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At some point, you've probably had to wake up in the night to pee.
Pregnancy, drinking too much water before bed or certain conditions that tend to be more common as you age can make middle-of-the-night trips to the bathroom more common.
In general, occasionally waking up at night with an urge to urinate, known as nocturia, is not a problem. However, if it routinely happens more than twice per night or interferes with your sleep, doctors might recommend simple lifestyle changes or, if needed, medication.
"Whether it needs to be brought up to a physician really is driven by the degree of bother," said Jeffrey P. Weiss, professor and chair of urology at SUNY Downstate Health Sciences University, who has been studying nocturia for 30 years.
In other words, if it is happening often enough to annoy you, it might be time to get it checked out.
30-Who gets nocturia, and why?
Nocturia is common, affecting about 1 in 3 adults older than 30, and the prevalence increases with age, with up to 60 percent of older people experiencing the issue, according to one widely cited study.
Broadly speaking, there are three main causes. It can happen when there is excess urine production, the bladder is not able to hold as much urine as it used to or when there are underlying conditions that affect sleep, experts said. Here's a closer look at some of the driving factors:
Excess urine production: In some cases, the body might produce excessive amounts of urine, a symptom known as polyuria. It may be caused by medical conditions such as kidney disease and diabetes, or medications such as diuretics, which flush excess water from the body.
Nocturnal polyuria — in which an unusually large portion of your daily urine output is produced overnight — often occurs when people drink too much fluid before bed, particularly alcohol or caffeinated beverages. It can also be caused by underlying conditions, such as heart disease and sleep apnea, among other things, said Camille Vaughan, a professor and director of geriatrics and gerontology at the Emory University School of Medicine.
Cardiovascular disease can cause fluid to accumulate in the lower extremities throughout the day, and when it returns to the bloodstream when you lie down at night, it can lead to increased urine production during sleep.
Similarly, untreated obstructive sleep apnea, a condition in which a person's airway collapses during sleep, temporarily reducing or stopping airflow, can put strain on the heart. This causes the heart to release a hormone that tells the kidneys to eliminate more sodium and water, resulting in increased urine production, Vaughan said. (Using a continuous positive airway pressure, or CPAP, machine, which blows air into the airways to keep them open during sleep, can help treat nocturia caused by sleep apnea.)
Reduced bladder capacity: Urinary tract infections (UTIs) are a common cause of urgency, frequency and pain with urination.
But there are many other causes of the urinary urgency that can lead to nocturia.
An overactive bladder at any age can reduce the amount of urine the bladder can hold by causing involuntary muscle contractions to pass urine before the bladder is full.
Symptoms of an overactive bladder can result from underlying medical issues such as diabetes or neurological conditions, including multiple sclerosis, Parkinson's disease and stroke, Weiss said.
Additionally, pregnancy, an enlarged prostate, tumors or even constipation can put pressure on the bladder or other parts of the urinary system causing symptoms, Weiss said.
Some people experience both low bladder capacity and excessive urine production — "a double whammy," he said.
Underlying sleep disorders: Conditions that make it difficult to fall or stay asleep or that cause people to wake during the night, such as insomnia, restless leg syndrome and chronic pain, can contribute to nocturia because people are more likely to notice even a mild urge to urinate when they're awake, Vaughan said.
"The coexistence of insomnia and nocturia is quite common," particularly among older adults, she said.
Does nocturia pose health risks?
Nocturia alone isn't usually harmful, but the sleep disruption it causes may be associated with daytime fatigue, brain fog and reduced cognitive performance, among other issues.
It can pose safety risks as well. Repeated trips to the bathroom when people are groggy and navigating in the dark can lead to falls. An analysis of studies on nocturia and falls suggests that people who wake up at night to urinate may have about a 20 percent increased risk of falls and a 30 percent increased risk of fractures compared with those without nocturia.
Weiss suggested that people use night-lights to illuminate the path to the bathroom or keep a bedside toilet or urinal handy if they know or suspect they might be at a higher risk of falling.
How is nocturia treated?
When it's bothersome enough to require treatment, nocturia can be managed with lifestyle changes or, in some cases, medications.
A first-line treatment — behavioral changes such as simple tweaks to your diet or drinking habits — can help curb nighttime urination. If the cause is drinking too much fluid, for instance, limit water — and avoid alcohol and caffeine — before bed and refrain from keeping a glass of water on the nightstand, Vaughan said.
People with cardiovascular disease might benefit from limiting sodium intake. In one study, Weiss and his colleagues found that dietary sodium restriction counseling appeared to reduce nighttime urination in cardiology patients with nocturia.
Varicose veins, which are swollen or enlarged veins usually in the legs, occur when weakened or damaged valves cause blood to pool. This can also contribute to fluid accumulating in the lower extremities. When lying down at night, the body reabsorbs that fluid, prompting the kidneys to produce more urine.
Wearing compression stockings throughout the day and elevating the legs when possible can help decrease excessive urine production overnight, Weiss said.
Additionally, Vaughan said that under close supervision from a physician, the timing of some medications that can cause increased urination, such as diuretics, can be adjusted so that they're taken earlier in the day, to reduce excessive nighttime urine production.
Medications should not be considered without "understanding the underpinnings of nocturia, because as you get older, there are generally more and more factors that contribute to the symptom," Weiss said.
When medications are necessary, desmopressin, approved by the Food and Drug Administration to treat nocturia, can reduce urine production. But it carries a boxed warning, as it can occasionally cause dangerously low sodium levels in the blood, which can be life-threatening in severe cases.
Medications that target enlarged prostates or relax the bladder muscles can also be effective but might cause side effects. Benign prostatic hyperplasia (BPH), an enlargement of the prostate gland, can be treated using lasers and other methods to remove the overgrowth of prostate tissue blocking the flow of urine.
In most cases, though, experts agreed that nocturia can be managed without medications. "Getting up frequently at night to urinate, particularly if it's bothersome, is something that we can often improve, so people don't need to feel like it's an inevitable part of getting older or that they have to suffer in silence," Vaughan said. "There are multiple contributors to nocturia. It's not just about the bladder."
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