Nocturia

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What is nocturia?

The nocturia definition is the need to urinate two or more times during the night. It can occur at any age, but becomes more common with advancing age.

Nocturia causes can be as basic as drinking fluids just before bedtime, drinking a large amount of fluid late in the day, or drinking beverages with caffeine. Pregnancy is another common, straightforward cause in women. However, medical conditions can also cause nocturia. Sometimes, a urologic disorder is to blame. This includes urinary tract infections, an enlarged prostate, sphincter control problems, and bladder prolapse. Conditions that affect other body systems, including diabetes and heart disease, can also lead to nocturia.

Less commonly, nocturia is a symptom of serious infections of the bladder or kidney, liver failure, or a tumor of the prostate or bladder. Congestive heart failure may lead to nocturia that occurs with difficulty breathing and wheezing.

Seek immediate medical care (call 911) if serious symptoms accompany nocturia, such as bloody or pink-colored urine, urinary retention, difficult or painful urination, burning with urination, or fever.

Also, seek prompt medical care if you are being treated for nocturia but mild symptoms recur or persist.

What are the different types of nocturia?

There are four main issues that can cause nocturia. Various medical conditions and benign situations lead to each one of these issues. Nocturia causes fall into the following categories:

  • Nocturnal polyuria is an overproduction of urine at night. It occurs when urine volume at night is more than 20 to 30% of the daily urine production. This is the most common cause of nocturia. It can happen with something as simple as drinking too much fluid close to bedtime. 

  • Global polyuria is an overproduction of urine throughout the day, including at night.

  • Low nocturnal bladder capacity is a storage issue instead of an overproduction issue. It can be the result of the bladder not fully emptying or feeling the urge before the bladder is completely full.

  • Sleep disorders, especially obstructive sleep apnea, can cause or contribute to nocturia.

Mixed nocturia occurs when more than one of these issues is causing nocturia.

What are the symptoms of nocturia?

Nocturia is the need to urinate two or more times during the night. It is a symptom with a wide variety of causes. Nocturia may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the urinary tract may also involve other body systems.

Urinary tract symptoms that may occur along with nocturia

Nocturia may accompany other symptoms affecting the urinary tract including:

Other symptoms that may occur along with nocturia

Nocturia may accompany symptoms related to other body systems including:

Symptoms that might indicate a serious condition

In some cases, nocturia may occur with other symptoms that might indicate a serious condition which should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have nocturia along with other serious symptoms including:

  • Bloody or pink-colored urine (hematuria)

  • Fever

  • Frequent urination that often produces only a small amount of urine

  • Urinary retention

What causes nocturia?

Your likelihood of having nocturia increases with age. This is because your bladder capacity decreases and urine production increases as you grow older. Lifestyle practices, such as drinking large amounts of fluid late in the day or consuming caffeinated or alcoholic drinks, can also cause nocturia. Alcohol is a diuretic, meaning it stimulates the kidney to produce extra urine. In women, nocturia often occurs with pregnancy, menopause, or uterine prolapse. Nocturia in men is sometimes associated with an enlarged prostate.

Urologic conditions, such as an enlarged prostate, as well as bacterial or viral infections of the urinary tract, bladder or kidney, can cause nocturia. In addition, prolapse of the bladder or problems with sphincter control decrease the bladder’s ability to hold urine, resulting in frequent nighttime urination. Conditions that affect other body systems can also lead to nocturia, including diabetes and congestive heart failure.

Common causes of nocturia

Nocturia may have common causes including:

  • Aging

  • Consuming caffeinated or alcoholic drinks at night

  • Drinking a lot of fluids before going to sleep

  • Medication side effects

  • Menopause

  • Pregnancy

Other causes of nocturia

Nocturia can also have other causes including:

  • Benign prostatic hyperplasia (enlarged prostate)

  • Bladder infections

  • Congestive heart failure (deterioration of the heart’s ability to pump blood)

  • Prolapse (slipping out of place) of the bladder

  • Type 1 diabetes (chronic condition where the pancreas produces too little or no insulin, so your body cannot process sugar properly)

  • Type 2 diabetes (chronic condition in which your body is either resistant to insulin or your pancreas does not produce enough insulin, so your

    body cannot process sugar properly)

  • Tumor of the bladder, ureters or urethra

  • Urinary tract infections

  • Uterine prolapse (condition when the uterus slips out of place, possibly putting pressure on the bladder)

Serious or life-threatening causes of nocturia

In some cases, nocturia may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Congestive heart failure

  • Malignant tumor of the bladder

  • Malignant tumor of the prostate

What are the risk factors for nocturia?

