Nocturia: 13 Reasons for Nighttime Toilet Visits

If you notice that you began to wake up at night due to the urge to urinate, you naturally have a question: why, in fact, is this happening? What has changed or, perhaps, broken in the functioning of the excretory system?

Nocturia is a steady tendency to nocturnal awakenings associated with an imperative need to go to the toilet. And of course, nocturia is not unreasonable, so ignoring this trend, to put it mildly, is not recommended.

The bad news is that many potential causes and factors can lead to nocturia, ranging from ingrained habits to serious latent diseases requiring investigation and treatment. The good news is that we are now going to try to figure out – with the help of experts – the main and most common reasons for interrupting a night’s sleep for an urgent visit to the toilet.

What causes nocturia?

According to the American Urological Association (AUA), nocturia can be based on very different (in terms of etiopathogenesis) conditions, processes, and diseases. However, first of all, it should be noted that nocturia itself is not a disease. It is always just a symptom, a sign of some more general pathology. In addition, it is important to emphasize the difference between nocturia and another urological symptom with a similar sound – polyuria. Polyuria means an abnormally large amount of urine is produced in the body. In contrast, nocturia means normal volumes of urination, but the urine is either not completely excreted or there are false urges when the bladder is empty.

Some pathological conditions and other causes that often cause nocturia are discussed below.

prostate enlargement

In many men, the prostate gland increases in size with age. In this case, the outflow of urine is partially pinched or blocked, which makes it difficult to empty the bladder. According to the Mayo Clinic, the symptoms of the so-called. Benign prostatic hyperplasia ( prostate adenoma ) notices in about every third man who has reached the age of 60. At the same time, nocturia is one of the most common and well-known symptoms of an enlarged prostate, which occurs in almost all cases. The impossibility of complete emptying of the bladder makes a person feel the urge to urinate more often and more acutely, including during a night’s sleep.

Bladder dysfunction

Bladder problems can occur in men and women, although the causes usually differ. In the context of nocturia, this could be the phenomenon of “increased urination due to reduced critical bladder volume,” says Mark Ellerkmann, MD, director of the Urogynecology Center at Mercy Medical Center in Baltimore. This condition can develop, in particular, due to age-related stretching of the bladder walls, which can no longer hold the usual amount of urine, due to the hyperplasia of the prostate mentioned above, and also due to a special syndrome known as an overactive bladder.

Diabetes

Both nocturia and polyuria are often present in the clinical picture of diabetes mellitus, and it is important to understand the differences between the two conditions.

Polyuria is a classic symptom of diabetes. In the uncontrolled course of this serious disease (i.e., in the body of patients left without observation and adequate therapeutic support), an abnormally large amount of urine is produced, primarily due to the high concentration of glucose in the blood. But in cases of nocturia, the volume of urine produced is not increased; just very inopportunely – at night during sleep – there is an urge to urinate.

In patients with diabetes, nocturia is usually due to a combination of two factors: edema and diabetic neuropathy. In 2020, an article was published in the specialty journal Journal of Wound, Ostomy, and Continence Nursing, where a significant increase in nighttime urination in older women with diabetes (compared to younger categories) is considered a consequence of these two causes acting simultaneously.

Edema (swelling)

According to Dr. M. Ellerkmann, swelling can also cause nocturia, often observed in patients with cardiovascular diseases and/or chronic heart failure. Fluid retention in the tissues can lead to swelling in any part of the body, but in this case, the legs and ankles swell most often, which causes frequent urination.

“When such patients lie down, the body tries to return excess fluid to the circulatory system, while the function of the kidneys is to remove this excess,” explains M. Ellerkmann, specifying that the cycle of transport of excess fluid through the kidneys can lead to increased urination, including a number at night.

Interstitial cystitis

According to the Centers for Disease Control and Prevention (CDC), interstitial cystitis is a chronic, non-infectious inflammation of the bladder. This very uncomfortable condition is why it is often referred to as the “painful bladder syndrome.” Often, interstitial cystitis is detected during the examination, the primary reason for which is precisely the patient’s complaints about nocturia.

