Health issues

When nature calls! What frequent trips to the bathroom at night mean

Aug 05, 2019

People who need to urinate several times a night are likely living with nocturia. Source: Shutterstock

The only thing worse than having to get up to use the bathroom after tucking yourself into bed for the evening is needing to repeat the process numerous times throughout the night. While running back and forth to the toilet can disturb your sleep and leave you feeling tired and irritable the next day, it can also cause problems with partners and loved ones and possibly indicate an underlying health issue.

Known as nocturia, the condition impacts around 40 per cent of the population and is characterised by waking up one or more times during the night to pass urine. While it can affect people of all ages, the likelihood of the condition does increase as people age.

“Getting up twice or more overnight is considered ‘meaningful nocturia’ and has been shown to decrease quality of life and health,” Joanne Dean, Nurse Practitioner and Continence Foundation of Australia clinical lead tells Starts at 60. “People who experience symptoms of urgency, which is a sudden and overwhelming desire to pass urine and is difficult to ignore, also often have nocturia.”

While it’s not yet clear why nocturia is more common in older age, specifically in older men, it could be linked to overall health as, in healthy people, urine production is lower during the night, allowing them to sleep undisturbed until morning.

A series of serious health issues are known risk factors of nocturia, which is why it’s important not to dismiss getting up to wee as a normal sign of ageing. For example, men with an enlarged prostate may experience it because the prostate blocks off the urethra and makes it harder to pass urine. This can weaken the bladder over time.

Post-menopausal women are also at risk, with hormone changes and a lack of oestrogen known to weaken the bladder and urethra.

“There is some evidence of a link between neurological diseases such as multiple sclerosis, Parkinson’s disease, stroke and restless leg syndrome and nocturia; however, the causes are not clearly understood,” Dean says.

Heart problems, kidney issues, poorly controlled diabetes and constipation are also common causes of the condition, according to the Continence Foundation. Meanwhile, certain medication such as high blood pressure tablets or diuretic medication may also increase the urge to pee.

“Taking these medications does not necessarily mean you will experience nocturia,” Dean says. “Always discuss concerns about medication with your treating doctor rather than making changes yourself.”

Health issues aside, nocturia can also increase the risk of falls, fractures and even death, particularly in older people who try to reach the bathroom in the dark or in a hurry.

There’s no one-size-fits-all treatment for the condition, particularly because there are so many potential causes and people are encouraged to discuss symptoms with a GP, continence nurse or continence physiotherapist.

“These steps may include investigating for prostate disease in men, hormone treatment for post-menopausal women, ensuring management of underlying diseases such as diabetes is optimal, reviewing medications, and a bladder training program if urgency is a problem for you,” Dean explains.

And while lifestyle factors haven’t directly been linked to nocturia, losing weight is thought to be beneficial and being physically active may also reduce the risk. People should also focus on improving overall bladder health by reducing caffeine and alcohol intake, increasing water consumption, practicing pelvic floor exercises and increasing fibre intake to reduce constipation.

“If these make a difference to you, then it is fine to continue any of these changes,” Dean says. “Strengthening your pelvic floor muscles and learning how to better ‘hold on’ may give you more time to reach the toilet or delay the need to go – meaning you can go back to sleep.”

People may also experience another condition known as polyuria — where people produce abnormally large amounts of urine at night. This is a different symptom to nocturia.

“In overnight polyuria, the kidneys produce large volumes of urine – filling the bladder more quickly and interrupting sleep,” Dean explains. “The causes of overnight polyuria can include diabetes, pituitary, renal and gastrointestinal problems or increased thirst.”

Again, it’s important to discuss symptoms with a GP or health professional to ensure the correct treatment is offered for individual circumstances. There’s also a National Continence Helpline (1800 33 00 66) to provide support and referrals to specialists in your area.

“It’s important to understand you are not alone in your bladder health issues,” Dean says. “Seek help so you have a chance at improvement, better management or even a cure for your symptoms.”