The Facts About Nocturia

It's a common question many Americans ruminate over with their morning coffee: Why do I urinate so much at night?

Getting up once in the night is normal, but more than once? You may have a condition called nocturia.

Nocturia is a common condition that causes you to wake up during the night to urinate. Your quality of life may be hampered by this sleep disruption. Though nocturia can strike at any age, it is more common in older adults, affecting about 1 in 3 people older than 30 years of age.

Nocturia may be caused by:

• Bladder storage issues. Your bladder is not storing urine well.
• Nocturnal polyuria. Your body makes too much urine at night.
• Polyuria. Your body produces too much urine throughout the day and night.
• Mixed nocturia. A mix of the three conditions above.

Other causes of nocturia include:

• Anxiety 
• Bladder infections
• Bladder obstructions
• Diabetes
• High fluid intake
• Sleep disorders
• Urinary tract infections (UTIs)

In women, pregnancy can contribute to these symptoms.

In general, if you regularly wake up more than twice to urinate, you may have nocturia. This disorder may carry other symptoms that can play a role in the diagnosis, including:

• Fatigue when waking
• Frequent urination throughout the day
• Urinary tract infections

Factors that increase the risk of having nocturia include:

• Certain medications and supplements, including diuretics, phenytoin, lithium and excessive amounts of vitamin D
• Drinking alcohol or caffeinated beverages before bed
• Drinking fluids too close to bedtime
• Older age
• Pregnancy
• Various medical conditions, including diabetes,edema, bladder infections, enlarged prostate and menopause

When making a nocturia diagnosis, your doctor asks about your symptoms and medical history. They may also ask you to keep a bladder diary to help with the diagnosis; this diary is used to keep track of the fluids you drink and your number of trips to the restroom each day. The diary can track trends over a period of time, which can help your doctor determine the right treatment for you.

Questions your doctor might ask include:

• Do you feel like you are getting enough sleep?
• Has the amount of urine you make increased or decreased recently?
• Have you changed your diet recently?
• How many times do you wake up to urinate each night?
• How much caffeine or alcohol do you consume each day?
• How much urine do you pass each time?
• What time of day do you drink caffeine and alcohol?
• When did your symptoms begin?

The cause of frequent urination in men is often benign prostatic hyperplasia (BPH), or enlarged prostate. The prostate gland, which lies at the base of the bladder and surrounds the start of the urethra, is normally about the size of a walnut. As tissue grows as men age, the prostate then blocks some of the flow of urine through the urethra.

More than 50 percent of men develop symptoms of BPH by age 60. Nearly all men in their 80s have benign prostatic hyperplasia.

Nocturia is a common symptom of a urinary tract infection (UTI). UTIs cause the lining of the urinary tract to become inflamed, which can lead to a variety of symptoms, such as:

• Blood in your urine (hematuria)
• Cramping or pressure in the groin area
• Having to urinate frequently
• Pain or burning during urination

How nocturia is treated depends on its cause. If your nocturia is caused by an infection, for example, antibiotics are prescribed. Nocturia can usually be managed through an array of methods, such as:

• Avoiding alcoholic and caffeinated beverages in the evening
• Taking medication earlier in the day, if meds are the cause
• Not drinking much two hours before bedtime
• Urinating before you go to sleep

In severe cases of nocturia, anticholinergic drugs may be prescribed. These drugs can help treat an overactive bladder. Desmopressin (brand name: Ddavp) is a prescription drug that can make your kidneys produce less urine.

Limiting the amount of liquid you drink before going to bed can help prevent you from needing to urinate at night. Avoiding drinks that contain alcohol and caffeine can help, as well as going to the bathroom before you go to bed.

Some foods, such as chocolate and spicy foods, can be bladder irritants, so avoid those. Kegel exercises can help strengthen your pelvic muscles, improving your bladder control.

"Sleep hygiene" refers to good sleeping practices that can help you fall asleep more easily and help you stay asleep. The amount and quality of sleep you get each night are impacted by developing and maintaining excellent sleep hygiene. It's vital for both your physical and emotional well-being. Practices that can enhance your sleep hygiene include:

• Cutting back on caffeine before bedtime
• Establishing a sleeping environment with soft lighting and a pleasant temperature
• Exercising earlier in the day
• Maintaining a consistent wake-up and bedtime schedule
• Turning off all electronics one hour before bedtime

Sleep deprivation and insomnia are considered risk factors for sexual dysfunction. This is how waking up in the middle of the night to use the restroom could impact your sexual health. In women, lack of sleep has been associated with reduced sexual desire and arousal. In men, sleep deprivation and disrupted sleep have been linked to a greater risk of erectile dysfunction (ED), the consistent inability to achieve and maintain an erection.

Several sleep disorders have been connected to sexual problems. Sleep apnea, which is characterized by recurring pauses in breathing that disrupt sleep, has also been linked with a higher risk of ED.

Research indicates sleep apnea is tied to sexual dysfunction in women, too.

How do you fix nocturia?

Treatment of nocturia may involve lifestyle modifications and medication, or both. Common interventions to address nocturia include:

• Elevate the legs and wear compression stockings during the day to help prevent fluid accumulation.
• If you're using diuretics, take them early in the afternoon or at least six hours before bedtime.
• Restrict fluids in the evening.

When the problem is a prostate blockage, medications that relax or shrink the prostate are frequently prescribed. Bladder relaxants may be helpful when the bladder is hyperactive. Synthetic antidiuretic hormone (ADH) may be useful for treating nocturnal polyuria.

What is the most common cause of nocturia?

The most common cause of nocturia is nocturnal polyuria, a syndrome where the usual day-to-night ratio of urine production is altered. Nocturnal polyuria is defined as nighttime urinary production that is greater than 20 percent of the total 24-hour urine volume in younger adults or greater than 33 percent in older individuals.

How many times is normal for urinating at night?

Individuals who do not have nocturia can usually make it through six to eight hours of sleep without having to make a trip to the bathroom. If you have to get up only once at night to urinate, you are likely still in the normal range.

Many people urinate more frequently at night as they age. However, most people over the age of 60 do not urinate more than twice a night. If you are waking up to urinate more than twice each night, consult your doctor because you may have nocturia.