cause of nocturia. Many factors can contribute to its development, including:

  • Prostate problems – Nocturia can often be a tell-tell sign of prostate problems in men. As men age, the prostate gland enlarges. This can cause problems. An enlarged prostate (BPH) can press on your urethra and prevent your bladder from emptying properly, resulting in urinary frequency.


  • Bladder problems– If you are feeling the need to urinate frequently, it could also implicate an overactive bladder. An overactive bladder (oab) affects your bladder capacity, causing a sudden urge to urinate. Alternatively, it may be a sign of a bladder infection. Symptoms include dark, cloudy, and smelly urine; pain when passing urine; and struggling to empty your bladder completely.


  • Multiple sclerosis– Bladder dysfunction is common in people with multiple sclerosis. It happens when MS lesions block transmission of nerve signals that control the bladder and urinary sphincters.


  • Obstructive sleep apneaObstructive sleep apnea is when your airways get blocked, causing your breathing to start and stop when you sleep. A study showed that over 84% of patients with sleep apnea reported frequent nighttime urination.


  • Medications– Medications often have side effects, and nocturia may be one of them. This is particularly true of diuretics, a medication used to treat high blood pressure.


  • Pregnancy– During pregnancy, women may experience the frequent need to urinate at night, resulting in poor sleep quality.

What are the Symptoms of Nocturia?

Nocturia can cause sleepless nights. If you are experiencing the following symptoms, you should visit your doctor so that he can give a diagnosis:



  • Urinary urgency


  • Disrupted sleep

How is Nocturia Diagnosed?

During diagnosis, your doctor will ask you a number of questions to help determine the symptoms you are experiencing and any possible causes. You may also be asked to keep a bladder diary, recording the amount your drink and how often you urinate.

Some questions your doctor may ask include:

  • When did the symptoms start?


  • How many times do you need to urinate each night?


  • How much urine volume do you produce?


  • Are you producing more or less urine than before?


  • How much caffeine and alcohol do you drink a day, and at what time?


  • Are you taking any medications?


  • Do you have a family history of diabetes mellitus?

Further diagnostics may involve:

  • Urinalysis to detect problems that may be shown by your urine, such as an infection.


  • Blood sugar test to check for type 1 or type 2 diabetes.


  • Complete blood count (CBC), a standard test that screens for certain disorders that can affect your health.


  • Bladder scan, which shows the volume of urine remaining in the bladder after you urinate.


  • Cystoscopy checks for a tumor or other causes of your symptoms. This is inserted through your urethra and into your bladder, providing a visual.

  • Urodynamic testing: checks to see how well your lower urinary tract stores and releases urine.

What are the Treatment Options for Nocturia?

Treatment of nocturia will be dependent on its cause.

Medication

Medicines to help the kidneys produce less urine. For example:

  • Desmopressin.


  • Anticholinergic medications to treat bladder muscle problems. They relax the bladder if it spasms. These are used to treat an overactive bladder. As do many drugs, anticholinergics come with several warnings. Reported side effects include memory problems, confusion, and blurry vision.


  • Diuretic medicines to regulate urine production and high blood pressure. For example, Bumetanide, Furosemide.

However, as with many drugs, each come with warnings and may have adverse side effects. Before taking medication, discuss the potential side effects with your doctor and do your research.

If your case of nocturia is related to underlying health problems, such as prostate problem or diabetes, your health practitioner will discuss the next steps for treatment.

Lifestyle Changes

To help manage the symptoms of nocturia, there are several changes you can make to your daily routine. These include:

  • Urinating before going to bed.


  • Taking steps to sleep better at night.


  • Reducing the amount of fluid you drink before bed.


  • Avoiding drinks, such as alcohol and caffeine, which can cause bladder irritation.


  • Avoiding foods, such as chocolate, spicy foods, acidic foods, and artificial sweeteners, which can also cause bladder irritation.


  • Keeping a food diary, so you can identify specific foods that may affect your symptoms.


  • If you are taking diuretics, timing is an important consideration to discuss with your doctor.


  • Practicing kegel exercises (pelvic floor exercises), to help strengthen pelvic muscles and improve bladder control.

Conclusion

Nocturia can be an embarrassing condition that leaves you sleep-deprived and fatigued. While it might be easy to dismiss as part of ‘growing older,’ it can affect the quality of life and could signify an underlying health problem.

Luckily there are many nocturia treatment options available, as well as lifestyle changes that can help to manage symptoms.

Sources

  1. Oelke M, De Wachter S, Drake MJ, et al. A practical approach to the management of nocturia. Int J Clin Pract. 2017;71(11):e13027. doi:10.1111/ijcp.13027
  2. Lose G1, Mattiasson A, Walter S, Lalos O, van Kerrebroeck P, Abrams P, Freeman R.. (2004). Clinical experiences with desmopressin for long-term treatment of nocturia.. Journal of Urology. 172 (3), p1021-1025.
  3. Chartier-Kastler ELeger DComet D, et al Prostatic hyperplasia is highly associated with nocturia and excessive sleepiness: a cross-sectional study
  4. https://www.sleepapnea.org/learn/sleep-apnea/nighttime-urination-and-sleep-apnea/
  5. Kyung Park, E, MD1, Hyun Park, J, Hyun Kim, J, Im Choi, J, Kim, K, et al. (2015). Relationships between Nocturia, Obstructive Sleep Apnea, and Quality of Sleep. Sleep Medicine Research. 6 (1), p28-34.
  6. Fitz F, Sartori M, Girão MJ, Castro R. (2017). Pelvic floor muscle training for overactive bladder symptoms – A prospective study.. Revista da Associação Médica Brasileira. 63 (12), p1032-1038.
  7. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Bladder-Dysfunction
  8. https://www.sleepfoundation.org/articles/pregnancy-and-sleep
  9. Chasens ER, Umlauf MG, Pillion DJ, Wells JA4. (2002). Nocturnal polyuria in type 2 diabetes: a symptom of obstructive sleep apnea. Diabetes Education. 28 (3), p424-434.
  10. Richardson KathrynFox ChrisMaidment IanSteelNicholasLoke Yoon KArthur Antony et al. Anticholinergic drugs and risk of dementia: case-control study 
  11. Lieberman JA 3rd. Managing anticholinergic side effects [published correction appears in Prim Care Companion J Clin Psychiatry. 2012;14(1):PCC.12lcx01362]. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):20–23.

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