Nighttime urination: causes and what you can do

General information, not medical advice. If it hurts to urinate and you also feel ill or have a fever, or if you suddenly cannot urinate at all, call your GP straight away.

Now that the nights are getting longer, you may notice more often how many times you wake up to go to the toilet. Many people dismiss nighttime urination as a normal part of getting older. Yet some causes can be addressed. Below you can read when it counts as a problem, what may lie behind it and what you can try yourself.

Nighttime urination: when is it a problem?

The medical term is nocturia: waking up because you need to urinate. According to Gezondheid en Wetenschap, the Belgian patient guideline website of Cebam (the Belgian Centre for Evidence-Based Medicine), there may be nocturia if you wake up more than twice a night to urinate and it bothers you. Normally you urinate between three and eight times a day, five times on average. Adults need 1.5 to 2 litres of fluid a day.

An American review article in American Family Physician sets the threshold slightly lower: from two times a night, nocturia is clinically significant. According to the same review, more than 30 percent of people over 60 are affected and it becomes more common with age. Another review, in the Tzu Chi Medical Journal, reports more than 50 percent in patients aged 80.

What can lie behind it?

The American review divides the causes into four groups: your body makes more urine at night, your bladder can store less, your bladder does not empty fully or a sleep disorder wakes you up. Gezondheid en Wetenschap also mentions benign prostate enlargement in men and, among other things, an overactive bladder, diabetes and heart failure. A sleep disorder such as sleep apnoea, in which your breathing briefly stops again and again during sleep, can also play a part. How to recognise sleep apnoea is explained in a separate article. Drinking a lot, alcohol and water pills (medicines that make your body pass more fluid) can also be a cause.

Effects on your sleep and your risk of falling

Waking up to urinate interrupts your sleep. The American review also links nocturia to a higher risk of falls and fractures. You can read more in the article on bone density and fall prevention.

A meta-analysis in the Journal of Urology pooled the results of 11 observational studies. In people with nocturia, the researchers found a relative risk of death of 1.27. Observational studies follow people without changing anything, so they show a link and not a cause. The authors rated the evidence that nocturia itself is the cause as very low. As a predictor of higher risk, however, they rated the evidence as moderate.

What you can do yourself

Gezondheid en Wetenschap and Thuisarts, the website of Dutch GPs, give some practical advice:

Two older friends take a walk together along a quiet street in the late afternoon

Drink less in the evening. Gezondheid en Wetenschap advises not drinking after 7 pm or 2 to 3 hours before bedtime, Thuisarts mentions 2 hours.
Limit caffeine from coffee, tea, cola and energy drinks, fizzy drinks and alcohol, especially in the evening. What alcohol does to your sleep is explained in a separate article.
Do not drink more than 2 litres a day and urinate before you go to bed.
Be active during the day. According to Thuisarts, men who move a lot have fewer urination problems than men who sit a lot.
Do not eat too much salt.

If you take water pills, Thuisarts advises not taking them after 3 pm and in any case not less than 6 hours before you go to sleep. Do not change your medication yourself without discussing it first.

When to see a doctor?

If these tips do not help, Gezondheid en Wetenschap advises contacting your doctor. If there is blood in your urine or you need to urinate often and it hurts, make an appointment with your GP, according to Thuisarts. A bladder diary helps during the consultation: for a few days you write down when and how much you drink and urinate. The American review also advises doctors to ask about your sleep and about signs of sleep apnoea.