Nocturia: Definition and Prevalence

Nocturia is the medical term for frequent nighttime urination. It is common and harmless to wake up once during the night to pee. However, nocturia is defined as making more than one trip to the bathroom to urinate at night. Nocturia is not a disease but a symptom that might indicate an underlying medical condition. Multiple bathroom trips at night can disrupt sleep, leading to tiredness, low energy, and daytime sleepiness. Furthermore, leaving the root problems untreated may lead to severe complications.

Peeing more often during the daytime is called frequent urination. Nocturia is when you pee at night more than once.

Nocturia is quite common. Approximately 1 in 3 young adults over the age of 30 and 1 in 2 older adults over the age of 50 have nocturia. Nocturia is more common in women under the age of 50, but among those older than 50, it is more common in men.

Brief Overview of Normal Urinary Patterns versus Nocturnal Disruptions

Normal patterns of urination can vary considerably from person to person. Generally speaking, adults urinate 6 to 7 times during a 24-hour period with no more than once during the night. Remember that the urination frequency can vary depending on the amount of fluid intake and the fluid types.

On average, the body produces around 1.2 to 1.5 liters of urine in 24 hours. Healthy adults have a bladder capacity of 400 and 700 mL of urine. Urinary frequency and nocturia can occur either due to an increased urine volume or reduced bladder capacity. Again, urine output can vary depending on age, health status, concurrent medications, and fluid intake.

Common Causes Behind Increased Nighttime Urination

Some of the underlying health conditions that can cause nocturia include:

Polyuria

Polyuria refers to when the body makes too much urine (generally more than 2.5 liters per day). When there is more urine than the bladder can hold, it can lead to frequent urination in the daytime and nocturnal polyuria or nocturia at night. Common causes of polyuria include drinking too much fluid and diabetes.

Nocturia is peeing two or more times at night. It is different from polyuria, which is an increased volume of urine.

Urinary Tract Infection (UTI)

In people with urinary tract infections and bladder infections, bacteria in the urine can irritate the urinary bladder. This can lead to symptoms including a burning sensation with urination, an increased urge to urinate, reduced bladder capacity, and increased urinary frequency. These symptoms can increase the risk of nocturia. Remember that the increased urination frequency caused by UTIs can happen day and night. Learn about 5 effective ways to cure a UTI.

Overactive Bladder (OAB)

OAB is a condition in which the muscles in the urinary bladder start to contract (tighten) even when the urine volume in the bladder is low. This leads to symptoms such as urgency, urinary incontinence, frequent urination, and nocturia. Check out the best medication options for an overactive bladder.

Diabetes

People with diabetes mellitus have high blood glucose levels and eliminate extra glucose in their urine. The presence of sugar in the urine stimulates the production of more urine, causing polyuria and nocturia. In addition, people with high blood glucose levels are at risk of urinary tract infections, which can also cause nocturia. Learn how to reduce blood sugar levels immediately.

Another type of diabetes called diabetes insipidus (water diabetes) can also cause nocturia. Signs and symptoms of diabetes insipidus include increased thirst, polyuria, frequent urination, and nocturia.

High Blood Pressure and Heart Disease

Nocturia can be a symptom of uncontrolled hypertension (high blood pressure) due to higher urine output. An increased frequency of nighttime urination may also be present in people with congestive heart failure due to fluid buildup in the body.

Benign Prostatic Hyperplasia (BPH)

BPH is a benign (non-cancerous) enlargement of the prostate gland in men. The enlarged prostate can cause obstruction to urine flow and bladder changes, resulting in increased urinary frequency and nocturia, among other symptoms. Learn about taking tamsulosin for Benign Prostatic Hyperplasia.

Obstructive Sleep Apnea (OSA) and Other Sleep Disorders

OSA is a condition in which the relaxation of the upper airway muscles blocks the flow of air during sleep, leading to repeated episodes of interrupted breathing. Nocturia is a common symptom in people with OSA because of increased pressure in the abdomen, hormonal changes, and nighttime awakenings. Other sleep disorders, such as restless legs syndrome (RLS), can also result in nocturia. Learn about apnea vs hypopnea.

Pelvic Organ Prolapse

Pelvic organ prolapse is the dropping down of one or more pelvic organs (urethra, bladder, vagina, uterus, or rectum) from their normal position. It occurs due to the weakening of the muscles and connective tissues of the pelvic floor. The most common causes of pelvic organ prolapse are pregnancy, vaginal childbirth, and menopause. Nocturia can occur in women with pelvic organ prolapse, along with other urinary symptoms.

