The first question a doctor will ask you if you complain about having to pee in the middle of the night is, 'Did the need to urinate wake you up, or did you wake up and notice you had to urinate?'
'How you answer makes a difference,' says Randy Wexler, MD, an associate professor of family medicine and vice chair of clinical affairs at the Ohio State University Medical Center.
Wexler explains that, when you sleep, increased blood flow to your kidneys can accelerate urine production. So if you wake up because of a snoring bedmate or insomnia or some other reason that has nothing to do with your bladder, you'll still have no problem producing urine if you decide to head to the bathroom.
But if having to pee is the reason you're waking up, that's not something to ignore, he says.
Here, he and other experts explain some of the most common causes of having to pee at night—and what to do about them.
You're drinking too much water before bed.
Yes, this is super obvious. But Wexler says some people don't realise just how much H2O they're swallowing in the hours before bed—and how that fluid can disrupt their sleep. 'I tell patients to stop drinking water two hours before bed,' he says. Also, hit the bathroom before you hop in the sack. If you follow these instructions and you're still waking up to pee, it's time to see a doctor.
You're drinking alcohol or caffeine too close to bedtime.
Both alcohol and caffeine can increase your urine output, Wexler says. If you're the type who enjoys a cup of joe after dinner, or if you drink booze before bedtime, you're asking for trouble. Wexler recommends cutting off all caffeine—that includes tea—at 6 PM. He also suggests you stop drinking alcohol at least three hours before bed. Again, if you try these changes and your problem persists, see your doc.
You're low on this hormone.
'With ageing comes a natural loss of antidiuretic hormone,' says Tobias Köhler, MD, chair of urology at Illinois's Memorial Hospital. This hormone helps your kidneys control their fluid levels. The less of the hormone you have, the more you pee. Köhler says this natural hormone loss usually starts around age 40, but often becomes noticeable much later—during your 60s or 70s. 'There are some drug therapies, but a lot of people just deal with it,' he says. (Think your hormones are wacky? Here's what happened when one staffer tried hormone testing for her workouts.
You have an infection.
If you're a woman and you've eliminated the 'self-inflicted\ pee triggers mentioned above, the most-likely culprit is a urinary tract infection, Wexler says. 'If it's a urinary tract infection, urination may be accompanied by burning or dribbling or discomfort,' he explains. Also, these sensations are going to persist during the day.
While far less common in men, a urinary tract infection can also cause guys to feel like they have to pee all the time, including at night, Wexler adds. Again, a burning sensation while peeing is something to watch for.
Your legs are swollen.
If you have swollen feet or legs—a condition known as edema—that fluid retention in your lower body can cause you to pee a lot when you lie down. 'All that fluid in your legs has to go somewhere, and that increases your urine production,' Köhler explains. The solution: Elevate your legs a couple hours before bed. That will help the fluid in your lower half flow upward, and so will allow you to get your peeing done before climbing in bed, he says.
You’re dealing with diabetes or prediabetes.
If you're suffering from diabetes or prediabetes, your body may ramp up your urine production in order to clear away excess blood sugar. That could explain why you're waking up to pee at night, Wexler says. As with a UTI, frequent peeing caused by diabetes or prediabetes will persist during the day. Especially if you tend to feel thirsty all the time—even when you drink a lot of water—that's a sign blood-sugar issues are to blame, he adds.
You have an STI.
'Some sexually transmitted infection can cause frequent urination, such as gonorrhea and chlamydia,' Wexler says. A burning sensation while you pee is also a sign your problem could be an STI —though for middle-aged or older adults, a UTI is a lot more likely, he adds.
Your uterus or ovaries are enlarged.
A wide range of conditions—including uterine polyps, ovarian cysts, or uterine and ovarian cancers—can cause an enlargement of these organs. If they're oversized, they can press on your bladder and make you feel like you have to pee all the time, Wexler says. 'There's really no way to know if one of these is the cause unless you see a doctor,' he adds.
Your bladder is slipping.
The muscle, ligaments, and connective tissue that help make up a woman's pelvic floor also support her bladder and other organs. As a result of age or, more commonly, vaginal child birth, that pelvic floor can weaken and a woman's bladder can slide or 'prolapse' into a position that puts pressure on it, Wexler says. If that happens, you may feel like you need to pee all the time. 'Women can do Kegel exercises for bladder prolapse, but they'd need to be diagnosed first,' he says.
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