Professor Vijay Sangar, Consultant Urological Surgeon and Professor of Urology. Expertise in assessing and treating nocturia. 

Do you regularly wake up during the night because you need to pass urine? You may have nocturia, the medical term for waking from sleep to urinate. Although getting up once during the night can be normal, regularly waking two or more times can become frustrating and can have a significant impact on your sleep, energy and quality of life. Importantly, nocturia is a symptom rather than a diagnosis. There are many possible causes, and they are not always related to the bladder or prostate.

What can cause nocturia?

In men, an enlarged prostate is a common cause of nighttime urinary symptoms. It can cause a weaker urinary stream, difficulty starting, urgency, increased frequency and a sensation that the bladder has not emptied completely.

However, waking at night should not automatically be blamed on the prostate. Problems such as an overactive bladder, urinary infection, bladder stones or incomplete bladder emptying can also cause nocturia.

Women may experience nocturia because of an overactive bladder, urinary infections, pelvic floor problems or changes associated with menopause. Bladder irritation and pelvic organ prolapse can also contribute to urinary frequency and nighttime symptoms.

Lifestyle and other medical conditions

Sometimes the cause is much simpler. Drinking large amounts of fluid in the evening, particularly close to bedtime, can increase nighttime urine production. Caffeine found in coffee, tea, cola, energy drinks and chocolate can increase urine production and may also irritate the bladder and disturb sleep. Alcohol can have similar effects.

Other medical conditions can also play a role. Diabetes can cause increased thirst and urine production, while sleep disorders can cause you to wake frequently and then decide to empty your bladder.

Swollen ankles and legs are another important clue. During the day, fluid can accumulate in the legs, particularly if you spend a lot of time standing or sitting. When you lie down at night, this fluid returns to the circulation and is processed by the kidneys, increasing urine production. Leg swelling can have several causes, including venous problems, but it can also occur with heart failure, so persistent swelling should be discussed with your GP.

What tests might be needed?

A urological assessment will usually begin with questions about your urinary symptoms, fluid intake, medications, sleep and general health.

A three-day bladder diary can be particularly useful. This records when you pass urine and how much urine you produce. A urine test may be performed to check for infection, blood or other abnormalities. Depending on your symptoms, your doctor may also consider blood tests such as kidney function and blood glucose, blood pressure assessment and, where appropriate, a prostate assessment in men or pelvic examination in women.

A bladder scan or ultrasound may be used to see whether you are emptying your bladder properly. Further investigations are sometimes required depending on the findings.

What can you do yourself?

There are several simple measures that may help:

• Avoid large amounts of fluid in the 2–3 hours before bedtime, while maintaining adequate hydration during the day.

• Reduce evening coffee, tea, cola and energy drinks, particularly if you notice they make your symptoms worse.

• Consider reducing alcohol, especially in the evening.

• Empty your bladder before going to bed.

•Maintain a healthy weight and regular physical activity.

• If you have swollen legs, discuss appropriate leg elevation or compression with your healthcare professional.

• Review the timing of medications such as diuretics (“water tablets”) with your GP. Do not stop prescribed medication without medical advice.

When should you see a urologist?

If waking at night to urinate is persistent, getting worse or affecting your sleep and quality of life, it’s worth having the underlying cause investigated.

A Urologist can assess whether your symptoms are coming from the bladder, prostate or urinary tract, while also recognising when conditions such as diabetes, sleep disorders, cardiovascular disease or medication may be contributing.

You don’t simply have to put up with getting up several times a night. Finding the cause is the first step towards finding the right treatment.

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