Angela Fishman, PTBladder Health Month—Week 4
Updated: Dec 2, 2021
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. Approximately 50% of all women and men older than 60 years of age get up at night to void 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 in the same age group wake to pee. One study reported a prevalence of 1 in 3 women over the age of 40. Clearly this is a common problem, and one that can affect one's health greatly.
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 lead to you being excessively sleepy during the daytime, interfere with your focus, and even alter your mood.
For older adults, nocturia can create a higher risk of falls and fall-related injuries, especially when rushing to get to the bathroom due to urgency. 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 depression. In this study of women aged 30-79, nocturia was associated with a threefold increase in odds of depression.
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 their woes. Problems with holding it all night can also stem from many other causes, including: overactive bladder syndrome, problems with fully emptying the bladder (for example, from an enlarged prostate in men), post-menopausal changes, interstitial cystitis/painful bladder syndrome, or even a urinary tract infection.
Increased fluid intake
Drinking overly large amounts during the day in a quest "to be healthy" or drinking right before bed can lead to bladder overload at night. And if the drinks contain caffeine, carbonation or alcohol, your bladder gets hit with a double whammy. This understandably can then wake us up at night, so our bladder can deal with all the extra fluid. 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 our own drinking habits (such as drinking that late-night latte or an extra water bottle before bed). Certain medical conditions such as diabetes mellitus, sleep apnea, Parkinson 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 excessive urine production 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. Here are some common-sense strategies to try:
Limit 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)
Avoid coffee, tea, alcohol and carbonated beverages in the afternoon and evening
Elevate your legs after dinner to help with circulation
Use compression stockings if your legs tend to swell during the day
Engage in regular physical activity such as an afternoon walk
Reduce dietary salt intake, especially late in the day
Speak with your doctor about adjusting the timing of taking medications if possible, especially diuretics
Use a bedside commode and/or night lights to help reduce the risk of falls
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.
Remember: as always, it is important to check with your healthcare practitioner BEFORE starting any new program, especially if you have a serious health condition. You can also schedule a virtual appointment with me to see if these suggestions are right for you.
Physical Therapy and Nocturia
If the above simple measures do not help, it's time to delve further into the cause of your nocturia. Your first stop is your physician. Many specialists are equipped to assist you, including your primary care physician, OB-GYN, urogynecologist, or urologist; or you can schedule a virtual appointment with me for guidance. Your physician will help drill down to the cause of the 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, electrical stimulation, treating overactive bladder symptoms and getting urgency under control are all physical therapy strategies that can help with nocturia.
Many patients are reluctant or too embarrassed to discuss voiding at night with their doctor, 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
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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.