Several factors increase the risk of experiencing nocturia including:

  • Certain medications, including diuretics, lithium, phenytoin, and excessive amounts of vitamin D

  • Lifestyle habits, such as drinking fluid too close to bedtime and drinking alcohol or caffeinated beverages late in the day

  • Older age

  • Pregnancy

  • Various medical conditions, including bladder infections, diabetes, edema, enlarged prostate, heart problems, and menopause

How do you prevent nocturia?

You may be able to prevent or improve nocturia by:

  • Elevating your legs in the evening, avoiding prolonged standing, or wearing compression stockings to prevent fluid accumulation

  • Getting regular physical exercise and maintaining a healthy weight

  • Managing medical conditions that cause nocturia

  • Napping in the afternoon

  • Restricting fluids in the evening and limiting caffeine and alcohol

  • Taking diuretics and other problematic medicines early in the day or at least six hours before bedtime

What are the diet and nutrition tips for nocturia?

There are several dietary strategies you can use to improve nocturia. These include:

  • Drinking fluids throughout the day, but restricting them in the evening for 2 to 4 hours before bedtime

  • Eating a low-sodium diet

  • Limiting caffeine and alcohol

Ask your healthcare provider for guidance before making significant changes to your diet.

How do doctors diagnose nocturia?

To diagnose the underlying cause of nocturia, your doctor will take a careful medical history, perform an exam, and maybe order testing.

Questions for diagnosing the cause of nocturia

Questions related to nocturia that your doctor may ask include:

  • How often do you get up at night to use the bathroom?
  • When did you first notice this issue?
  • When you void at night, is it a large or small volume?
  • Have you noticed a change in urine volume during the day?
  • Do you have any other symptoms, such as feeling tired during the day?
  • How much caffeine and alcohol do you have daily?
  • Do you have any chronic medical conditions?
  • What medications are you taking?

Exams and testing for diagnosing the cause of nocturia

During the physical exam, your doctor will check your heart, lungs, abdomen, lower extremities, and nervous system. The exam may include a rectal exam and, in women, a pelvic exam.

Depending on the results of the history and physical, your doctor may order testing including:

  • Bladder scan to see how much urine remains in the bladder after voiding
  • Blood tests to check kidney function, blood chemistry, and blood counts 
  • Cystoscopy, which involves inserting a thin tube with a camera into the bladder to examine it
  • Urinalysis to check for signs of infection, blood in the urine, or other problems
  • Urodynamic tests to measure how well you store and release urine

Your doctor may also ask you to keep a bladder diary. You will record what, how much, and when you drink. You will also note trips to the bathroom and how much you void. This tool can help identify trends that may be clues to the underlying cause of nocturia.

How do you treat nocturia?

Treatment of nocturia depends on the underlying cause. If a medical condition is causing nocturia, the goal will be to control or manage the condition.

Regardless of the cause, the same interventions that can prevent or improve nocturia can help manage it. Behavioral techniques may also be useful in managing nocturia including:

  • Delayed voiding and urge-suppression training

  • Fluid management

  • Pelvic floor muscle training, such as practicing Kegel exercises

  • Sleep hygiene, including maintaining a regular sleep schedule, keeping the bedroom comfortable for sleeping, and avoiding stimulation, such as TV and computers, before bedtime

About half of people with nocturia will have success with lifestyle changes and behavioral techniques.

Doctors may recommend medications in some cases. This includes:

  • Anticholinergics to relax the bladder when there are bladder muscle problems due to overactive bladder. Examples include darifenacin (Enablex), oxybutynin (Ditropan), solifenacin (Vesicare), tolterodine (Detrol), and trospium chloride (Sanctura)

  • Antidiuretic hormone therapy with desmopressin (DDAVP) to decrease urine production

  • Diuretics that can help regulate urine production, such as bumetanide (Bumex) and furosemide (Lasix)

What are the potential complications of nocturia?

Because nocturia can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage.

Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your healthcare professional design specifically for you to reduce the risk of potential complications including:

  • Difficulty sleeping

  • Embarrassment

  • Progression of prostate disease

  • Spread of cancer

  • Spread of infection
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 1
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Leslie SW, Sajjad H, Singh S. Nocturia. [Updated 2021 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518987/
  2. Nocturia. American Urological Association. https://www.urologyhealth.org/urology-a-z/n/nocturia
  3. Nocturia. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14510-nocturia
  4. Nocturia. National Association for Continence. https://www.nafc.org/nocturia
  5. Nocturia or Frequent Urination at Night. National Sleep Foundation. http://www.sleepfoundation.org/article/sleep-related-problems/nocturia-and-sleep
  6. Overactive Bladder. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715
  7. Urinating More at Night. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/003141.htm
  8. Weiss JP, Wein AJ, van Kerrebroeck P, et al. Nocturia: new directions. Neurourol Urodyn 2011; 30:700.
  9. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012.