Nocturia

What is nocturia?

Nocturia is a condition that causes you to wake up during the night to pee. This condition is also called nocturnal urinary frequency — having to pee more often at night. Nocturia becomes more common as people age (usually older than 60) and occurs in all genders and sexes, sometimes for different reasons. It can be common for people to wake up once during the night to pee, but peeing more frequently may be a sign of an underlying condition or problem.

When a person pees too much during the daytime, but can limit the amount of trips to the bathroom at night, it’s referred to as frequent urination. Nocturia is strictly using the bathroom multiple times after bedtime and before you wake up in the morning. Whether it’s happening due to an underlying medical condition or something else, it can leave you feeling tired because your regular sleep cycle is disrupted.

How common is nocturia?

Nocturia is a common condition affecting more than 50% of adults after age 50. It’s more common in men and people assigned male at birth (AMAB) after age 50. Before 50, nocturia is more common in women and people assigned female at birth (AFAB). It affects up to 1 in 3 people over the age of 30.

What are the symptoms of nocturia?

Typically, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. But, people who have nocturia wake up more than once a night to pee. This can cause disruptions in your normal sleep cycle, and leave you tired and with less energy during the day.

Symptoms of nocturia can include:

• Waking up twice or more to pee at night.
• Peeing more in volume if polyuria is present. Polyuria is peeing too much in milliliters (total volume of pee), but not necessarily peeing too many times.
• Fatigue and sleepiness during the day. This occurs because peeing so frequently can interrupt your typical sleep cycle.

What are the most common causes of nocturia?

There are anatomical differences between the sexes that can contribute to waking up to pee at night. For example, men and people AMAB have a prostate, but women and people AFAB may have pelvic organ prolapse due to childbirth.

Causes of waking up to pee at night in all people include:

• Drinking too much fluid before bedtime: Beverages containing alcohol and caffeine may make it worse.
• Medications that contain a diuretic: Diuretics, or water pills, cause your body to remove excess fluid and salt and make you pee more often.
• Reduced bladder capacity: Your bladder may not be fully filling or emptying when you pee. Things like a bladder obstruction, swelling, infection and pain in your bladder could cause this to happen.
• Habit or routine: You may have unintentionally trained yourself to wake up and go to pee, even if you don’t have to. Or, you may be waking up for an unrelated reason, but go straight into the bathroom thinking you woke up to pee.

Certain health conditions can cause you to need to wake up to pee at night. These include:

• Polyuria (your body produces too much pee for your bladder to hold).
• Diabetes.
• High blood pressure.
• Benign prostatic hyperplasia or prostate obstruction.
• Heart disease or congestive heart failure.
• Obstructive sleep apnea or other sleep disorders.
• Pelvic organ prolapse.
• Childbirth, pregnancy or menopause.
• Restless legs syndrome.
• Edema.

What are the complications of nocturia?

Many conditions that affect your bladder or prostate can lead to having to wake up to pee. Not treating these underlying conditions could lead to continuing to have to wake up to pee or the condition worsening.

The other complication of nocturia is a loss of quality sleep, which is important to your overall health and well-being.

How is nocturia diagnosed?

To help your healthcare provider diagnose nocturia, it may help to keep a diary of your nighttime bathroom trips and the factors surrounding each trip. This could also include things like how much you drank, how often you went, what time it was and how much you peed (volume in milliliters). Knowing how much you pee can be difficult, but you should be able to purchase a urine catcher with measuring lines at your local pharmacy. Or, your provider may give you one to take home. Your healthcare provider will review the diary in order to determine the possible cause(s) of and treatment for the nocturia. Be sure to make a list of all medications you’re taking.

Your provider may ask you the following questions:

• When did you first start waking up to pee?
• How many times do you need to pee each night?
• Is there a large or small volume of pee each time?
• Has there been an increase or decrease in the amount of pee each time?
• How much caffeine do you drink each day?
• Does frequent urination during the night keep you from getting enough sleep?
• Do you drink beverages containing alcohol? If so, how many each day?
• Has your diet changed recently?
• What medications do you take and when do you take them?

