I wake up twice a night because I have to urinate. Should I receive treatment or is this normal for a particular age?

Alan Wein, M.D., is chief of the division of urology at Penn Medicine and co-director of the urologic oncology and incontinence programs at Penn Medicine. Wein has authored texts on Nocturia, overactive bladder, and other related topics, and is a leading authority in this area.

If you are experiencing this condition, you have nocturia. Nocturia means waking up at night because you have to urinate. It doesn't mean you urinate because the dog or the TV woke you up. So, what's abnormal, what's normal, and what's bothersome?

For those 65 and older, getting up once a night to urinate is average. Whether you get up at night to urinate depends on what your bladder capacity is, and how much urine you make from the time you go to sleep to the time you wake up in the morning (when you don't go back to bed and are up for the day). If the amount of urine you make exceeds your bladder capacity during that time period, you're going to get up at least once a night. People generally are not bothered by that.

The normal individual puts out about one third of their urine volume during the nighttime hours (one third of 24 is 8).

Statistically, the bother starts at two times a night, but not everyone is bothered by waking up two times a night. Most people who get up three times a night are significantly bothered by it.

Does getting up to urinate an abnormal number of times affect your general overall health? Evidence shows that nocturia is associated with many health issues, from falls and fractures (from having to go to the bathroom at night), to diseases associated with nocturia that a physician looks for in the evaluation, ones that nocturia doesn't necessarily cause, but are associated with it, such as diabetes.

Two studies show nocturia is associated with increased mortality, even when accounting for co-existent morbidity from heart disease and other ailments. The statistical association looks accurate. The question is why, and if nocturia is in fact associated with increased mortality, it should be treated.

Your urologist or general internal medicine specialist needs to determine if and why you have nocturia. Some people get up at night because they don't empty their bladder well. For example, if they make too much urine at night, known as nocturnal polyuria, if they make too much urine in general, they may have diurnal polyuria, which is common among diabetics.

First, you look at systemic diseases (diabetes, urologic diseases, etc.), then there are psychological reasons (people might get up at night and think they're going to urinate and do not urinate). Sometimes people wake up due to sleep apnea, but do not have to urinate. If you cure the sleep apnea, the nocturia goes away. Sometimes you try behavior modification, such as restricting fluid intake after 4 p.m., among other methods. If you take a diuretic, ask your internist if you can adjust your diuretic dosage.

Sometimes, you can give patients a medication for overactive bladder; sometimes surgery is involved. If you're bothered by getting up two times a night, you should see your urologist or your general internal medicine specialist. They should evaluate some of these and other aspects of your condition.

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