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Nocturia – Peeing at night

Dr Deborah Lee

By Dr Deborah Lee, Dr Fox Online Pharmacy

 

 

 

 

 

 

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Are you one of millions of Brits constantly peeing at night?

  • Why does this happen?
  • Is it dangerous for our health?
  • What can we do to prevent it?

Read on and find out.

 

The problem

Needing to pee at night is very common, and it’s not just an old age problem. In one 2015 study, 18.2% of women aged 18 to 30 said they got up at least once a night to pee. In another study in those aged over 40, 34% of men and 28% of women needed to pee at least once a night. For those aged 70 – 80-years, around 60% of both men and women get up twice a night to have a pee.

 

Does it matter?

Going to the toilet a lot at night interrupts your sleep and makes you feel tired in the daytime. Moreover, the health consequences of nocturia are greater than you think, as it lowers your quality of life, leads to depression, and increases your risk of dying.

Frequent waking at night leads to loss of REM sleep – deep, restorative sleep during which your body is busy undertaking numerous, extensive, cellular repair and regeneration processes. Cognitive function and memories are also sorted and processed during this time. A lack of REM sleep means you wake unrefreshed in the mornings, and feel less alert, which has a knock-on effect meaning you are more likely to have an accident, which includes falls and fractures.

Sleep deprivation itself has serious outcomes –  increasing your risk of high blood pressure, type-2 diabetes, heart disease, and cancer. Getting 7 hours a night of good quality sleep is vital for health.

 

Fluid balance

Your body is cleverly designed to regulate what you take in in the way of fluid in food and drink, and what you lose every day in the form of urine, faeces, and sweat. It’s all to do with a clever hormone called antidiuretic hormone (ADH)

  • No drink? – If you haven’t had a drink for a while, the hypothalamus in the brain detects this and sends a message to the kidney to secrete ADH. As a result, the kidney absorbs more water from the blood. Because of this, more water remains in the blood circulation, and less urine collects in the bladder.

 

  • Had a drink? – But if you have recently had a drink of water, this will be absorbed through the stomach and intestines into the bloodstream. The hypothalamus detects there is too much water in the circulation and tells the kidney to stop producing ADH. As a consequence, when blood passes through the kidney, less water is reabsorbed into the bloodstream, meaning there is an increased volume of water passing out into the urine. As more urine collects in the bladder, the more you feel the need to pee.

In this way, your body controls the volume of fluid, so your blood plasma concentration always stays within normal limits. If you go all day without drinking any water, or if you have had a night out and drunk a large amount,  your fluid balance system can cope with these peaks and troughs of water intake. This means your body is robust and can cope overnight with no problem if you do not drink any water.

 

How to reduce nocturia

There are some steps you can take to help stop peeing at night.

  • Keep a fluid diary – Write down what you’ve had to drink and when, over a 7-day period, and also record how often you had to get up to pee at night. This may show a pattern and give you a baseline for making improvements.
  • Restrict fluids – Avoid any drinks in the – hours before bedtime, especially any caffeine or alcohol. Caffeine is not recommended after 6 pm.
  • Regular exercise – Take regular exercise. Research has shown that men who undertake at least one hour of physical exercise per week are 13% less likely to have nocturia, and 34% less likely to have severe nocturia. Exercise helps lower your BMI, improves your sleep and lowers levels of chronic inflammation.
  • Benefits of weight loss – Being overweight or obese is strongly linked to nocturia. This may be for several reasons. Increasing amounts of intrabdominal fat physically put pressure on the bladder. Sometimes people who are obese are prone to night-time snacking. In men, obesity is linked to enlargement of the prostate. The good news is that losing weight improves nocturia.
  • Eat less salt – The vast majority of us consume more than twice the daily recommended amount of salt. This is dangerous as it is a major cause of high blood pressure and heart disease. However, eating too much salt is also a cause of nocturia because excess salt makes you thirsty, so you drink more. Don’t add salt to food, use a low-sodium salt, and avoid salty snacks like salted peanuts and crisps.
  • Pelvic floor exercises – In women, Kegel exercises can help reduce the symptoms of an overactive bladder.
  • Medication – If you need to take diuretics (water pills), take these first thing in the morning, not at night, so the increased need to pass urine will long since have disappeared before it’s time for bed in the evening.
  • Put your feet up – When you get into bed and lie horizontally, any fluid which has collected in your lower legs and around your ankles will be forced back into the bloodstream, and this will then need to be passed out in the urine. To avoid having to get out of bed soon after getting in, make sure you get your legs up in the afternoon and earl part of the evening, so this has taken place and you have peed out this extra urine before you get into bed. You do need to get your legs right up above the level of your heart.
  • Stop smoking – Several studies have linked smoking to nocturia. Giving up smoking is the single best thing you can do for your health. Smoking is associated with bladder inflammation and irritability.

 

When to see your GP

If you are frequently waking up at night to pee, it’s probably time to see the doctor. This is especially true if this is a new symptom. If so, go and see your GP. You need to have a check-up, to exclude common conditions such as diabetes, a urinary tract infection, or kidney disease. Your GP can advise you how best to improve things.

 

Final thoughts

You don’t need to be getting up and down quite so often during the night. Don’t suffer in silence. What could you do from the list above to help make things better? Above all, getting a good uninterrupted night’s sleep has so many benefits.

 

For more information

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