Urination - excessive at night

Definition

Waking up several times a night to urinate is called nocturia.

Considerations

Normally, urine decreases in amount and become more concentrated at night. That means, most people can sleep 6 to 8 hours without having to urinate.

But, persons with nocturia get up more than once during the night to urinate. Because of this, those who have excessive urination at night often have disrupted sleep cycles.

Common Causes

• Drinking too much fluid before bedtime -- particularly coffee, caffeinated beverages, or alcohol
• Benign prostatic hyperplasia
• Diabetes
• Chronic or recurrent urinary tract infection
• Chronic renal failure
• Congestive heart failure
• Cystitis (acute urinary tract infection)
• Drugs such as diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D
• Obstructive sleep apnea

Home Care

Keep a diary of how much fluid you drink, how often you urinate, and urine output. Record your body weight at the same times and on the same scale daily.

Call your health care provider if

• Excessive nighttime urination continues over several days, and is not explained by medications or increase of fluids before bedtime.
• You are bothered by the number of times you must urinate during the night.

What to expect at your health care provider's office

Your health care provider will perform a physical examination and ask questions about your nighttime urination, such as:

• When did it start?
• How many times does this occur each night?
• Has there been a change in the volume of urine produced?
• Do you ever have "accidents" or bed wetting?
• How much urine is voided each time?
• What makes the problem worse? Better?
• How much fluid do you drink before bedtime? Have you tried restricting fluids before bedtime?
• What other symptoms are also present? Do you have increased thirst, pain or burning on urination, fever, abdominal pain, or back pain?
• What medications are being taken?
• How much caffeine do you consume each day?
• Have you had any bladder infections in the past?
• Is there a family history of diabetes?
• Does nighttime urination interfere with adequate sleep and rest?
• Do you drink alcoholic beverages and, if so, how much each day?
• Have you changed your diet recently?

Electrolytes and fluids will be monitored over a period of time.

Diagnostic tests that may be performed include:

• Blood urea nitrogen
• Serum creatinine or creatinine clearance
• Fluid deprivation
• Osmolality
• Serum electrolytes
• Urinalysis
• Urine concentration
• Urine culture

TREATMENT

Treatment depends on the cause. If excessive nighttime urination is due to diuretic medications, you may be told to take your medication earlier in the day.

References

Asplund R. Nocturia, nocturnal polyuria, and sleep quality in the elderly. J Psychosom Res. 2004 May;56(5):517-25.

Illustrations

Female urinary tract

Male urinary tract

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Nocturia ; nocturia; nocturia cause; nocturia treatment