Nocturia

What is nocturia?

If you wake up often during the night with an urgent need to pee (urinate), you may have nocturia. This condition can affect anyone. But it is more likely to occur as you get older. About 50% of adults over age 50 have nocturia.

Getting up once at night to pee is common. It may not be a problem. But waking up 2 or more times a night to pee may mean that you have nocturia. This constant sleep disruption can affect how well you function during the day. You may feel very tired and grouchy. It may affect your quality of life.

Nocturia is often a symptom of an underlying health problem.

How the urinary tract works

Pee is your body’s liquid waste. The urinary tract is where pee is made and stored, and how it leaves the body.

Here are the parts of the urinary tract and what they do:

• Kidneys. These are 2 bean-shaped organs. They make pee by filtering waste from the blood. Normally the kidneys make about 1.5 to 2 quarts of pee a day in an adult, and less in children.

• Ureters. These are 2 tubes that take pee from the kidneys to the bladder.

• Bladder. The bladder stores pee until you need to go to the bathroom. It gets larger as it fills up with pee.

• Urethra. When you pee, this tube empties urine from the bladder and takes it out of your body.

Types of nocturia

There are 3 main ways that nocturia can occur:

• Polyuria. This is when your body makes too much urine. It can occur when the kidneys filter out too much water from the blood.

• Nocturnal polyuria. Your body makes too much urine at night.

• Bladder storage problems. Your bladder has problems storing or releasing urine.

You may have more than one of these problems.

What causes nocturia?

Some common causes of nocturia include habits such as:

• Drinking too many fluids before going to bed

• Having drinks that contain caffeine, like coffee or soda

• Drinking alcohol before bed

• Eating foods with high amounts of salt

• Taking medicines such as water pills (diuretic medicines) or other medicines too close to bedtime, or in high doses

• Behavioral patterns (you have conditioned yourself to get up and pee at night as a routine)

Nocturia can also occur because of conditions or physical issues such as:

• High blood pressure

• Diabetes mellitus

• Diabetes insipidus

• Heart disease

• Congestive heart failure

• Vascular disease

• Gastroesophageal reflux disease (GERD)

• Being overweight or obese

• Pregnancy and childbirth

• Menopause

• An enlarged prostate gland (called benign prostatic hyperplasia or BPH)

• Bladder infection or urinary tract infection

• Sleep disorders such as obstructive sleep apnea, insomnia, and restless leg syndrome

• Leg swelling (edema)

• Interstitial cystitis

• Pelvic organ prolapse

In many cases, there may be more than one issue causing nocturia.

What are the symptoms of nocturia?

Symptoms of nocturia include:

• Waking up from sleep 2 or more times at night to pee

• Peeing a larger amount than normal

• Feeling an urgent need to pee but only peeing a small amount

• Feeling very tired and grouchy during the day, due to constant sleep disruption at night

• In older adults, being more likely to fall due to feeling very tired

These symptoms may be caused by other underlying health problems. Always talk with your healthcare provider for a diagnosis.

How is nocturia diagnosed?

Your healthcare provider will give you a physical exam. They will ask about your symptoms and health history. They may also ask you to keep a diary. You will write down the fluids you drink and when you drink them. You will also write down when and how much you pee.

You may also need tests done, such as:

• Blood test. This is done to check for diabetes, anemia, and other conditions.

• Urinalysis and urine culture. These check for infections in your urine.

• Urodynamic testing. This is done to see if your lower urinary tract

• Cystoscopy. The healthcare provider checks inside your bladder using a thin tube with a tiny camera.

• Bladder scan. This checks the amount of urine left in your bladder after you pee.

If you are diagnosed with nocturia, you may be referred to a urologist. This is a doctor who specializes in conditions affecting the urinary tract.

How is nocturia treated?

Treatment is aimed at reducing symptoms. If you have an underlying health condition, treatment will also focus on that condition.

Nocturia can be treated in several ways:

What are the possible complications of nocturia?

Nocturia disrupts your sleep. This can lead to daytime tiredness (fatigue) and irritability. In older adults, nocturia can lead to daytime cognitive problems, depression, and social isolation. Daytime tiredness can lead to a greater risk of falls.

Key points about nocturia

• Nocturia is when you wake up 2 or more times each night to pee. It is more likely to occur as you get older.

• It can be a symptom of an underlying health problem.

• It can be caused by lifestyle habits such as drinking fluids or taking diuretics before bedtime, having a lot of drinks with caffeine, and eating a lot of salt.

• It can also be caused by conditions such as high blood pressure, diabetes, heart disease, enlarged prostate gland.

• The constant sleep disruption can affect how well you function during the day. Older adults may be at greater risk for falls.

• Treatment can include a mix of lifestyle changes and medicines. If you have an underlying health condition, you will treat that as well.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is advised. and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.