While most adults are able to sleep 6 – 8 hours a night, you may find yourself having to wake up several times during the night to go to the bathroom. This is a condition called nocturia.*
Nocturia can leave you feeling like you were up all night long, and you may feel extremely tired when morning arrives. Nocturia negatively affects a person’s quality of life by interrupting sleep, increasing the risk of nighttime falls, causing fatigue and/or depression, and decreasing work efficiency, among other possible problems. Men are much more frequently affected by nocturia than women are, and those who have difficulty walking are at increased risk of injury. Nocturia is also highly prevalent in individuals over 60 years of age.
Causes of Nocturia
Urinating at night, which interrupts sleep, is called nocturia. A common urological condition causing nocturia in men is an enlarged prostate or benign prostatic hyperplasia (BPH). The enlarged prostate can close off the urethra, thus making the bladder contract harder to push out urine. Over time, this weakens the bladder and leads to a variety of BPH symptoms. Conditions that might reduce the bladder’s capacity to hold urine through the night – post-radiation fibrosis, bladder surgery, interstitial cystitis, bladder stones — can also manifest as nocturia in men and women.
Nocturnal polyuria is the most common cause of nocturia and is the result of a medical condition. Nocturnal polyuria refers to abnormal high urine production and output during the night. In this setting, the bladder and prostate may be functioning normally, but the urine production overwhelms bladder capacity during the night.
Medical conditions contributing to nocturnal polyuria both in men and women are:
- Some prescribed medications – some medications may cause more urine to be produced during the night
- Heart failure – may cause fluid that has accumulated during the day in the feet to be pumped to the kidneys at night
- Diabetes and Metabolic Syndrome
- Obstructive sleep apnea (OSA) – nighttime production of urine increases with people with OSA
- Chronic kidney (or renal) failure
- Too much fluid intake or wrong time of fluid intake – fluids should be restricted a couple of hours before going to bed, and caffeinated and alcoholic beverages should be curtailed in the evening
- High blood calcium level (also called hypercalcemia)
Management / Treatment of Nocturia
Seek treatment for nocturia when you are bothered by the number of times you must wake up and go to the bathroom at night. This is usually more than once a night.
After an initial assessment by a physician (this should involve a discussion regarding the number of times you must get up each night to go to the bathroom and perhaps some diagnostic tests), the factors contributing to your nocturia should be clearer. Next, targeted steps can be taken to reduce these factors. This all should be done under the continuing guidance of a healthcare professional.
An important part of your medical evaluation requires a fluid or bladder diary in order to determine if the cause of nighttime voiding is due to urological causes, or if this is due to a medical condition, which causes abnormal higher production of urine overnight. The bladder diary requires documentation of both time of day and volume of urine excreted. Using these measurements, a calculation can be used to make this distinction and to better manage or treat the causes. Sometimes patients have both conditions due to more than one diagnosis. Interventions can target all of these in order to optimize improvement in sleep, as well as the underlying medical condition.
Depending on the contributing factors and other health issues a person might have, the steps to reduce the number of nighttime trips to the bathroom might include:
- Treating high blood pressure
- Treating chronic venous insufficiency of the lower extremities
- Implementing a weight loss program
- Treating BPH
- Trying a medication for overactive bladder (OAB) symptoms or a medication for the reduction of urine production at night (eg., Noctiva (desmopressin acetate) nasal spray for adults)
- A potential change in the timing of taking currently prescribed medications
- Continuous positive airway pressure (CPAP) for those with obstructive sleep apnea
- Acupuncture may be a new potential treatment for nocturia in some patients
Working with your healthcare professional could potentially reduce the frequency of nighttime trips to the bathroom and help you sleep through the night. In all cases, make sure that you continue to report how your nocturia is changing and how it affects your life to your healthcare professional. Your nocturia should be monitored over time, and how it is managed may also change over time. So, keep the conversation going!
* Nocturia has been defined by the International Continence Society as the general complaint that the individual has to wake at night one or more times to void.
Medical Reviewer: Jeannette M. Potts, MD
Dr. Jeannette Potts is Co-founder of Vista Urology and Pelvic Pain Partners in San Jose, California. She attended Case Western Reserve University, Cleveland, Ohio. She completed residency training in Family Medicine in 1994 and joined the Department of Urology at the Cleveland Clinic Foundation, where she spent 15 years as a member of the Glickman Urological Institute. Although starting as a general office urologist she quickly gravitated to Men’s Health where she developed several areas of specialization: a signature biopsychosocial approach to Urological Chronic Pelvic Pain Syndromes (UCPPS); prostate needle biopsy strategy and ACTIVE “active surveillance” of prostate cancer; no-scalpel vasectomy. Before coming to California, she was Director of Pelvic Pain and Alternative Therapies in Urology at University Hospitals of Cleveland and helped them initiate a multidisciplinary center for research in chronic pelvic pain. She is internationally recognized for her expertise in Men’s Health and especially for male pelvic pain syndromes. She is an ardent advocate for men and has published numerous articles in urology and family medicine. She has given over 100 lectures on UCPPS and related topics in 18 countries,and is an invited speaker at medical and urological conferences worldwide. She has been a collaborator with the US National Institutes of Health and the International Prostatitis Collaborative Network, to advance research and care of patients suffering from Urologic Chronic Pelvic Pain Syndromes. She was co-investigator for the NIH clinical trial showing the benefits of specialized physical therapy for patients with UCPPS. She is the editor of three urology textbooks, published by Humana and Springer Press as well as author of the book, Tango: Lessons for Life. Her fourth textbook. A Men’s Health Primer, was published in late 2015.