Why do I have to pee so much at night?

Are you having trouble sleeping at night because the urge to pee keeps nudging you awake?

If so, you’re not alone. More than one-third of adults 30 and older make at least two trips to the bathroom every night, according to the National Association for Continence. Waking up frequently at night to pass urine is a condition called nocturia, and it is common among men and women — especially as they get older.

Getting to the root of the problem may require a visit to the doctor, especially if these nighttime bathroom visits are causing daytime drowsiness or irritability. 

“While it is not uncommon to wake up once per night as we get older, frequent nighttime urination can be bothersome, lead to tiredness during the day and cause other health problems,” says Dr. Justin Cohen, a urologist at Advocate Condell Medical Center in Libertyville, Ill. “Of all of the urinary issues we treat, it is the one that is most often caused by multiple factors, including prostate, bladder, fluid and sleep issues.”

Because multiple factors can play a role in nocturia, it’s important to narrow the possible causes. It’s also necessary to determine if the cause is serious or can be addressed with a change in routine or medication. In making a diagnosis, these may be among the questions a physician will ask:

• How long has this problem been occurring?
• How often do you need to urinate at night?
• When you get up at night to urinate, is the volume large or small?
• Do you drink caffeinated beverages or alcoholic beverages? If so, how often and how close to bedtime?
• What medications are you taking?

Answering these questions can help a physician determine if the patient is producing too much urine, if the patient’s bladder is having difficulty holding fluid or a combination of both. Conditions that can cause the body to make excessive urine include diabetes. Conditions that can cause low bladder capacity include bladder overactivity, infection, inflammation or obstruction.

In addition to asking questions, Dr. Cohen suggests that patients keep fluid intake and voiding diaries to evaluate how much they are drinking and how often and how much they are urinating.

High fluid intake can affect nocturia. Gender can play a role, too.

“The most common causes that I encounter of frequent nighttime urination in men are prostate enlargement and sleep apnea,” Dr. Cohen says. “In women, overactive bladder is a common cause of frequent urination at night.”

Once the causes are clearer, treatment can be discussed. This may involve something simple, such as drinking less fluid before bedtime — especially coffee, caffeinated beverages and alcohol. Or it may involve taking medication or obtaining a test, such as a blood test, to evaluate the health of the prostate gland in men.

If fluid limitation and medications do not improve symptoms to a patient’s satisfaction, they may benefit from a sleep study or a procedure to examine the lining of the bladder and urethra, Dr. Cohen says.