For the media

Peeing a lot at night? This may be why

By The Health News Team | February 13, 2024
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If you really think about it, growing older truly is a blessing — one not everyone can enjoy. However, there are a few things that come with advanced age that might not seem so rosy.

One example: waking several times during the night having to urinate. Known as nocturia — and more informally as “having to pee a lot at night” — this common concern among older adults can lead to decreased sleep and for some people, embarrassment.

“While age alone is not a direct cause of nocturia, older people tend to have more of the problems related to the condition,” says Dr. Claudia Sevilla, a urologist affiliated with Sharp Chula Vista Medical Center. “These causes include medical conditions and medications, such as diuretics for heart conditions or blood pressure.”

According to Dr. Sevilla, medical conditions that can lead to nocturia include:

  • Overactive bladder or low bladder capacity, commonly known as “having a small bladder”

  • Untreated or poorly managed diabetes

  • Congestive heart failure, when the heart is unable to pump enough blood through the body, which can cause fluid retention

  • Obstructive sleep apnea, when breathing is interrupted during sleep

  • Nocturnal polyuria, when the body produces excessive urine at night

“In some cases, frequent nighttime urination may be the first presenting symptom of congestive heart failure or diabetes,” Dr. Sevilla says. “Or it can simply be because a person is drinking too many fluids before going to sleep. Our initial step is trying to figure out why a patient has nocturia and ensuring that all preexisting conditions a patient has are being treated appropriately. We then begin treating the nocturia.”

How frequent nighttime urination is treated

The International Urogynicological Association reports treating nocturia is classified into three categories: conservative approaches, medications, and surgical or procedural options:

Conservative approaches

  • Restricting the intake of fluids after 4 pm

  • Taking diuretics, sometimes known as “water pills,” no less than six hours before bedtime

  • Elevating the legs often during the day

  • Wearing compression stockings

Medications

  • Desmopressin, which reduces the amount of urine produced at night but cannot be used by people with congestive heart failure

  • Medications that reduce bladder spasms

  • Medications that relax bladder muscles and increase bladder capacity

Surgical or procedural options

  • Bladder instillation, an in-office procedure to place medication directly in the bladder

  • Injecting purified botulin neurotoxin — commonly known by the brand name Botox — into the bladder wall

  • Placing a device similar to a pacemaker to signal the bladder when and when not to contract

  • Urinary diversion, a procedure to reroute urine through a newly constructed bladder, usually made from the bowel

“Getting complete control of nocturia can be difficult at times,” Dr. Sevilla says. “I usually recommend having a commode at the bedside or using adult diapers or pads. If necessary, we sometimes recommend a PureWick device, which is a noninvasive external catheter that can be worn to catch urine in the middle of night, so the individual can get more rest.”

Most importantly, Dr. Sevilla always tries to assure her patients that frequent nighttime urination is a common problem. There are several treatment options and no need for embarrassment.

“Although nocturia can be embarrassing, it is more common than most people realize,” she says. “I recommend seeking treatment and asking your primary care physician for a referral to see a urologist.”

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