It's Week 4 of Bladder Health Month! What’s up for this week? 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?
One in three adults older than age 30 makes at least two trips to the bathroom every night, and nocturia pretty equally affects women and men of all ages. Clearly this is a common problem, and one that can have a significant effect on your health.
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.
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.
Older 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.
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.
Other 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.
Physical Therapy and Nocturia
If you've tried these simple measures and you're still waking to pee more than once per night, it's time for professional guidance. Pelvic floor muscle strengthening, bladder retraining, and getting overactive bladder symptoms 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 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!
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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.