If you're waking up repeatedly in the middle of the night to urinate, one of the biggest questions on your mind is probably why? We can't change or improve health-related problems if we don't know what's causing them, so pinpointing the source of your late-night urges to use the bathroom—also known medically as nocturia—is an important first step to reducing all those night wakings and getting a better night's sleep.
The bad news is there are a lot of potential reasons why you could have nocturia, from simple lifestyle habits to more complicated medical conditions. The good news is that we're here to help you out! Here are all the major reasons why you could be waking up mid-sleep with the urge to run to the bathroom, according to experts.
What causes nocturia?
There are many health conditions that can cause nocturia, according to the American Urological Association (AUA). It's important to note, however, that nocturia is a symptom, not a disease; in contrast with polyuria, where the body makes an excess amount of urine, a person with nocturia is producing a normal amount of urine but either not voiding it all or simply feeling an urge to go even when their bladder is fairly empty.
Here's a list of medical conditions and other issues that might make you get up to go:
As men age, it's not uncommon for their prostate glands to become enlarged, which makes it difficult to fully void the bladder; because the glands are enlarged, the flow of urine becomes blocked or impeded, per the Icahn School of Medicine at Mount Sinai.
Also called benign prostatic hyperplasia (BPH), about one-third of men report symptoms by the age of 60, and it often continues to increase from there, reports the Mayo Clinic. Nocturia is one of the most well-known symptoms of an enlarged prostate, as being unable to fully void makes it feel as if you need to urinate more often and more urgently.
Bladder problems can occur in men or women, though usually for different reasons; if you're urinating frequently due to nocturia, this is known as "low-volume bladder voiding," says Mark Ellerkmann, MD, director of the Urogynecology Center at Mercy Medical Center in Baltimore.
This can happen, Dr. Ellerkmann explains, because of reduced bladder capacity—as you age, the bladder wall stretches and can't store as much urine—or bladder dysfunction: "The two most common causes of low-volume voiding are benign prostatic hypertrophy in men, causing bladder obstruction, and overactive bladder."
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Both nocturia and polyuria can occur in people with diabetes, reports the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), so it's important to understand the distinction between the two conditions.
Polyuria is a classic symptom of diabetes. People with uncontrolled diabetes produce elevated amounts of urine, primarily because of high blood glucose levels, says the Mayo Clinic. With nocturia, the root cause of nighttime wakings is different—you don't make more urine, you just feel a more frequent urge to go.
Typically, nocturia in people with diabetes is due to a combination of factors, including swelling and diabetic nerve damage. A small 2020 study in the Journal of Wound, Ostomy, and Continence Nursing found that older women with diabetes were more likely than their younger counterparts to have urinary frequency at night, partly because of these co-existing conditions.
Edema (aka swelling)
Seen often in patients with heart disease or congestive heart failure, edema can also be a cause for nocturia, says Dr. Ellerkmann. Though tissue can swell in any part of the body thanks to fluid retention, the lower legs and ankles are the most common spots—and this can lead to an increase in urination.
"When these patients lay down and elevate their lower extremities, the body attempts to mobilize the excess fluid back into the circulatory system, and the kidneys attempt to get rid of it," Dr. Ellerkmann explains, adding that this cycle of sending excess fluid into the kidneys can lead to an increased frequency in voiding.
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According to the CDC, interstitial cystitis (IC) is a chronic pain condition of the bladder that often includes inflammation of the bladder walls. Also called "painful bladder syndrome," IC is sometimes diagnosed based on a person reporting an increase in nocturia, per the Interstitial Cystitis Association.
Because of increased uterine growth and pressure on the surrounding organs, pregnant people often feel like they have to go—all—the—time. For the most part, this only happens because the bladder is being squeezed; per the Cleveland Clinic, all that pressure means your bladder may not be able to hold quite as much urine as normal.
Physical damage to the spinal cord or central nervous system can also contribute to nocturia, says S. Adam Ramin, MD, urologist and medical director of Urology Cancer Specialists in Los Angeles, who adds that it can happen as a result of several conditions, such as Parkinson's disease or spinal cord injury. The National Association for Continence refers to this symptom as neurogenic bladder.
It's also common in people who have a history of stroke. In fact, two separate studies—one from 2012 and one from 2019—suggest that urinary incontinence and lower urinary tract dysfunction are extremely common in the first three to six months after having a stroke.
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Common infections, like those of the urinary tract (UTI) and bladder, often cause intense, sudden urges to urinate, reports the Mayo Clinic. If you have an infection, you would probably not only have this symptom at night (in other words, you'd feel it during the day, too), but if your nocturia is a brand new problem and you have other signs of infection—such as fever, burning sensation when you pee, or pelvic or lower abdominal pain—it's worth considering.
Age and Ethnicity
There are some risk factors for nocturia that are 100% out of your control:
Age. Per Dr. Ellerkmann, an increased volume of nighttime urination can occur with a decrease in the anti-diuretic hormone called arginine vasopressin (AVP.) "Normally, there are higher AVP plasma levels at night, which lead to less urine production," he says, "however, in older patients the level of nighttime AVP production may be lower, leading to age-related increases in nocturia."
According to the National Association for Continence, the majority of people with nocturia are over the age of 60.
Ethnicity. Nocturia is more common in Black and Hispanic people, especially men. But Dr. Ramin says it may not be because of any particular genetic or hereditary disposition; rather, in many causes, the causes may be socioeconomic or even cultural.
"Black and Hispanic men are generally less likely to have access to healthcare and are less inclined to seek medical care, so their disease condition progresses and symptoms become more pronounced," he explains.
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There are some medications that can cause nocturia; diuretics are an obvious culprit, but the AUA reports that some heart medications and mood stabilizers can increase nighttime urination. While it may not be feasible for you to stop taking these drugs entirely if you need them, in some cases you can change the timing of your dosage so you aren't taking them close to the evening.
If you're waking up several times during the night to pee, you're probably assuming the problem is with your urogenital system (i.e. the part of your body responsible for your urinary and reproductive organs), but it could actually be a sleep-related problem instead.
"Obstructive sleep apnea may cause nocturnal polyuria by the release of atrial natriuretic peptide (ANP), a hormone that can cause the kidneys to make more urine," says Dr. Ellerkmann. "Sometimes patients awaken due to insomnia or restless legs, and once awake, they have the sensation of needing to void, but it really was their sleep disorder that awakened them and not their bladder."
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Dealing with anxiety? Dr. Ramin says that may help explain your nighttime bathroom runs to void your bladder.
"Some patients get chest pain or discomfort, some patients have increased bowel movements or diarrhea, and a lot of patients get an increased urge and frequency to urinate," he says. "It can happen at night and in the daytime, so anxiety can definitely lead to nocturia, even in cases where the person has no problems with their bladder or prostate."
Similarly, mental health conditions such as depression or obsessive-compulsive disorder can also leave people feeling like they "need" to use the bathroom every time they wake up at night, especially if they sleep lightly or have frequently disrupted sleep cycles. These people haven't woken up because of the urge to urinate, says Dr. Ramin, but because they've learned out of habit to use the bathroom after they've woken up.
We're assuming you don't regularly drink 64 ounces of water every night before settling into bed, but if you do…you should stop! If you're waking up to use the bathroom frequently during sleep, it could be for the simple reason of having a full bladder thanks to drinking too much, too close to bedtime, Try to cut yourself off from liquids two to three hours before going to bed, the AUA advises.
You should also consider what you drink along with how much: some beverages, like alcohol and caffeine, are diuretics, which means they increase your urine output.
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