Do you pee multiple times at night? Here's what that means about your health
Waking up to pee overnight is nothing to be ashamed of, but frequent nighttime bathroom breaks can be annoying and disrupt your sleep.
Waking up more than once during the night to urinate is technically called "nocturia," and it can happen to anyone at any age.
If you experience nocturia regularly, you’re not alone. “It’s one of the most common things that brings people into the urologist, men and women,” Dr. Jennifer Lloyd-Harris, surgeon and assistant professor of urology at the Perelman School of Medicine at University of Pennsylvania, tells TODAY.com.
Nighttime urination isn't always something to worry about, but it can be a sign of an underlying health condition. How often is too often to pee during the night, why does this happen and what can you do about it?
How many times is it ‘normal’ to pee at night?
“It’s normal for most people not to wake up to pee at night,” Shelby Harris, Psy.D., a clinical psychologist specializing in sleep medicine and the director of sleep health at Sleepopolis, tells TODAY.com.
Typically, people should be able to sleep for about six to eight hours overnight without needing to get up to urinate, according to the Cleveland Clinic.
The normal amount of urine that the body produces tends to decrease at night while we're sleeping, says Lloyd-Harris.
However, some people find themselves waking up to pee most nights. “I’d say once or maybe twice (sometimes) is in the realm of normal, considering maybe that second time is right before you wake up,” says Lloyd-Harris.
Regularly peeing more than once a night is considered nocturia. "If you’re waking up to go to the bathroom two or more times per night, it’s a good idea to talk to a doctor," says Harris.
Frequent nighttime urination can disrupt sleep, leading to tiredness, fatigue or sleep deprivation over time. It may also be a symptom of an underlying health condition.
Reasons for nighttime urination
There are many reasons for frequent nighttime urination — it's often multifactorial and requires some investigation to get to the root cause, says Lloyd-Harris.
Possible causes range from behavioral habits to chronic diseases and aging or pregnancy. These may cause increased frequency or urgency to urinate, excess urine production, or bladder issues which can all lead to nocturia.
Drinking too many liquids
One of the most obvious causes of nighttime urination is drinking too many fluids. "How much you're drinking and that proximity to bedtime matters," says Lloyd-Harris.
Although the body produces less urine overnight, your kidneys are still working. “(After) you drink, it’s going to take your body and kidneys a few hours to process the liquid,” says Lloyd-Harris.
The more liquids you consume and the closer to bedtime, the more urine you'll produce. When the bladder fills up, the body will sense it's time to go and wake you up.
What you’re drinking matters, too. "Alcohol is a bladder irritant, so certainly it can cause nighttime urination and same with caffeinated drinks, which are diuretics (which promote fluid loss through urine)," says Lloyd-Harris.
Overactive bladder
Another possible cause of nocturia is an overactive bladder, a common condition in both men and women, the experts note.
"The bladder is a big muscle, so when it contracts, you have that urgency to urinate," says Lloyd-Harris. Bladder overactivity occurs when that muscle contracts on its own, even when the volume of urine in the bladder is low, per the Mayo Clinic.
This can cause the frequent and sudden urge to urinate which may be difficult to control, both during the day and night.
Most people pee about seven to eight times a day, but this varies depending on the individual and factors like age and lifestyle. People with an overactive bladder tend to urinate eight or more times per day or two or more times per night, according to the National Library of Medicine.
An overactive bladder can be caused by various health conditions, medications, hormonal changes, and neurological disorders.
Infections
In addition to bladder issues, certain infections can also cause frequent nighttime urination, says Harris. These include urinary tract infections, bladder infections and kidney infections.
In addition to an increased urge or frequency to urinate, infections may also cause a burning sensation while urinating, abdominal pain, pressure and fever.
“If someone has that frequency at night, I wouldn’t necessarily be suspicious that they have an infection, but if there’s an acute change, that can be a good reason to get testing to rule out an infection,” says Lloyd-Harris.
Prostate enlargement
Frequent urination during the nighttime is also a symptom of an enlarged prostate, also known as benign prostatic hyperplasia or BPH, per the National Library of Medicine.
