Having to get up a few times a night to urinate is not only likely to disrupt your sleep, but it can also sometimes be linked to age-related changes in the prostate. Dr Harriet Connell explains more about nocturia, including possible reasons why this might happen, general steps that may help and when to speak to your GP.
If your sleep is regularly disturbed by having to make multiple trips to the toilet throughout the night, it may be a sign of nocturia. This is the medical term for frequent night-time urination, a common experience that, while not life-threatening, can certainly be life-affecting, and is estimated to affect around 20–44% of men aged 20–40, and up to 93% of men over 701 . It is often seen as something that is simply a normal part of ageing, and while it is more common in older adults, it is not something you should have to grin and bear, particularly if it is impinging on your quality of life. Excessive nighttime urination can not only disrupt a good night’s sleep which may contribute to fatigue, drowsiness, low energy, difficulty concentrating, and changes in mood, but it can sometimes be linked to underlying prostate or bladder issues2 . If you’re concerned, it’s always worth speaking for your GP for personalised advice.
Common causes of nocturia
Nocturia (waking up at night to urinate) can have a variety of contributing factors. It may be influenced by lifestyle habits, age-related changes in hormone levels, or other health-related factors. For example, as we age, the body produces less anti-diuretic hormone (ADH), which can lead to increased nighttime urine production.
Unsurprisingly, nocturia can also commonly caused simply by drinking too much too close to bedtime — especially alcohol and caffeinated drinks like coffee, tea (including green tea), hot chocolate, cola, and energy drinks (these can act as diuretics, causing your body to produce more urine if consumed in excess). Blackcurrant juice and citrus juices are other seemingly innocuous drinks that may irritate the bladder due to their acidity, particularly for those with an overactive bladder or bladder sensitivities.3 If frequent night-time urination is affecting your sleep or quality of life, it's best to speak with a healthcare professional.
The prostate and nighttime urination
An enlarged prostate (also known as benign prostatic hyperplasia or BPH) is a common age-related change that may contribute to nocturia and affect normal urinary function. As the prostate grows, it surrounds more of the urethra (the tube that carries urine from the bladder out of the body), and this may influence how easily urine flows. The reason why this can start happening in a man’s late 30s or early 40s is that prostate size varies throughout life; in his twenties it is roughly the size of a walnut; by his forties it may be larger; and by his sixties, it could be about the size of a lemon. The larger the prostate becomes, the more pressure it may place on the urethra. This narrowing can sometimes affect urine flow and contribute to more frequent urination, particularly at night.
How to manage nocturia
Lifestyle changes may be a helpful first step in managing nighttime urination and could be enough to reduce your night-time toilet trips. However, if you don’t notice improvement after a few weeks, it’s a good idea to see your GP. To help you manage, you might consider:
Record what is happening
To help pinpoint why you are peeing more during the night, keep a record over a few weeks logging how many times you get up and what appears to irritate the bladder or increase the need to pee: alcohol; any non-alcoholic drinks that seem to irritate the bladder; too much fluid consumed close to bedtime; any foods that might irritate the bladder; increased stress or anxiety—or any other factors. This information can help identify which lifestyle changes might be helpful and will also be useful to share with your GP if needed.
Check your diet
We might not give it much thought but what we eat may influence how our bladder behaves. For example, a diet high in sugar has not only been associated with an increased likelihood of being overweight or obese (and carrying excess weight can place additional pressure on the bladder) but may also stimulate and irritate the bladder resulting in an increased urge to pee and pee more often. This could be because the body works harder to process and remove excess glucose, which may place strain on the urinary system.
Lower your salt intake
A high salt (sodium) intake can increase thirst, which may lead to greater fluid consumption. Some sources suggest that salt may also have a mild diuretic effect in certain individuals. Unsurprisingly perhaps, research indicates that reducing salt intake may help support more balanced urination patterns at night for some people. Don’t just think about how much salt you are physically adding to food but also check the levels in the foods you are consuming (not just the more ‘obvious’ ones like crisps and salted peanuts but also ready meals, stock cubes, salad dressings, pizza, sausages and cheese etc).
Prevent constipation
Not moving your bowels regularly can lead to a buildup of faeces in the colon, which may cause the bowel to distend which can put pressure on the bladder. Increasing your intake of high-fibre foods (such as vegetables, fruits, pulses like chickpeas and lentils, brown rice and oats) alongside drinking adequate water, may help support regular bowel movements and overall digestive comfort.
Maintain a healthy weight
Carrying extra weight can place additional pressure on your organs.
Practise pelvic floor exercises
These can strengthen your pelvic floor muscles and give you better control over your bladder.
Drink less just before bed
Try to limit your intake of fluids (particularly caffeinated drinks, alcohol, blackcurrant and citrus juices) two to three hours before you go to bed. Do, however, make sure you are drinking enough fluids throughout the day.
Try to develop a ‘getting back to sleep quickly’ routine
It may be helpful to learn strategies – such as breathing or muscle relaxation techniques – that support falling back to sleep more easily after waking to use the bathroom.
Use the bathroom before bed
It might seem obvious but have a wee before you go to bed.
References