Urination at night: symptoms and treatment of nocturia

The medical term for nighttime urination is nocturia and it is sometimes also called nocturia. This indicates the nighttime urge to urinate; when you have to go to the toilet more than once during the night to urinate. This can seriously disrupt sleep and limit quality of life in the long term. Urinating at night mainly occurs in the elderly and is often considered a harmless complaint that comes with aging. In most cases, nighttime urination is not a disease or the result of a disease, but a harmless phenomenon. However, it can also be a symptom of an underlying condition or disease and should therefore be clarified by a doctor.

  • Urinating at night (nocturia)
  • Who is affected?
  • Causes of nighttime urination
  • Too much urine production (polyuria)
  • Heart failure
  • Diabetes
  • Decreased kidney function
  • Obstructive sleep apnea syndrome (OSAS)
  • ADH deficiency
  • Medication
  • Urological causes
  • Benign prostate enlargement
  • Prostate cancer
  • Overactive bladder
  • Urinary tract infection
  • Decreased bladder capacity
  • Examination and diagnosis
  • History and physical examination
  • Follow-up research
  • Treatment of nighttime urination

 

Urinating at night (nocturia)

Nocturia is the urge to urinate more than once per night. Nighttime urination mainly occurs in the elderly, both men and women. These complaints can be associated with various conditions, such as heart failure, diabetes, reduced kidney function, sleep apnea, lack of antidiuretic hormone (ADH), certain medications (such as diuretics or water pills, some antidepressants and antibiotics), benign prostate enlargement, prostate cancer, overactive bladder, poor functioning of the bladder muscles, lower urinary tract infections and reduced bladder capacity. The diagnosis is made on the basis of an interview with the doctor (anamnesis), physical examination, drinking and elimination diary, ECG and/or exercise ECG, urine examination, ultrasound, prostate examination and blood tests. The treatment depends on the cause.

Who is affected?

Urinating at night is a common phenomenon among the elderly. Roughly 77 percent of all people over 60 suffer from nocturia and it affects both men and women. In a survey of 2,934 men (55-75 years old), 1 in 3 participants had to get out of bed twice or more at night to urinate.[1]

Causes of nighttime urination

Nocturia is not an isolated disease, but a symptom that can occur with a wide variety of physical conditions. In most cases, nighttime urination is not a disease or the result of a disease, but a harmless phenomenon. There are basically two mechanisms that lead to excessive urination at night:

  • the body produces too much urine (polyuria)
  • the urinary tract does not function properly (urological cause)

 

Too much urine production (polyuria)

Polyuria can have several causes, for example:

Heart failure

In heart failure, your heart works less well and does not pump enough blood. The body stores water in the legs during the day (leg edema). At night, the fluid is flushed away while lying down, leading to an increased urge to urinate at night. Other symptoms of heart failure include fatigue and shortness of breath.

Diabetes

People with undiagnosed and uncontrolled diabetes often feel very thirsty (polydipsia) and therefore consume significantly more fluid than healthy people. Hi , this also makes your body produce more urine.

Decreased kidney function

If the small blood filters in the kidneys, called glomeruli, are damaged, albumin often accumulates in the urine (albuminuria). The protein binds water, ultimately causing more urine to be excreted.

Obstructive sleep apnea syndrome (OSAS)

People with sleep apnea also often have a tendency to urinate at night. Treating sleep apnea usually reduces the number of trips to the toilet at night. Other possible symptoms of OSAS include:

  • stagnant breathing
  • repeatedly woken up
  • waking up tired
  • daytime fatigue
  • loss of concentration
  • night sweats
  • forgetfulness (easily forgetting things)
  • mood swings

 

ADH deficiency

Normally, antidiuretic hormone (ADH) slows the production of urine at night. However, if the body does not get enough ADH, too much urine is produced at night. Nocturnal ADH production can be temporarily disrupted, especially when working in shifts (night shifts): after switching from night to day shifts, nocturia may occur for a short time.

Medication

Diuretics or water pills increase urine production. Therefore, these medications should not be taken in the evening. Calcium channel blockers (for example for high blood pressure), antidepressants of the SSRI class and antibiotics of the tetracycline group can also increase urine volume.

Urological causes

Benign prostate enlargement

Many older men develop a benign enlargement of the prostate (benign prostatic hyperplasia). This is often associated with an urge to urinate at night. The enlarged prostate narrows the urethra, or urethra, so that the urinary bladder cannot be completely emptied during urination. Every time you go to the toilet, hundreds of milliliters of residual urine remain in the urinary bladder. After a short time, the bladder fills again, causing a renewed urge to urinate.

Prostate cancer

In addition to a benign enlargement of the prostate, a malignant enlargement of the prostate (prostate cancer) can also be responsible for the increased urge to urinate.

Overactive bladder

In women, on the other hand, an overactive bladder or a malfunction of the bladder muscle is usually the cause of nighttime urination. Those affected feel an excessive urge to urinate both during the day and at night.

Urinary tract infection

Infections of the lower urinary tract (urinary tract infection), such as a bladder infection, can also lead to an increased need to urinate. A strong burning sensation when urinating is another typical symptom of this condition.

Decreased bladder capacity

Rarely, reduced bladder capacity is the cause of nighttime urination. For example, bladder stones or a bladder tumor can reduce the capacity of the bladder.

Examination and diagnosis

History and physical examination

If you have to urinate more than once at night for a longer period of time, it is wise to consult your doctor. If sleep is interrupted several times, it will have a negative effect on your quality of life over time. In addition, nocturia can be a symptom of serious conditions that require medical attention. When making a diagnosis, the doctor first asks you all kinds of questions about your complaints and assesses your medical history. this is followed by a physical examination. The doctor may ask you to keep a so-called ‘drinking and urination diary’. Write down for at least two weeks what you drank, when, how much and how much urine you excreted and when. This accurate data helps the doctor make a diagnosis.

Follow-up research

Depending on the suspected cause, your GP may refer you to a specialist (e.g. cardiologist, urologist, neurologist). However, the doctor often also carries out certain tests himself. The most common test methods for clarifying nocturia are:

  • general physical examinations, for example listening to the chest with a stethoscope (auscultation)
  • an electrocardiogram (ECG) if heart disease is suspected to be the cause of nocturia
  • an exercise test (or: cycling test), in which an electrocardiogram (ECG) is made during exercise
  • urine test: for example, blood in the urine can indicate a urinary tract infection and sugar in the urine can indicate diabetes
  • ultrasound of the kidneys, bladder and prostate
  • rectal examination: the size, shape, firmness and surface of the prostate can be assessed.
  • blood tests to identify common health disorders

 

Treatment of nighttime urination

The treatment for nighttime urination depends on the cause, for example:

  • In case of heart failure: medication, a healthy lifestyle, possibly a pacemaker or a heart transplant.
  • For diabetes: medicines to lower blood sugar levels, healthy lifestyle.
  • For urinary tract infections: usually antibiotics.
  • If the bladder is overactive or if you have reduced bladder capacity: bladder training.
  • Enlarged prostate: surgery and/or medication.

Notes:

  1. Gourova LW, Beek C van de, Spigt MG, Nieman FH, Kerrebroeck PE van. Predictive factors for nocturia in elderly men: a cross-sectional study in 21 general practices. BJU Int. 2006;97:528-32.
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