Peeing at Night? What Frequent Urination Says About Your Health
Waking up to pee once every night is normal. Anything more than that may be nocturia.
Waking up once during the night to pee isn’t that uncommon for most people, and generally it’s nothing to be concerned about.
However, if you are getting up even more often it could be nocturia, or frequent nighttime urination, which isn’t necessarily healthy in the long term.
Nocturia itself is not a disease or condition, notes Kirsty M. Borawski, MD, associate professor of urology at the University of North Carolina-Chapel Hill School of Medicine.
It’s a symptom, and could be due to anything from drinking too much fluid, uncontrolled diabetes, sleep apnea, and more.
About a third of adults have nocturia, which becomes more prevalent as people age.
What is nocturia?
For these nighttime episodes to be considered nocturia, they have to come in between periods of sleep. So that first morning stream does not count.
In early adulthood, frequent nighttime urination tends to affect women more often than men, while this is reversed in later life, says Dr. Borawski.
Nocturia is not the same as nocturia polyuria, which means you produce too much urine at night, says Dr. Borawski.
Typically, the body produces less urine at night, so people can sleep six to eight hours (the recommended amount) without waking.
(You may want to learn more about how to sleep deeper and better.)
What can happen if you have nocturia
Interrupted sleep, in general, is not good for your health, and chronic nocturia is no exception.
“Nighttime urination is linked to increases in mortality, especially among elderly people,” says Erin L. Ohmann, MD, an attending urologist at Montefiore Health System and assistant professor of urology at Albert Einstein College of Medicine in New York City.
Poor sleep leads to daytime fatigue and changes in alertness and mood.
If you’re elderly, making that trip to the bathroom in the middle of the night, especially if the area is poorly lit or obstructed, can lead to falls or fractures, says Dr. Ohmann.
Overall, nocturnal trips to the toilet have been linked with lower quality of life.
Here are the causes of nocturia.
Drinking too much fluid
This seemingly harmless habit is probably the No. 1 cause of urinating excessively at night, says Dr. Ohmann. And especially if you’re imbibing anything containing caffeine or alcoholic within two to three hours of bedtime.
Both caffeine and alcohol are diuretics that make your kidney produce more urine in a rapid time frame, explains Dr. Ohmann.
There’s an easy fix here: Don’t drink caffeine or alcohol before bedtime and, in general, curtail your intake of fluids within four to six hours of retiring. Visit the bathroom last thing before you go to bed.
As people age, bladders don’t have as much capacity, so even drinking what you always have may result in more trips to the bathroom when you’re older. Be careful not to limit your fluids so much as to risk dehydration.
Doctors prescribe diuretics or “water pills” such as chlorothiazide (Diuril) and spironolactone (Aldactone), for high blood pressure.
On the plus side, these drugs help the kidneys get rid of excess fluid and salt. The benefit is that this lowers the amount of blood circulating, easing the burden on your heart.
The down side is that needing to pee can wake you up at night.
“If you take this close to bedtime, you will increase your risk for nocturia,” says Dr. Borawski.
If you’re peeing too much at night, you may be taking your medication at the wrong time. But don’t make any changes to medication without consulting your doctor.
Pregnancy increases the urge to urinate both during the day as well as at night. (Here are other changes that happen when you’re expecting.)
This is due to hormonal changes and the basic mechanics of carrying more weight: the growing fetus puts ever more pressure on your bladder.
This is normal but if you have any other symptoms like burning and pain which could be due to a urinary tract infection, get medical help.
Childbirth can also contribute to nocturia, as can menopause. As women get older, they produce less antidiuretic hormone (ADH), which, in younger years, cuts down nighttime urges to empty.
“As people age, nocturia is caused by excessive urine production at night,” explains Dr. Borawski.
“You should make less than a third of your 24-hour urine volume at night.”
Treatment with desmopressin, a synthetic version of the ADH, is possible.
An enlarged prostate, known as benign prostatic hyperplasia or BPH, is one of the most common conditions affecting older men.
The prostate is a gland located next to and around the bladder and urethra; it produces the fluid found in semen.
An enlarged prostate can obstruct the urinary pathway, making it difficult to empty the bladder completely, explains Dr. Ohmann.
Peeing a lot, especially at night, is a hallmark symptom of BPH.
Heart failure and hypertension
Nocturia is a common symptom of heart failure, a chronic condition in which the heart enlarges and has difficulty pumping enough blood.
Because the heart doesn’t beat as strongly, salt and fluid build up in your body during the day. When you lie down at night, it retreats into the blood. The bladder then works overtime to get rid of the excess fluid.
Several studies have also linked nighttime trips to the toilet with hypertension. In fact, studies have shown that the worse the nocturia, the higher the blood pressure.
Remember that diuretics are one of the most common treatments for hypertension and heart failure. These drugs may also be causing you to pee more at night.
Undiagnosed or poorly controlled diabetes (type 1 and type 2), is linked with higher urination rates overall, including at night.
“High blood sugar content leads to a diuretic effect,” explains Dr. Ohmann. In other words, all that excess glucose gets flushed out in the urine.
Obesity, a major risk factor for type 2 diabetes, links to both daytime and nighttime peeing.
Sleep apnea is when you briefly but repeatedly stop breathing at night. Nocturia is so common in people with sleep apnea that it’s one of the symptoms doctors look for when diagnosing the condition.
“When someone is not breathing well at night, their body senses that the volume of fluid is overloaded so it sends hormones to tell the kidneys to make more urine,” explains Elena Campbell, MD, a urologist with Ochsner Health System in Baton Rouge.
