Q: Why do I wake up so frequently to urinate?
A: The occasional late-night trip to the bathroom is generally no cause for alarm. However, two or more instances of wakeful urination a night, known as nocturia, can cause disruption in a normal sleep cycle and may be a symptom of a more serious condition.
About one in three adults over the age of 30 experiences nocturia, according to the National Association for Continence (NAFC).
Men may experience nocturia as the result of an enlarged prostate. For women, it is often a result of childbirth, menopause or pelvic organ prolapse.
The problem can stem from a wide variety of causes. For example, your body may produce excessive amounts of fluid during the day and release it during the night. Or, you may have a small bladder capacity.
Nocturia can also occur as a result of conditions such as diabetes and heart disease. If you have heart disease, you may accumulate blood or fluid in your lower limbs throughout the day because your heart cannot pump blood as efficiently. Therefore, when you lie down at night, the fluid returns to your heart, where it is circulated, filtered and turned into urine, causing you to wake at night.
Nocturia is not detectable in a regular physical, but you can help your doctor diagnose it by keeping a fluid and voiding diary — a one- or two-day record of your fluid intake, output and times of urination. To diagnose nocturia, your doctor may ask you a few questions, including:
- How much do you drink before bed?
- Do you drink a lot of coffee, tea, soda or alcohol during the day, especially after 4 p.m.?
- Do you snore?
- Are you taking any diuretic medications?
- Do you have a history of sleep apnea, diabetes or heart failure?
Once diagnosed, your doctor can perform a urinalysis and bladder scan to determine how best to treat your nocturia.
In many cases, the problem requires common-sense treatments. Minimize fluid intake after dinner, and avoid diuretics, such as caffeine or alcohol, after 4 p.m.
In cases occurring from heart disease or diabetes, your doctor may recommend wearing compression stockings or elevating your legs in the evening to help eliminate excess fluid in your lower limbs.
If nocturia persists, your doctor may recommend more advanced treatment, such as medication or surgery.
Richard Charney, MD, is a urology health specialist at Nazareth Hospital.