Overview

Nocturia is where you frequently wake up in the night and need to pee (pass urine). It often increases with age. It is common with elderly people who may be getting up twice a night. More frequent visits to the toilet may indicate a problem that can be treated.

If you start needing to make several trips to the toilet at night you may find this distressing or your sleep may be disturbed.

Causes of nocturia

Hormonal changes

The antidiuretic hormone (ADH) helps regulate the amount of water in your body. You produce less of this hormone as you get older. Lower levels of this hormone mean that more urine is produced at night.

Prostate problems

Prostate glands often start growing as you get older. This gland is a small gland found only in men and trans women. It surrounds the urethra (the tube that urine passes through before exiting the body). An enlarged prostate can press on your urethra and prevent your bladder from emptying properly, so you need to pee more often.

Bladder problems

• Urge incontinence (also known as an overactive bladder). This is where you have a sudden need to pee and may leak before you are able to reach a toilet.
• Bladder infections. These are usually caused by bacteria entering your bladder. Symptoms include dark, cloudy and smelly urine; a burning feeling or pain when passing urine; and not being able to empty your bladder completely.

Medical conditions

• Heart problems. If you have a heart condition, your heart and circulation become less efficient and you will notice swelling around your ankles. When you are lying down or your feet are raised up, fluid is absorbed into your blood stream and removed by your kidneys. This increases the need to pee at night.
• Diabetes. High blood sugar increases your thirst, so you may drink more than usual. This leads to a frequent need to go to the toilet. High blood sugar levels also irritate the bladder causing you to pee more often.

Sleep related problems

You are more likely to feel the urge to go to the toilet while you are awake. So, if you keep waking up in the night or have problems sleeping, you are more likely to need to pee.

Drinking fluids

Drinking a lot of fluid, especially close to bed time, will increase your need to go to the toilet during the night.

Things that can help

• Reduce the amount you drink before you go to bed. For example, have your last drink at 8pm instead of 10pm. However, make sure you are still drinking the recommended daily amount. This is 6 to 8 cups of fluid a day, which is about 3 to 4 pints or 2 litres. Reducing the amount you drink does not help, unless you currently drink large amounts.
• Have fewer drinks that contain caffeine, such as tea, coffee, chocolate and cola. These can irritate your bladder and change your sleep patterns, as can alcohol.
• If you regularly have swollen ankles, make sure you sit or lie down for about an hour during the day. Raise your legs and feet so they are at, or above, the level of your heart. It may also help to wear support stockings.
• Some medicines make your body produce more urine, or increase its flow. In many cases this is how the medicine works to treat the condition (for example, water tablets for high blood pressure). Ask your GP if you are not sure if your medicines could be causing nocturia. Please do not stop taking your regular medicines without the advice of your doctor.
• Consider whether anything is disturbing your sleep. If your room is too light or too cold, this may wake you up. If you have painful conditions that disturb your sleep, talk to your GP. Reduce any naps you take during the day to see if this helps you to sleep better at night. Also, avoid stimulants like drinks containing caffeine before you go to bed.

Specialist treatment for nocturia

If nocturia continues you may have a bladder or prostate problem that requires treatment.

• Prostate problems. These may be treated in different ways and your doctor or nurse specialist will discuss the options with you. They may include treatment with medicines and possibly trans-urethral resection of prostate (TURP) surgery.
• Urge incontinence. This is commonly treated using a group of medicines called antimuscranics, such as solifenacin or tolterodine. These medicines relax your bladder so that it can hold more urine.
• Antidiuretic hormone (ADH). ADH helps to regulate water balance in the body. A lower level of this hormone increases excessive thirst and the need to go to the toilet. In a few cases of nocturia, taking desmopressin medicine an hour before bedtime reduces the amount of urine produced overnight. Replacement of antidiuretic hormone using the medicine desmopressin can help.

A low dose of diuretic in the early evening may help to pass excess urine before bed time. When used during the day this will help the body produce more urine, so that any excess is passed before you go to bed. 

Your doctor or nurse will explain the benefits and potential side-effect of these medicines. They may take a routine blood test before prescribing medicine to help your nocturia.

Useful information

Bladder and Bowel UK

Offers advice and assistance from specially trained nurses. Helpline, phone: 0161 214 4591

Parkinson’s UK

Provides support and advice for people with bowel and bladder problems and has a network of local groups. Helpline, phone: 0808 800 0303

Multiple Sclerosis Trust (MS)

Provides support and advice for people with bladder and bowel problems. Helpline, phone: 0808 800 8000

Living made easy (Disabled Living Foundation)

Advises on and provides equipment for older and disabled people.