Nocturia: Causes and Treatments for Frequent Urination

What Is Nocturia?

Nocturia describes needing to wake up at night in order to urinate. It is a symptom of other conditions, not a disease itself.

According to technical definitions, a person has nocturia if they get out of bed to urinate one or more times per night Trusted Source Wiley Online Library Wiley Online Library is one of the largest and most authoritative collections of electronic journals published by Wiley, as well as a vast and growing collection of reference works and other books. View Source . By this standard, nocturia is widespread, affecting around 40% of adults ages 18 to 79 Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . While many people may not find one awakening to be problematic, nocturia tends to be more bothersome when a person awakens two or more times a night. 

Nocturia can affect younger people, but it becomes more common with age Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source , especially in older men and people assigned male at birth. It is estimated that nearly 50% of men in their seventies have to wake up at least twice per night to urinate. Overall, nocturia may affect up to 80% of older adults Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Nocturia frequently occurs during pregnancy but usually goes away within three months after giving birth. Nocturia is not the same thing as bedwetting, which is also known as nocturnal enuresis. Unlike nocturia, which involves waking up and recognizing the need to urinate, bedwetting typically occurs involuntarily and without the sensation of having a full bladder.

Causes of Nocturia

The main causes of nocturia include producing excess urine at night, decreased bladder capacity, and sleep disruptions. Each of these issues can be caused by a variety of underlying health conditions.

Producing Excess Urine at Night

Producing excess urine at night, known as nocturnal polyuria, may be the most common cause of nocturia. It is estimated to be a contributing cause for up to 88% of cases.

For some people, excess urine production occurs throughout the day and night. This condition, called global polyuria, is most often tied to excess fluid intake, diabetes, and poor kidney function Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source . Diuretics, including certain medications and substances like alcohol and caffeine, can cause enhanced urine production Trusted Source Merck Manual First published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers. View Source as well.

Elevated amounts of urine production that occurs only at night can happen when fluid intake goes up at night. It can also occur when peripheral edema — swelling or fluid accumulation in the legs — relocates after a person moves into a lying position Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . Coexisting medical problems can contribute to peripheral edema and raise the risk of nocturnal polyuria.

Some research indicates that changes to the body’s circadian rhythm cause older adults to have a greater proportion of their daily urine production occur at night, which may be a contributing factor to their higher rates of nocturia.

Decreased Bladder Capacity and Increased Urinary Frequency

Even without increased nighttime urine production, reduced bladder capacity and increased urinary frequency can give rise to nocturia.

Urinary tract infections (UTIs) can cause a person to feel that they need to urinate frequently Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source . These infections can occur among people who have an overactive bladder or an enlarged prostate, also known as benign prostatic hyperplasia (BPH) Trusted Source National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) NIDDK research creates knowledge about and treatments for diseases that are among the most chronic, costly, and consequential for patients, their families, and the Nation. View Source .

A heightened urge to urinate, inflammation of the urinary tract, and bladder stones Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source can all be risk factors for diminished bladder capacity and increased urinary frequency that can lead to nocturia. Some people experience increased urinary frequency and urgency throughout the day while others find them to occur primarily at night.

Sleep Disruptions

Though we tend to focus on nighttime urination as disrupting sleep, there is compelling evidence that sleep problems are also a major factor in provoking cases of nocturia.

One of the clearest examples is obstructive sleep apnea (OSA), which causes repeated pauses in breathing during the night. OSA repeatedly reduces airflow and oxygen levels during sleep and influences hormones in a way that increases urine production. On top of that, people with OSA have frequent sleep interruptions, so they are more likely to notice the need to urinate. Nocturia occurs in around 50% of people with OSA.

Beyond OSA, there is debate among experts about whether nocturia causes sleep disturbances or the other way around. It is more likely that sleep problems, including insomnia, are the root cause if a person struggles to get back to sleep after going to the bathroom.

Research in older adults indicates that lighter sleep may increase susceptibility to nocturia. Older people spend less time in deep sleep stages, which means they are more easily awoken. Older adults have been found to produce more of their daily urine at night. This demonstrates how multiple factors can work simultaneously to cause frequent nighttime urination.

Nocturia Symptoms and Diagnosis

If you find that you are going to the bathroom two or more times each night, it is important to discuss your symptoms with your health care provider. Though nocturia is not a disease, it can have significant health consequences. It may be connected to serious underlying problems, and nighttime bathroom trips can both disrupt sleep and create additional health concerns. 

Your doctor can address any underlying issues and help develop a treatment plan. 

Preparing for Your Doctor Visit 

To better understand your symptoms, your doctor will likely ask questions about your medical history and complete a physical examination. 

To prepare for your doctor visit, it may help to keep a log of symptoms and other details, including:

• How many bathroom trips you make per night
• How difficult it is to fall back asleep after each trip
• How much liquid you consume throughout the day and in the evening
• What kinds of meals you eat and how much sodium you consume
• Any current medications you are taking

Following your visit, your doctor may recommend additional lab tests or bloodwork to identify potential causes of your nocturia.

Tips to Manage Nocturia for Better Sleep

Treating nocturia focuses on addressing any underlying medical conditions or habits that could be contributing to nighttime symptoms. Because it can have significant health consequences and connections to other illnesses, it is important to talk to your doctor about how to manage nocturia. A doctor can help identify the most likely cause and appropriate therapy.

Medical Treatments for Nocturia

When an underlying condition is causing nocturia, treating that condition may reduce nighttime trips to the bathroom. Many patients with nocturia are treated with medications or have adjustments to their existing medications.

Lifestyle Changes

A number of lifestyle changes can help reduce problematic nocturia. These changes are designed to reduce nocturnal urine production and include:

• Reducing evening fluid intake, especially before bed
• Decreasing consumption of alcohol and caffeine, especially in the afternoon and evening
• Elevating the legs an hour or more before bed in order to reduce the resorption and conversion of peripheral edema to urine during sleep

Working with a doctor and making lifestyle changes can reduce the number of bathroom trips you take each night, but they may not eliminate them completely. For that reason, it is important to take steps to make those trips as safe as possible, especially for older people.

Motion-activated, low-wattage lighting can make it easier to walk safely to and from the bathroom. The path should be cleared of common trip hazards like cords or rugs. People with mobility issues or who have high urgency to urinate upon awakening may find that a bedside urinal or commode improves safety and reduces sleep disruption.

Sleep Hygiene

Focusing on sleep hygiene, which includes your bedroom environment and sleep habits, can reduce awakenings during which you notice a need to go to the bathroom. Examples of healthy sleep habits include:

• Keeping a consistent sleep schedule, including waking up at the same time on weekdays and weekends
• Having a steady routine that gets you ready for bed each night
• Learning relaxation techniques that can put your mind at ease when you go to bed and when you want to fall back asleep after going to the bathroom
• Getting daily exercise that can help you have deeper sleep
• Setting up your bed with the best mattress, pillows, and bedding to promote comfort
• Customizing your bedroom to have a minimal light and noise, a cool temperature, and a pleasant smell
• Limiting the use of electronic devices, including smartphones, which can activate the brain and reduce the production of the sleep-promoting hormone melatonin