Angela Fishman, PTBladder Health Month—Week 4
It's Week 4 of Bladder Health Month! What’s up for this week? Waking at night to void (also called Nocturia).
What is Nocturia?
Nocturia is a fancy word for your bladder waking you at night to void. The more often you wake to pee, the more disruptive this is to your sleep and the more distress this can cause to your health.
How Common is Nocturia?
Nocturia is actually really common, and pretty equally affects women and men of all ages. About half of all women and men older than 60 years of age get up at night to pee at least once, with the prevalence increasing with age.
But nocturia isn't just for aging adults. Studies show that between 20-44% of women aged 20-40 get up one time or more per night to go to the bathroom, while 11-35% of men aged 20-40 wake to pee. Clearly this is a common problem, and one that can have a significant effect on your health.
Note: Getting up at night to void is a common and normal adaptation to being pregnant; this usually resolves on its own within weeks after the baby is born. Nocturia also has the added bonus of getting you used to getting up for baby!
Why is it Important to Treat Nocturia?
Aside from the obvious irritation of having your sleep interrupted, there are other important reasons to break this habit and work to get more shut-eye. The more often you wake up at night from your bladder, the more distress this can cause your body. This may include:
Reduced total sleep time and more fragmented, lower-quality sleep. Also, over 40% of people who have a nighttime awakening will have trouble going back to sleep. This can cause daytime sleepiness, interfere with your ability to focus and stay on task, and even alter your mood.
Older adults who have to get up to empty their bladder at night are at a higher risk of falls and fall-related injuries, especially when rushing to the bathroom. People who make at least 2 or more nocturnal bathroom visits a night have more than double the risk of fractures and fall-related traumas.
Nocturia has also been associated with reduced scores on quality of life measurements as well as other negative health conditions including up to a threefold increase in odds of depression.
→ Download Now: 4 Ways to Get Your Bladder to Sleep Through the Night [Free Tip Sheet]
What Causes Nocturia?
According to this excellent study by Matthias Oelke et. al. in 2017, causes for nocturia can be broken down into three main categories:
Decreased bladder capacity
While many people with bladder problems assume they "have a small bladder", this may or may not be the true reason for waking at night to use the bathroom. Other causes may be overactive bladder syndrome, problems with fully emptying the bladder (for example, due to an enlarged prostate in men), post-menopausal changes, interstitial cystitis/painful bladder syndrome, or a urinary tract infection.
Increased fluid intake
Drinking right before bed or overly large amounts during the day can overload your bladder at night, especially if those drinks contain caffeine, carbonation and/or alcohol. There are also certain medical conditions which can cause excessive thirst and drinking, leading to the same overload.
Increased nighttime urine production
This can occur from taking certain medications right before bedtime, such as diuretics, as well as from drinking right before bed, as discussed above. Certain medical conditions such as diabetes mellitus, sleep apnea, Parkinson's disease and chronic venous insufficiency of the legs (where the valves in the veins of your legs don't function properly, leading to leg swelling), can also cause your body to produce more urine at night.
Treatment for Nocturia
Addressing nighttime voiding may be as simple as watching what you drink and when, or complex enough to need your physician's assistance.
Some common-sense strategies to try include:
Limiting fluid intake in the late afternoon and evening, especially after dinner (though be sure to drink enough water earlier in the day to stay properly hydrated). If you drink more than 6-8 cups per day, consider cutting back a bit temporarily to see if you sleep longer at night.
Avoiding coffee, tea, alcohol and carbonated beverages in the afternoon and evening
Elevating your legs after dinner to help with circulation
Using compression stockings if your legs tend to swell during the day
Engaging in regular physical activity such as an afternoon walk
Reducing dietary salt intake, especially late in the day
Using a bedside commode and/or night lights if needed to help reduce your risk of falling
Because nocturia occurs in about 50% of patients with sleep apnea, consider speaking with your physician to determine if this may be the cause of you waking at night to void.
Want additional tips? Download your free guide to my 4 top tips to keeping your bladder quiet at night and you asleep 😴 💤
→ Download Now: 4 Ways to Get Your Bladder to Sleep Through the Night [Free Tip Sheet]
(As always, it is important to check with your healthcare practitioner BEFORE starting any new program, especially if you have a serious health condition.)
Physical Therapy and Nocturia
If you've tried the simple measures above and in the free download and you're still waking to pee more than once per night, it's time to delve further into the cause of your nocturia. Your first stop is your physician. Your physician will help drill down to find the specific cause(s) of your nighttime voids, so you can get the right kind of targeted treatment.
Often, pelvic physical therapy is part of this treatment. Pelvic floor muscle training, bladder retraining, treating overactive bladder symptoms and getting urgency under control are all physical therapy strategies that can help with nocturia. You can also schedule time to talk with me to figure out your plan of attack to get better sleep:
Many patients are reluctant or too embarrassed to discuss voiding at night with their doctor or physical therapist, or they mistakenly believe it is just a normal part of aging that you have to live with. But we've just learned that this is not true! So don't hesitate to bring it up and advocate for yourself, and for a good night's sleep.
Take time out TODAY to tackle your bladder problems
Happy Bladder Health Month, Week 4!
Sources: The Urology Care Foundation; Leslie, SW et al
In case you missed it: here are Week 1, Week 2 and Week 3 of Bladder Health Month!
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About the Author:
Angela is the owner of My Pelvic Therapy, PLLC and a licensed physical therapist. Prior to starting her telehealth private practice, she worked as a senior physical therapist for 17 years at Advocate Lutheran General Hospital in Park Ridge, IL, specializing in helping both women and men overcome their pelvic floor challenges. She received her physical therapy degree from Duke University, biology degree from University of Illinois, and is a lifelong learner of all things PT.
Click here to schedule an appointment with Angela, or you can contact her at angela@mypelvictherapy.com.