Reasons Why You're Getting Up To Pee So Much at Night

Always getting up to use the bathroom at night? This could be why.

Nocturia is defined as waking up one or more times during the night to urinate, according to a 2017 article published in the International Journal of Clinical Practice. When the loss of sleep from nocturia leads to falls, reduced work productivity, symptoms of depression, or other problems, it is called clinically relevant nocturia. In other words, it affects your quality of life and treatment is needed.

However, it may be helpful to view nocturia as a possible symptom, not a disease. Nocturia often means that another underlying health condition is present, such as high blood pressure (hypertension), a sleep disorder, or a problem with your bladder. And any underlying condition causing your nocturia will need to be treated to stop you from waking up at night to urinate.

This article explains several reasons why you may be waking up throughout the night to urinate. It also discusses how nocturia may be treated (depending on the cause).

Urinary Tract Infections Often Cause Nocturia

Nocturia is a well-known symptom of urinary tract infection (UTI)—the most common type of infection seen by healthcare providers in outpatient settings, according to a 2019 article in the journal Therapeutic Advances in Urology.

Urinary tract infections cause the lining of the urinary tract to become inflamed and irritated, which can lead to the following symptoms:

  • Pain or burning while urinating
  • Needing to urinate frequently
  • Needing to urinate despite having an empty bladder
  • Blood in your urine
  • Pressure or cramping in your groin or lower abdomen

If you have been experiencing any of these other symptoms in addition to nocturia, make sure to let your healthcare provider know so that they can evaluate you for a UTI.

Hypertension and Nocturia Are Closely Linked

Research presented at the 2019 annual scientific meeting of the Japanese Circulation Society links high blood pressure to nighttime bathroom trips. "Our study indicates that if you need to urinate in the night—called nocturia—you may have elevated blood pressure and/or excess fluid in your body," study author Satoshi Konno, MD, said in a press release published by the European Society of Cardiology.

Nocturia can generally be considered a symptom of hypertension, but there can also be other factors involved. In particular, hypertension is commonly treated with diuretic medications that, just like any other type of diuretic, cause frequent urination as a side effect.

If you are currently taking diuretic medications for your hypertension, but nocturia is affecting your sleep or quality of life, be sure to let your healthcare provider know. Healthcare providers may be able to prescribe a different kind of blood pressure-lowering medication for you.

Nocturia Can Be Related to Bladder Problems

A condition called nocturnal polyuria could be the reason you can't sleep through the night without a bathroom break. "Nocturnal polyuria is a syndrome where the usual day to night ratio of urine production is altered," according to a report from the American Society of Nephrology. People with nocturnal polyuria produce more than 33% of their daily urine output at night.

Congestive heart failure, neurologic diseases such as Parkinson's and Alzheimer's, chronic kidney disease, and obstructive sleep apnea are some conditions that can lead to nocturnal polyuria.

Some people with nocturnal polyuria also have low bladder capacity, meaning that their bladder does not have enough "storage" for the amount of urine being produced. A number of things can cause low bladder capacity, including infections and inflammation.

Many people who experience nocturia are affected by both nocturnal polyuria and low nocturnal bladder capacity. These are two separate issues, but people affected by both are diagnosed with mixed nocturia.

Additionally, an overactive bladder can cause low nocturnal bladder capacity. So can a bladder obstruction such as benign prostatic hyperplasia, which is when the prostate and surrounding tissue expands. People who have this may feel like their bladder is full even after they urinate. Treatment options include prescription drugs like alpha blockers or surgery.

Another condition called urethral stricture disease can lead to nocturia. That's when swelling, or an infection or injury, produces a scar that blocks or slows the flow of urine in the urethra, which is the tube that lets urine leave the body. The condition is more common in people with a penis because of the longer urethra.

If the cause of nocturia is unknown, a healthcare provider may perform cystoscopy. This is a procedure that allows the healthcare provider to examine the inside of your bladder by inserting a thin tube with a lens inside the urethra.

Sleep Disorders Can Cause Frequent Urination at Night

Your body has a 24-hour rhythm, known as a circadian rhythm, that works like an internal clock—putting you to sleep when it is dark and waking you up when it is light. For people with circadian rhythm disorders, this sleep-wake pattern is dysfunctional or may even be entirely reversed.

Circadian rhythm disorders affect more than when your body sleeps and wakes. They also affect your body's metabolic processes, including when you need to use the restroom. In other words, if your internal clock thinks you should be awake at night, it will also think you should urinate at night.

What To Do if You're Waking Up To Pee Too Often

If you find yourself losing sleep because of nocturia, the first thing you should do is see your healthcare provider for an evaluation.

Urgent issues like infections will need to be treated. You might be asked to keep a "fluid and voiding diary." This entails keeping a record of everything you drink and every time you have to go to the bathroom; the diary can help your provider figure out what might be causing your nocturia.

Treatment for nocturia might involve curing whatever ailment has led to the condition instead of curing the condition directly. For example, if a urinary tract infection is causing your nocturia, you may need to take antibiotic medications. Or, if high blood pressure is causing your nocturia, your provider might recommend watching your salt intake or being more physically active.

If there's no underlying condition to address, a few simple lifestyle tweaks might help resolve your nocturia:

  • Cutting back on the alcohol you consume before bed may reduce your nighttime trips to the bathroom. Drinking alcohol after dinner may cause nocturia.
  • Another after-dinner stimulant to avoid is caffeine. It, too, can be a cause of nocturia. This might not be the news you wanted to hear if you enjoy a cup of coffee after your evening meal, but there's a possible silver lining: Maybe if you're getting better sleep you won't require as much coffee.
  • Additionally, drinking more water during the morning hours than in the evening could help.

A Quick Review

Having to pee in the middle of the night once in a while is usually not a cause for alarm. In some cases, a few lifestyle fixes may do the trick. It may be as simple as drinking more water earlier in the day, cutting back on alcohol before bedtime, and avoiding caffeine after dinner.

If lifestyle changes don't work, an underlying disease may be the culprit. Conditions like hypertension, sleep apnea, and UTIs can cause nocturia. If your full night of beauty rest is being disrupted more often than not because of a need to pee, a healthcare provider will be your best resource for getting to the bottom of what's causing your nighttime bathroom trips.

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