The prostate gland, which is part of the reproductive system in males, is located just below the bladder. An enlarged prostate can push against the bladder and urethra, which can increase the urge and frequency to urinate.
Prostate enlargement can also make it difficult to empty the bladder. "They may pee right before bed and feel like they are empty, but they will get up often during the night," says Lloyd-Harris.
Although BPH is not linked to prostate cancer, the two conditions can cause similar symptoms, including frequent urination at night, according to the National Cancer Institute. Always talk to your doctor about any concerns and regular prostate screenings.
Diabetes
"Diabetes and its treatment can cause nocturia," Lloyd-Harris explains. Urinating frequently is a common symptom of diabetes, especially when it is undiagnosed or poorly managed.
High glucose levels in the blood causes the kidneys work overtime to flush out the excess sugar, which ends up in the urine along with other fluids from the body's tissues, resulting in excessive thirst and frequent urination, per the Mayo Clinic.
Fluid buildup in the legs, a common symptom of diabetes, may also contribute to nocturia, Lloyd-Harris notes.
In addition to increased frequency of urination, other symptoms of diabetes include increased hunger, feeling more tired than usual and blurry vision.
Other chronic conditions that can increase nighttime urination include heart disease, kidney disease and high blood pressure.
Medications
Some medications can increase the frequency of nighttime urination, says Lloyd-Harris. These include diuretics or water pills, beta-blockers, anticholinergics and some antidepressants.
Diuretics or medications with diuretic effects should be taken at least six to eight hours before bedtime to minimize the effects on nocturia, accoridng to the National Library of Medicine.
It's also important to pay attention to how much water you drink with medications taken before bed, the experts note. Even if a medication itself doesn't increase the risk of nocturia, try to keep your water intake to a few sips.
Sleep disorders
Sometimes, sleep disorders and disturbances can lead to nocturia, the experts note. It's a bit of a chicken and egg situation.
"It can be hard to discern sometimes whether somebody's waking up at night to urinate, or whether, they're urinating because they're awake," says Lloyd-Harris.
Sleep apnea and insomnia, which can cause a person to wake up during the night, often go hand in hand with nocturia.
"When something is disturbing your sleep or you have a decreased threshold for waking up, you may also pee," says Lloyd-Harris. Snoring partners, crying children and needy pets can all prevent deep sleep and make it easier to wake up and urinate, she adds.
We know too much screen time isn't good for sleep, but it may also increase nighttime urination, according to a new study in Neurology and Urodynamics.
Researchers analyzed U.S. survey data from 13,294 participants, ages 20 and older, between 2011–2016, and found that 32% experienced nocturia. Of those, people who spent five or more hours a day watching TV or videos during the day were 48% more likely to experience nocturia than those who watched less than one hour a day.
Does peeing at night disrupt sleep?
"Waking up multiple times during the night to go to the bathroom can lead to sleep fragmentation, meaning your sleep is interrupted," says Harris. Interrupted sleep can prevent you from getting to the deeper, restorative stages of sleep, she adds.
"Because of this, you may wake up feeling tired, groggy, or less refreshed in the morning," says Harris.
Over time, interrupted sleep may lead to sleep deprivation, which can increase the risk of cardiovascular problems, diabetes, kidney disease, Alzheimer's and mental health disorders, among many other long-term health issues, TODAY.com previously reported.
"One of the first things that brings people in (for nocturia) is because it interrupts sleep," says Lloyd-Harris.
How can people urinate less at night?
When nighttime urination is a result of certain behaviors, simple habits may help manage the condition. The experts recommend these tips to avoid frequent bathroom breaks at night:
Restrict fluid intake 3-4 hours before bedtime
Reduce consumption of alcohol and caffeine in the evening
Use the bathroom before getting in bed
Take diuretics earlier in the day
Wear compression socks or stockings
Elevate your legs during the day
Keep a diary of your nighttime urination habits
If the issue becomes chronic or persists despite making these changes, talk to your doctor to rule out any underlying health conditions, the experts emphasize.
This article was originally published on TODAY.com