Your healthcare provider may order a urinalysis or urine culture to look for infection, proteins and other elements.

Other tests that may help with determining an underlying cause could involve:

• Blood tests to check kidney function.
• Imaging tests on your bladder to see if it fills or empties.
• Cystoscopy.

Most primary care providers can help with nocturia, but you may also need to visit a urologist or another specialist depending on the underlying cause.

How can I stop peeing so much in the middle of the night?

Treating the underlying cause typically comes first. For example, if you have sleep apnea, you may need to see a sleep specialist. If your prostate is enlarged, you may need medication or surgery to treat that condition.

Your healthcare provider may recommend certain lifestyle changes, regardless of what’s causing your nocturia. This is because small lifestyle changes tend to be low risk and often go a long way in helping reduce the number of trips you make to the bathroom at night.

Lifestyle changes for nocturia include:

• Restricting fluids in the evening (especially caffeinated beverages).
• Taking diuretic medication in the morning or at least six hours before bedtime.
• Taking afternoon naps. Naps allow your bloodstream to absorb liquid, meaning you’ll need to use the bathroom after a nap. This could reduce your trips to the bathroom at night.
• Elevating your legs while you’re sitting at home. This helps with fluid distribution.
• Pelvic floor physical therapy to strengthen your pelvic floor muscles.
• Wearing compression stockings, which also helps with fluid distribution.

Medications are an additional treatment option your provider may consider. These medications include:

• Anticholinergics: These medications reduce symptoms of overactive bladder. Up to 40% of people find success with anticholinergics. Examples of this type of medication include mirabegron (Myrbetriq®), darifenacin (Enablex®), oxybutynin (Ditropan®) and tolterodine (Detrol®).
• Diuretics: Medication like bumetanide (Bumex®) and furosemide (Lasix®) assist in regulating how much pee you produce.
• Desmopressin (DDAVP®): Helps your kidneys produce less pee.

You should always talk to your healthcare provider about what treatments will work best for you. Be sure to ask them questions about medications and what they believe will give you the best success.

Why do I pee every 2 hours at night?

Peeing frequently at night could be a sign of an underlying condition. Or, it could mean you’re drinking too much before you go to bed. It might be a good idea to make some simple lifestyle changes like eliminating beverages two to three hours before bedtime. Discuss your symptoms with a healthcare provider if this doesn’t work. You may need medication or tests to determine if something else is causing you to pee so often.

Can nocturia be prevented?

Nocturia isn’t preventable. Many times it’s a side effect of an underlying condition. Managing chronic conditions like diabetes may help it. But sometimes it’s unavoidable. In the case of menopause or pregnancy, there’s not much you can do to prevent it.

Lifestyle changes like drinking less liquid after dinner can help when there isn’t an underlying condition contributing to nocturia.

Is nocturia a serious condition?

Nocturia isn’t life-threatening, but the underlying conditions that can cause it may be. It’s important not to ignore having to pee several times per night because it can point to a more serious condition. This isn’t always the case, though. Some people pee more than others. So if your test results don’t indicate any medical problems, there’s no reason to be concerned about nocturia causing you harm unless it disrupts your sleep cycle.

When should I see my healthcare provider?

Nocturia is treatable — it’s not a condition you need to live with. Contact your healthcare provider if you find yourself waking up to pee more than once or twice per night. It may be a sign of something else going on and the frequent wake-ups may leave you feeling exhausted.

What questions should I ask my provider?

It’s normal to have questions about a health condition. Some questions you may ask your healthcare provider about nocturia include:

• What tests do I need?
• What conditions may be causing me to pee at night?
• What treatments do you recommend?
• Is this a sign of something more serious?

A note from Cleveland Clinic

Nocturia can be a challenging and frustrating condition. Contact a healthcare provider if you’re waking up several times per night to pee. Often, lifestyle changes can make a big difference. But sometimes, medication is necessary, especially if you have an underlying bladder or prostate issue. Fortunately, most cases are highly treatable.