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Nocturia: Frequent urination at night

Wesley S. Hilger

Wesley S. Hilger, M.D., FACOG

Sutter Medical Center, Sacramento

Surgery Center Division

Sutter Independent Physicians

Sutter Roseville Medical Center

Question:

What can I do about frequent urination during the night? I wake up at least once or twice to urinate.

Answer:

The benefits of uninterrupted sleep cannot be overstated. When we wake frequently at night with a bladder that is giving us the "gotta go" signal, we suffer the next day.

Nocturia is the term to describe the number of times a person has to wake from sleep to pass urine. It is not unusual for people to wake up once a night, but any more than that and it becomes disruptive. As we age, this can become more common and after the age of 70, it is not unusual for people to wake up two to three times a night to urinate.

There can be many causes for nocturia including:
  • Drinking too much fluid before bedtime, especially coffee, caffeinated beverages, or alcohol
  • Untreated diabetes (yype 1 and type 2)
  • Edema of the lower extremities (swelling of the legs)
  • Sleeping disorders such as obstructive sleep apnea (breathing is interrupted or stops many times during sleep)
  • Certain drugs, including diuretics (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
  • Bladder obstruction (difficulty completely emptying one's bladder)
  • Bladder overactivity
  • Bladder infection or recurrent urinary tract infection
  • Interstitial cystitis (pain in the bladder)

A very simple and informative way to assess for nocturia is to keep an accurate voiding diary. This should be done for at least two days and should note the amount and type of fluid that is consumed, when medications are taken, and the time and amount of urine that is voided.

Simple solutions for reducing the number of times you have to void at night include restricting fluids in the evening (especially coffee, caffeinated beverages, and alcohol); taking diuretics mid to late afternoon; elevating the legs during the day (helps prevent fluid accumulation); and wearing compression stockings (helps prevent fluid accumulation). If these measures do not help reduce the number of times you wake up at night to urinate, then consult with your physician. Further testing and assessment could lead to treatment that could help you get a more restful night's sleep.

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