Overactive bladder at night
If you need to get up to urinate more than one time during the night, you may have an overactive bladder at night. This condition is called nocturia, and it’s not the same as overactive bladder (OAB). It’s possible to have nocturia along with OAB, or to have this condition on its own even when daytime urination is normal.
Nocturia is common, especially as you age. One in three adults over the age of 30 need to make at least two trips to the bathroom at night.
Nocturia is different from bedwetting. Most people can sleep six to eight hours without having to get up. But if you have nocturia, you’ll wake up more than once a night. This disrupts your normal sleep cycle and causes sleep loss along with other complications. Read on to learn more about nocturia and how to treat it.
There are four types of nocturia:
Nocturnal polyuria: You produce an excessive amount of urine during the night.
Global polyuria: Your body produces excess urine during the day and night.
Low nocturnal bladder capacity: Your bladder can’t hold as much fluid during the night.
Mixed nocturia: This is a combination of the previous three types of nocturia.
Nocturia can be caused by OAB, but it can also be the result of other conditions. The cause depends on the type of nocturia.
For example:
| Causes of nocturnal and global polyuria | Causes of low nocturnal bladder capacity |
| excess fluids, especially caffeinated beverages or alcohol near bedtime | bladder obstruction |
| untreated or poorly controlled type 1 or 2 diabetes | bladder overactivity |
| congestive heart failure | urinary tract infection |
| swelling of your legs | bladder inflammation |
| sleep disorders such as sleep apnea | bladder tumor |
| diabetes insipidus | interstitial cystitis |
| gestational diabetes | benign prostatic hyperplasia in men, or an overgrown prostate |
| certain medications | pregnancy |
Some of the medications that cause nocturia include:
- cardiac glycosides
- demeclocycline (Declomycin)
- lithium
- methoxyflurane
- phenytoin (Dilantin)
- propoxyphene
- excessive vitamin D
- diuretics such as furosemide (Lasix) and torsemide (Demadex)
The Cleveland Clinic recommends keeping a fluid and voiding diary to help your doctor diagnose nocturia. This involves recording:
- how much you drink
- how often you go to the bathroom
- how much urine you release
- what medications you take
- symptoms of urinary tract infections such as pain with urinating or difficulty urinating
- any symptoms such as fatigue
In addition to a physical exam, your doctor will also ask about your condition. These questions include:
- When did your nighttime urination start?
- How many times do you urinate a night?
- Do you urinate a lot or a little when you go?
- Has the amount of urine ever changed?
- Do you drink caffeine? If so, how much?
- Do you drink alcohol? If so, how much?
- Does the urination prevent you from getting quality sleep?
Depending on your symptoms, your doctor may also conduct several tests such as:
- urinalysis, to check for an infection
- cystometry, to measure the pressure in a bladder
- cystoscopy, to look at your bladder with a small camera
- ultrasound, to get an image of your bladder
- CT scan, to get a more detailed image of your bladder
- sleep study, to see how you sleep
Your doctor may refer you to a specialist, if you have nocturia.
One of the first-line treatments for nocturia is making lifestyle changes. Your doctor will recommend that you restrict your fluid intake before going to bed. Stop drinking beverages a few hours before bedtime, but make sure you get enough fluids throughout the day.
Other lifestyle changes that can help reduce and prevent nocturia include:
- avoiding beverages with caffeine and alcohol
- maintaining a healthy weight, as excess weight can put pressure on your bladder
- timing when you take diuretic medications so they don’t impact your nighttime urine production
- taking afternoon naps
If edema is the cause of your frequent nighttime urination, you can try elevating your legs throughout the day to reduce swelling. Naps can help with nocturia too, so have an afternoon nap with your legs up. Compression stockings can also help prevent fluid buildup.
Your doctor may prescribe medications when preventive measures and lifestyle changes fail to reduce the frequency of your nighttime urination. Doctors prescribe a class of drugs called anticholinergics to treat symptoms of OAB, if that’s the cause of your nocturia. They reduce bladder spasms that create the urge to go.
Your doctor may suggest you take a diuretic for regular urine production. A diuretic can itself cause nocturia. But if you take it early enough in the day, it may help you get rid of excess fluid while you’re awake. This should decrease your urine production at night.
Other drugs that may help are:
- desmopression (DDAVP) in cases of diabetes insipidus to cause the kidneys to produce less urine
- tamsulosin (Flomax), finasteride (Proscar), or dutasteride (Avodart) to treat prostate enlargement
- antibiotics if you have a urinary tract infection
Your doctor may also adjust your diabetic medications to lower your blood sugar if they’re causing nocturia.
Nerve stimulation
Sometimes the underlying cause of nocturia is neurological. Nerves that send signals to your bladder to contract may be giving you the urge to go. This treatment can be invasive or noninvasive.
The invasive treatment involves implanting a small device that sends regulated impulses to your bladder near your tailbone. One
The noninvasive version of this treatment requires more studies, but research shows there’s evidence that electrical stimulation works for OAB and nocturia.
Surgery
When prevention and medications don’t work, your doctor may suggest a surgical procedure to treat your nighttime OAB. The success rate for the surgery depends on the underlying cause. For example, prostate surgery for men with an enlarged prostate can help with obstruction and relieve symptoms.
Many people turn to complementary and alternative medicine (CAM) before seeking medical help. You may also be interested in alternative medications or treatments for nocturia, but there are few studies to support their use. These treatments may work for nocturia, but only if OAB is the cause.
For example, research has found that:
- herbal medications have a positive impact on symptoms of OAB and quality of life
- acupuncture provides short-term relief for OAB symptoms
- homeopathic remedies may have benefits, but need more studies
- alternative treatments have fewer side effects than medications
- saw palmetto berry extract has no benefit for nocturia
But more research is needed to confirm if CAM works for OAB.
Always talk to your doctor before trying a supplement or alternative treatment. Certain CAM treatments can cause unintended side effects, especially if you’re already taking medication.
Read more: Alternative treatments for an overactive bladder »
Nocturia can cause long-term side effects such as sleep loss and increase your risk for other health conditions. Talk to a doctor if you experience frequent nighttime urination. They’ll be able to suggest lifestyle changes or medical treatments to improve your symptoms.