If your doctor suspects sleep apnea, they will likely send you off for a sleep study to confirm. Treating the sleep apnea (often with a CPAP machine. which is a face mask worn at night that delivers a stream of air in the nose) will also resolve the urination issue.
Snoring, a common symptom of sleep apnea, has also been linked with nocturia.
Swelling in your legs and feet
Nocturia can be a sign of daytime fluid retention in your legs and feet, which is known as edema.
“If someone has a lot of fluid on their legs during the day, when they put their legs up at nighttime, the fluid goes back into [blood] circulation, so your body produces more urine in the nighttime,” explains Dr. Campbell.
“We recommend elevating your feet above the level of the heart in the [day] to allow some of that urine to pass in the early evening rather than during the night.”
Compression stockings may also help.
The swelling itself could be due to something as simple as standing on your feet all day or a more serious medical condition like heart failure.
Chronic kidney disease
Your kidneys normally concentrate urine at night in response to antidiuretic hormone.
If you have kidney problems, the kidneys lose some of their ability to concentrate their urine at night, leading to increased urine production, says Dr. Borawski.
Normally, the kidneys filter out all the electrolytes and other elements the body does not need, says Ali Dabaja, MD, a urologist with Henry Ford Hospital in Detroit.
“The kidneys are designed to prevent us from losing water.”
This helps maintain fluid balance in the body. But any time the kidneys notice that there’s extra fluid on board, it will be excreted, Dr. Dabaja adds.
Overactive bladder is not so much a disease as it is a syndrome, meaning it involves a combination of symptoms, one of which is peeing a lot.
“It’s characterized to be a combination of frequent urination, the urge to get to a bathroom right away and incontinence, meaning you can’t make it to the bathroom in time,” explains Dr. Campbell.
One cause may be involuntary muscle contractions, but the reasons aren’t always clear.
The best treatment for nocturia is to do identify and treat any underlying causes.
“It’s such a common problem and so many factors that can be contributing factor, addressing the cause is most beneficial,” says Dr. Ohmann.
Many of the reasons for nocturia are interrelated (for example, sleep apnea, diabetes, and hypertension). And about half of patients report having at least three conditions contributing to their nighttime excursions.
The first choice is behavioral changes like drinking less caffeine and alcohol before bed, elevating your feet, and making sure you’re taking diuretics at the appropriate time.
Behavioral therapy, including pelvic floor muscle exercises, is also an option.
Simple sleep “hygiene” measures may be all you need. This includes keeping a regular sleep schedule and keeping your bedroom dark at a comfortable temperature.
When to see a doctor about nocturia
If you suspect nocturia is due to anything other than drinking too much, especially if it’s robbing you of sleep, you should see a doctor.
It’s also time to get medical help if you see blood in your urine, if you have any abrupt changes in your symptoms or if you think you might have an infection (you’d probably also be experiencing burning when you urinate), says Dr. Borawski.
“There are many, many causes of nocturia,” adds Dr. Ohmann. “Seeing a provider can help with quality of life and prevent complications.”
- National Library of Medicine: "Nocturia"
- Kristy M. Borawski, MD, associate professor of urology, University of North Carolina-Chapel Hill School of Medicine
- Urology Care Foundation: "What is Nocturia?"
- National Library of Medicine: "Urinating more at night"
- Erin L. Ohmann, MD, attending urologist, Montefiore Health System and assistant professor of urology, Albert Einstein College of Medicine, New York City
- Hartford Hospital: "Women's Health Services | Nighttime Urinary Voiding"
- National Association for Continence: "How to stop waking up at night to pee"
- Harvard Medical School: "Tips for taking diuretic medications"
- National Library of Medicine: "Hydrochlorothiazide"
- Marshfield Clinic Health System: "What Causes Frequent Urination During Pregnancy?"
- Eunice Kennedy Shriver National Institute for Child Health and Human Development: "What are some common signs of pregnancy?"
- Beaumont Health: "Frequent Nighttime Urination (Nocturia)"
- Merck Manual: "Benign Prostatic Hyperplasia (BPH)"
- Hypertension Research: "Hypertension, cardiovascular disease, and nocturia: a systematic review of the pathophysiological mechanisms"
- European Eurology Focus: "Nocturia: The Complex Role of the Heart, Kidneys, and Bladder"
- Journal of the American Heart Association: "Nocturia as an Unrecognized Symptom of Uncontrolled Hypertension in Black Men Aged 35 to 49 Years"
- European Society of Cardiology: "Trips to the toilet at night are a sign of high blood pressure"
- Journal of Hypertension: "Nocturia and night-time blood pressure, an association too frequently overlooked"
- Journal of Wound, Ostomy, and Continence Nursing: "Nocturia in Women With Type 2 Diabetes Mellitus"
- Merck Manual: "Diabetes Mellitus (DM)"
- Johns Hopkins Medicine: "Diabetes Insipidus"
- Elena Campbell, MD, urologist, Ochsner Health System, Baton Rouge
- American Sleep Apnea Association
- Sleep Medicine Research: "Nocturia and Sleep: Focus on Common Comorbidities and Their Association with Obstructive Sleep Apnea"
- Ali Dabaja, MD urologist, Henry Ford Hospital, Detroit
- Merck Manual: "Urinary Incontinence in Adults"
- Urology Care Foundation: "What is Overactive Bladder (OAB)?"
- Food and Drug Administration: "FDA approves first treatment for frequent urination at night due to overproduction of urine"