Pregnancy

Due to the rapid increase in the uterus and, as a result, the growing pressure on the surrounding organs, pregnant women often complain that they want to go to the toilet almost constantly. Thus, the main (but not the only possible) cause of nocturia during pregnancy is the mechanical compression of the bladder, which does not allow it to hold the usual volumes of urine.

neurobiological disorders

Physical damage to the spinal cord and other central nervous system structures can also cause nocturia, says S. Adam Ramin, MD, medical director of the Urology Cancer Center in Los Angeles. Many such conditions are known: spinal injuries, Parkinson’s disease, strokes, etc. In particular, studies in 2012-19 confirmed that urinary incontinence and dysfunction of the lower urinary tract are typical symptoms in the first 3-6 months after a stroke.

infections

According to Mayo Clinic experts, widespread urinary tract infections often cause a sudden, intense urge to urinate. In the presence of such an infection, such urges are likely to occur during the daytime. Still, even if this remains a purely nocturnal problem for someone, it should be paid attention to – especially if nocturia is combined with other symptoms of urogenital infection, such as feeling a burning sensation when urinating, fever, pelvic pain, pain in the lower abdomen.

Age and ethnic factors

There are some risk factors for nocturia that are completely uncontrollable. In particular, age: according to Dr. M. Ellerkmann, an abnormally large amount of urination at night may be due to a decrease in the level of the antidiuretic hormone arginine-vasopressin (AVP). “Normally, blood plasma contains an increased level of AVP at night, which inhibits urine production,” the expert says. “However, in elderly patients, the level of nocturnal secretion of AVP may be insufficient, which leads to age-related nocturia.”

Ethnicity. Nocturia is more common in blacks and Hispanics, especially males. However, Dr. S.A. Ramin doubts that the reason here lies in any genetic or hereditary predisposition; in many cases, socioeconomic and even cultural factors come into play. “Black and Hispanic men tend to have less access to high-quality medical care and are less likely to go to the doctor with such complaints,” the expert explains. “Thus, the primary problems progress, and the symptoms become more pronounced.”

Medicines

Several drugs can cause nocturia. The most obvious culprit here is diuretics (water pills), but the AUA reports that some heart medications and mood stabilizers can also increase nighttime bladder filling. In your case, it is likely impossible or highly undesirable for medical reasons to stop taking such drugs. Still, in many cases, in consultation with the doctor, it is possible to adjust the administration time so that the last dose does not occur in the late evening.

Sleep disorders

Suppose you wake up several times a night because you urgently need to go to the toilet. In that case, it is logical to assume that there are problems in the urogenital (genitourinary) system. However, in reality, sleep disturbances as such may be the cause.

“Obstructive sleep apnea can cause nocturnal polyuria through the release of atrial natriuretic peptide (ANP), a hormone that can stimulate the kidneys to produce more urine,” says Mark Ellerkmann. “Sometimes patients wake up due to dyssomnia or restless leg syndrome and, upon waking up, feel the need to empty their bladder. But a sleep disorder wakes them up, not a bladder.”

Psychological reasons

According to Dr. S.A. Ramin, in some cases, the cause of nocturia is anxiety, expressed in the degree of an abnormal state of the psyche.

“Some patients with high anxiety have chest pain or discomfort, others have increased bowel movement or diarrhea, but many anxious people complain of frequent and urgent urges to urinate,” he says. “This can happen both during the day and at night, so a person with increased anxiety can develop nocturia even if there are no problems with the bladder or prostate gland.”

Similarly, mental illnesses such as depression or obsessive-compulsive disorder can manifest: patients may feel that they “must” go to the toilet whenever they wake up at night, especially if sleep is shallow or sleep phasing is disturbed. In such cases, a person goes to the toilet not because of the urge to urinate but because he is used to doing this every time he wakes up.

Lifestyle features

We assume that you do not have the habit of regularly drinking two liters of water before going to bed … and if you do, then this habit is best abandoned. The cause of nocturia may be elementary: the natural overflow of the bladder due to excessive volumes of liquid drunk at night. According to the AUA recommendations, limiting yourself to this two to three hours before a night’s sleep is advisable. It matters not only how much you drink but also what exactly you drink: some drinks, such as alcohol or coffee, are diuretics in themselves; that is, it is this factor that can increase nocturnal diuresis.