Why Am I Waking Up to Pee Again?

No one wants to keep getting up in the middle of the night. And if your bladder is repeatedly waking you up, it can make you drowsy and irritable throughout the day.

If you wake up to pee more than twice each night, you may have a condition called nocturia. It’s more common among pregnant women and seniors but can occur in men and women of any age or condition. It’s not fun for any of us, but could be dangerous for seniors, due to an increased risk of falls and subsequent bone fractures.

What causes frequent nighttime urination?

The causes for nocturia are wide-reaching, so your doctor needs to understand your overall health and lifestyle habits to determine and treat the source of the problem.

Causes may range from drinking too much before bed to an underlying disease or infection. Some people have unintentionally trained their bladder to feel full even when it’s not, simply by urinating too often.

Underlying health issues may cause nocturia.

These include:

• reduced bladder capacity due to scarring, radiation, or other damage
• excessive nighttime urine production
• urinary tract infection
• bladder conditions: overactive bladder, infection, stones, cancer, tumor
• tumors of the prostate or pelvic area
• bacterial cystitis, radiation cystitis, interstitial cystitis
• diabetes mellitus, diabetes insipidus
• high blood pressure
• heart disease
• congestive heart failure
• vascular disease
• restless leg syndrome
• sleep apnea
• insomnia
• chronic kidney failure
• high blood calcium level
• edema or swelling of the legs
• enlarged prostate
• stress and anxiety
• fluid redistribution
• nephrotic syndrome
• malnutrition
• venous stasis
• neurological disorders such as Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, or spinal cord compression

Certain behaviors can trigger your waking up to pee at night.

Try to avoid:

• not urinating before going to bed
• urinating too often out of habit
• consuming caffeine in late afternoon or evening
• drinking alcohol within a few hours of going to bed
• drinking too much water or other liquids a few hours before bed

Are you taking any of these medications?

They can cause overactive bladder, too.

• diuretics (“water pills”)
• selective serotonin reuptake inhibitors (SSRIs)
• calcium blockers
• tetracycline
• lithium

If your nocturia is caused by a medication, taking it earlier in the day may help you avoid bladder-related side effects at night.

Can nocturia be treated?

It depends on the cause.

If it’s due to a condition like a urinary tract infection, prostate enlargement, or diabetes, this frequent waking up to pee will usually stop when the main underlying condition is successfully treated.

Anticholinergic drugs, which is often used to treat incontinence, and bladder relaxants can reduce the symptoms of overactive bladder. The drug desmopressin regulates how the body uses water and can cause the kidneys to produce less urine at night.

Some behavioral changes can also help. Two to four hours before going to bed, don’t drink much and avoid alcohol and caffeine. Some foods are bladder irritants, including chocolate, spicy foods, acidic foods, and artificial sweeteners. Avoid these and see if your nocturia improves.

Pelvic floor physical therapy and Kegel exercises can strengthen your pelvic muscles and improve bladder control, if that’s contributing to the problem.

Your doctor can help you determine what treatments can minimize the problem. The most effective response is often a combination of medication, therapy, and behavioral changes.

Should I see my doctor about waking up to pee?

If nocturia is interfering with your sleep, speak with your primary care physician or a urologist to determine the cause. An appropriate course of treatment may relieve constant trips to the bathroom and help you regain a sense of control over your bladder and your sleep.

It helps to write it down.

Keep a urination “journal” for five days before talking to your doctor. Throughout the day, write down each time you urinate, what you had to drink, and how much you drank.

Your doctor may also ask you:

• When did this issue start?
• How many times per night do you find yourself waking up to pee?
• Do you have urinary accidents during the day or while you sleep?
• When you feel the urge to urinate, are you producing smaller amounts than before?
• Does anything make the problem worse?
• Are you experiencing pain or burning with urination?
• Do you have sleep apnea?

Be prepared to discuss your diet and drinking habits, if you smoke, your medical history, your family history with bladder problems or diabetes, all medications and supplements you’re taking, and any other symptoms like anxiety.

What are the tests for nocturia?

• frequency-volume chart analysis
• urinalysis
• diabetes blood sugar test
• blood test for red/white blood cell counts
• urine culture
• fluid deprivation test
• ultrasound or CT scan
• cystoscopy

If you are bothered by frequent nighttime urination, call the University of Miami Health System’s Urology Experts at 305-243-6090 or schedule an appointment.

Medically reviewed by Nicholas Hauser, M.D., urologist with the University of Miami Health System. Written by Dana Kantrowitz, a contributor to UMiami Health News.

Tags: Dr. Nicholas Hauser, Urology