Night-time toilet visits: when to worry and what to do about it

Do you often get up in the night to do a wee? While this is completely normal and even common, particularly once we get into our 60s and beyond, it can become a problem if the night-waking occurs more than twice a night and is affecting your daylight hours and energy.

Janie Thompson from Alfred Health Continence Service says nocturia, as it’s known, should be taken seriously because day-time fatigue can increase your risk of falling or hurting yourself, and also affect your concentration, memory and mood.

So why does it happen? Janie explains, “Normally when we sleep we make only up to about 30 per cent of the urine we make during the day. This is because the anti-diuretic hormone (ADH) we make overnight causes our kidneys to produce smaller volumes of more concentrated urine so our sleep is uninterrupted.

“But as we age, the urine volume made at night can increase to about 50 per cent of the daytime volume. Although researchers are still not sure why this happens, one theory is that ADH levels decrease as we age, thereby increasing the volume of urine made overnight and the prevalence of nocturia with age.”

That said, there are numerous other factors that can also contribute to nocturia, including an enlarged prostate for men or a urinary tract infection. Neurological conditions such as stroke, multiple sclerosis or Parkinson’s Disease can also impact bladder function, although these conditions would also cause day-time symptoms.

Some other contributing factors include:

• A decline in heart an kidney function (clue: look for swollen ankles)
• Drinking too much before bedtime
• Sleep apnoea
• Diabetes
• Excessive thirstiness caused by medications

What can be done about nocturia?

Janie says it’s important to manage any underlying conditions that might cause you to need to wee more in the night. The Royal Australian College of General Practitioners offers this advice for managing nocturia:

• Avoid drinking caffeine and alcohol in the evening
• Limit excessive fluid and food intake three hours before bedtime
• Elevate your legs for an hour or so in the evening
• Pre-emptive voiding (aka, have a wee before bed!)
• Take medications with a diuretic effect to the mid-afternoon (after checking with your doctor first)
• Exercise regularly to improve sleep quality and raise the threshold at which your bladder will wake you up

Another consideration is to determine whether the need to wee is waking you up, or if waking up makes you need to wee. Make sure your room is at a good temperature (cooler tends to be better), that there is no light breaking into your room and that you are going to bed at a consistent time.

Janie reminds us to get enough fluid during the day – around 1.5 to 2 litres, including beverages other than water and the water in food, but to try not to drink much in the two to three hours before bedtime.

“If you have tried to manage nocturia yourself without success, there are continence professionals throughout Australia who can help. Some of the treatments recommended after a continence assessment may include small doses of a diuretic or water
tablets in the afternoon to remove fluid from the body before bedtime, medications or techniques to retrain your bladder to hold more urine or not empty so often.

For more information about nocturia and to find your nearest continence service, contact the National Continence Helpline  on 1800 33 00 66.

Do you experience nocturia? Does it affect your waking hours?