You wake up in the middle of the night and the to pee or not to pee question comes up. You're comfortable and you're tired. But your bladder really isn't going to let you stay. So you get up, deal with it. And the same thing happens again. Nearly everyone wakes up in the middle of the night to urinate at some point. But sometimes frequent urination can be a sign of health problems.
Frequent nighttime urination, or nocturia, is generally defined as getting up at least once a night to pee. If you get up to pee at night occasionally—most people do—it’s no big deal. But if it's mostly nightly and it bothers you, it's worth bringing up to a doc.
Technically, getting up even once a night can be considered nocturia. It's generally considered more bothersome to your quality of life when your nighttime bathroom breaks reach two or more times, according to Reviews in Urology.
Still, how much it bothers you is individual. And frequent urination at night becomes a problem when you experience daytime fatigue as a result of interrupted sleep, says Matthew Rutman, M.D., associate professor of urology at Columbia University Medical Center.
Nocturia tends to happen for one of three possible reasons: your bladder is having a hard time holding urine, you’re producing more urine than usual during the day, or you’re producing more urine during the night.
Sometimes, the latter is just a function of growing older, says Dr. Rutman. But if it’s happening consistently more than once a night or interfering with your ability to function the next day, the problem goes beyond normal aging. There could be an underlying reason that can and should be dealt with. And sometimes, when you deal with the underlying problem, the nighttime need to pee goes away, too. (If you think you're peeing too much during the day, check out the reasons that could be behind that.)
Here are some common reasons nocturia could be getting you up at night:
Cause of nocturia: high blood pressure
According to a 2019 study presented at the annual Scientific Meeting of the Japanese Circulation Society, people who woke up at least once per night to use the bathroom were 40 percent more likely to have high blood pressure. And those who woke up multiple times each night had an even greater likelihood of it.
Of course, this doesn't mean that your nightly bathroom visits are a sure-fire sign that you have high blood pressure. But if you have no idea whether your blood pressure is normal or not, you should get it checked. Especially if you're at risk of hypertension. Many factors can put you at risk; a short list includes having diabetes, eating too much sodium and too little potassium, not being physically active, having extra weight, smoking, having a family history of hypertension, and overdrinking alcohol.
If you're at risk of hypertension and you're waking up several times a night to urinate, it's worth discussing with a doctor.
Cause of nocturia: unrelated sleep problems
The more you wake up, the more opportunities you’ll have to notice you have to pee—and to empty your bladder. So, it may not actually be the urge to urinate that’s waking you up, says Dr. Rutman. You might just be waking up anyway.
One possible reason? Sleep apnea, a condition in which your breathing pauses while you sleep, can wake you up throughout the night. One recent study, for example, found that treating sleep apnea also treated nocturia. If you’re dealing with any other sleep issues, addressing them might help stop the peeing.
Cause of nocturia: not-great drinking habits
Alcohol is a diuretic, which increases your urine production, so drinking it late in the day could lead to excessive nighttime urination. Drinking too many fluids at night, regardless of what type, can also lead to nocturia.
Jason M. Phillips, M.D., a urologist with North Coast Urology, recommends cutting out all fluids two to four hours before bed and steering clear of alcohol in the evening to prevent late-night bathroom trips if you've been bothered my nighttime peeing.
Cause of nocturia: certain medications
Some common medications, including Lasix and hydrochlorothiazide, which are used to treat edema (swelling) and high blood pressure, are also diuretics, says Dr. Phillips. If you’re on one of these, take it six hours or more before bed.
It's possible other meds can be the culprit too, so your doctor if nocturia is a side effect of any medications you’re on.
Cause of nocturia: untreated diabetes
When you have diabetes, the excess glucose, or blood sugar, rushes to your kidneys, leading water to enter as well, says Dr. Phillips. So you might find your bladder filling up more quickly than usual.
If your constant peeing happens throughout the day as well as at night, and you're really peeing a lot, you might want to get a urinalysis test, says Dr. Phillips. This measures several substances in your urine, including glucose.
Cause of nocturia: an enlarged prostate
As men grow older, something called benign prostatic hyperplasia—or an enlargement of the walnut-shaped prostate gland—can occur. This can be due to changing levels of hormones, including less testosterone production or an accumulation of dihydrotestosterone.
An enlarged prostate gland can cause pressure on your bladder, making you think it needs emptying more often than it does, says Dr. Phillips. A bigger-than-usual prostate can also cause other urinary symptoms, like issues starting or stopping your flow, a weak stream, or the feeling you didn't complete empty your bladder after peeing.
Cause of nocturia: an irritated bladder or an infection
Similarly, irritants like spicy food, alcohol, and urinary tract infections can trick your bladder into thinking it’s full, says Dr. Phillips. Bladder problems will also likely show up as frequent urination throughout the day, not just at night.
Another challenge to your bladder can be bladder infections. Yes, men can get them, too, particularly if they have an enlarged prostate, kidney stones, or their urethra narrows in size due to sexually transmitted infections or injuries. Other signs of a bladder infection including burning or tingling, fever, and bloody or cloudy urine.
Bottom line on waking up to pee
How often you pee is affected by many factors, like fluid consumption, so there's no need to automatically panic if you have to get up to urinate at night. But if you change your lifestyle and you're still bothered by nocturnal urination, it's worth working with a doctor to get to the root cause.
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