Pregnancy

During the later stages of pregnancy, it is common to experience increased urination. As the baby grows, more pressure is applied to the bladder, resulting in feeling the need to urinate more frequently. These symptoms can occur throughout the day and overnight, leading to nocturia.

Lifestyle Factors and Nighttime Urination

Fluid Intake Before Bedtime: How Much Liquid is Too Much?

Drinking water and other fluids immediately before bedtime can cause you to go to the bathroom during the night and prevent you from getting quality sleep. It’s best to limit water intake to 8-12 oz and drink fluids at least 2 hours before bedtime to prevent excess urine production during the night.

Alcohol and Caffeine

Alcoholic and caffeinated beverages have a diuretic effect, meaning they cause the body to make more urine. Drinking alcohol, caffeine, or carbonated beverages before bedtime can cause you to pee at night.

Shift Work

Shift work frequently causes disruption of the circadian rhythm (normal sleep-wake cycle). Nocturia is common among night-shift workers due to increased urine production and decreased bladder storage.

Habit

Some people unintentionally train themselves to pee at night even if they wake up due to unrelated causes, such as poor sleep hygiene.

Medication Side Effects

Certain medications, such as diuretics (water pills), increase the amount of urine the kidneys produce, which can cause you to pee overnight. If you are on a diuretic, take your last dose in the early afternoon, at least six to eight hours before bedtime, to minimize nocturia.

Other medications with diuretic effects that can contribute to nocturia include beta-blockers, cholinesterase inhibitors, anticholinergics, and lithium. Learn about 6 medications that can cause frequent urination.

Diagnosing and Treating Conditions That Cause Frequent Nighttime Urination

When to See a Healthcare Provider

Inform your healthcare provider immediately if you regularly wake up to pee more than a couple of times at night without extra fluid intake close to bedtime. Nocturia may be a sign of an underlying health problem that is treatable.

Diagnostic Tests for Nocturia

To find out the cause of nocturia, your healthcare provider will obtain a medical history, perform a physical examination, and order tests such as:

Blood tests to check kidney function
Urine tests, such as urinalysis, urine culture and sensitivity, urodynamics, and 24-hour urine volume
Imaging studies to see bladder filling and emptying
Cystoscopy to look inside your urethra and bladder

Treatment Options for Nocturia

Lifestyle Changes

Restrict fluid intake in the evenings before bedtime, especially caffeine and alcohol.
Reduce salt intake, especially for those with congestive heart failure.
Keep a log of how much caffeine and alcohol you are drinking, any recent diet changes recently, and how this relates to nighttime bathroom trips.
Take diuretic medicines at least six to eight hours before bedtime.
Elevate your legs while sitting to help with fluid distribution.
Wear compression socks to redistribute fluid from the legs.
Take afternoon naps when possible. Peeing after a nap can reduce the number of nighttime trips to the bathroom.
Learn pelvic floor strengthening exercises.

Medications

Treatment of nocturia depends on the root cause:

Urinary Tract Infection (UTI): Antibiotics such as nitrofurantoin (Macrodantin) or trimethoprim/sulfamethoxazole (Bactrim)
Overactive bladder: Anticholinergics such as mirabegron (Myrbetriq), tolterodine (Detrol), or oxybutynin (Ditropan)
Prostate Enlargement: Alpha-blockers such as tamsulosin (Flomax), doxazosin (Cardura), and alfuzosin (Uroxatral)
High blood pressure: Antihypertensives such as ace-inhibitors such as lisinopril
Diabetes: Medications to control blood glucose levels. A common medication is metformin.
Diabetes insipidus: Hormones such as desmopressin (DDAVP) that cause the body to make less urine
Obstructive sleep apnea: Sleep study and CPAP (continuous positive airway pressure) machine

Frequently Asked Questions (FAQs) About Nighttime Peeing

Is it normal to pee three times a night?

It is not normal to pee three times a night. Peeing more than once at night is called nocturia, and it can be a sign of underlying conditions.

Why do I always pee at 3 am?

Many people pee once during the night. You may be waking up at 3 am to pee if you are drinking too many fluids before bedtime, especially caffeinated or alcoholic beverages.

What are the causes behind peeing every 15 minutes at night?

Both acute and chronic conditions can cause frequent urination in the daytime and nocturia (frequent peeing at night). Contact your healthcare professional for an evaluation to find out the cause.

Why do I pee a lot on the night shift?

You may be peeing more on the night shift due to a disruption of your circadian rhythm (sleep-wake cycle). This can cause increased urine production and decreased bladder storage capacity.

How many nighttime bathroom trips are normal?

One nighttime bathroom trip is normal. If you regularly go to the bathroom more than once at night without drinking more fluid close to bedtime, make an appointment to see your doctor and find out the cause of your nocturia.