Nightly urination
Nightly urination
Nighttime urination, or nocturia , means that you are awoken during the night in order to urinate. This situation arises more frequently with increasing age and can affect both men and women. If you get up once in the night, then this can be regarded as being within the norms. If, however, nighttime urination occurs more frequently, this could be a sign that something is wrong. In some cases, nocturia is combined with an increased frequency of urination during the day. It is necessary to differentiate between nocturia (frequent nighttime urination) and polyuria (excessively large production or passage of urine).
You should normally sleep between 6 and 8 hours at night, regardless of whether you have to go to the toilet. People with nocturia wkae up needing the toilet more than once a night. This ultimately leads to the disruption of a normal sleep cycle.
Symptoms of nocturia include:
Getting up more than once a night to urinate.
Excessive passage of urine (in cases of polyuria)
Tiredness, sleepiness – even after waking (a sign of disrupton to the sleep cycle)
What is the cause of nocturia
Causes may include an increased intake of liquids during the afternoon or evening, a sleeping disorder, or an obstruction to the outflow of urine from the bladder. This is why treatment for nocturia includes limitations to the intake of liquids during the evening, or medication for symptoms causing irritation – hyperactive bladder.
Additional symptoms of nocturia can include:
Polyuria
Nighttime polyuria
Increased frequency of nighttime urination
Polyuria
People suffering from polyuria pass over 3 litres of urine per 24 hours. This is is usually due to an increased flow of liquids through the kidneys and subsequently their increased filtration. This degree of filtration becomes increased when the body is trying to remove some substance in the urine which is present in excessive quantities, such as glucose.
Causes of polyuria include:
A large intake of liquids
Untreated diabetes
Diabetes insipidus
Gestational diabetes (occuring during pregnancy)
Nighttime polyuria
People suffering from nighttime polyuria pass a large volume of urine during the night. The volumes they pass during the day are normal or even a little less than normal. The usual reason is the retention of liquids in the course of the day. The liquids collect in the person‘s lower limbs. In the moment that you lie down to sleep, thanks to gravity, there is a shift of liquids from the legs into the circulatory system and, subsequently, this liquid becomes filtered by the kidneys, passing on into your bladder.
Causes of polyuria include:
Heart failure
Swelling of the lower limbs
Sleep disorders (e.g. sleep apnea)
The use of certain medication (diuretics, Cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, or an excessive intake of vitamin D)
The intake of larger quantities of liquids in the evening. In particular coffee, other drinks containing caffeine, or alcohol
A diet rich in sodium
Increased frequency of nighttime urination
In this case you go to the toilet more often, passing smaller quantities of urine, such that the overall quantity of urine is not raised. This could be due to your bladder not fully emptying, leading to it filling more quickly. The secong most common cause can be the inability of your bladder to hold larger quantities of urine before the need to urinate is felt . (hyperactive bladder).
Another common reason can be a sleeping disorder causing you to wake up for some other reason, and yet you go to the toilet simply because you have been awoken and it occurs to you to do so.
The causes of increased frequency of nighttime urination include:
The inability to complete the process of urination (obstruction)
Interstitial cystitis
Obstructive sleep apnoea
A tumor in the bladder
How the problem is diagnosed
The most appropriate tool for diagnosis is to keep a so-called bladder record. This consists of making a twice-daily entry of thet times and quantities of liquid intake and urination. In cases of frequent drinking of tea, coffee, alocholic beverages, or fruit juices, it is appropriate to note this in your records. It is also necessary to prepare a list of all medication that you take.
The most frequently asked additional questions are whether you have started a new diet, or whether the nighttime urination affects the quality of your sleep, and you feel after waking up.
How the problem is treated
The treatment tries to target the particular cause. In cases of sleep apnoea, you are most often refered to a pulmonologist (a doctor specializing in the respiratory system, including the lungs). A hyperactive bladder or urinary tract infection are dealt with independently.
Usual treatments (regardless of cause) include:
Limited intake of fluids during evening hours
Limits to coffee, black or green tea, and alcohol
Chronological changes in the use of of diuretics (at the latest 6 hours before commencing sleep)
Afternoon sleep
Elevation (raising) of the lower limbs several times a day (preventing the accumulation of fluids)
Compression stockings (prevention of accumulation of fluids)
Anticholinergics or other medicines for lowering detrusor overactivity (the muscle in the bladder wall)
Furosemide or bumetanide (diuretics regulating the production of urine)
Desmopressin (hormone regulation of urine production over a 24 hour cycle)