Causes of Frequent Urination at Night

Frequent urination at night (nocturia) can be a normal part of aging, but it can also be a sign of a medical concern like diabetes, heart disease, or bladder problems. Some health conditions that cause nerve damage, like Parkinson's and MS, can also lead to bladder problems. You might also wake up to pee because of lifestyle factors (like your diet) or medications you take.

Nocturia can lead to sleep deprivation, daytime fatigue, impaired concentration, depression, and a loss of productivity, so it's important to bring it to your healthcare provider's attention.

This article discusses common causes of frequent urination at night. It's possible for one or more to be at play.

Age

Age is one of the main factors associated with nocturia. Most people with the condition are over the age of 60, though younger age can be a factor in nighttime urination, too.

One well-known aging-related cause is a condition called nocturnal polyuria (NP). With this, the body makes high volumes of urine during sleep.

Younger people (especially kids) get nocturia simply because their bladders have not reached their full size yet. The amount of urine that's made at night can be more than the organ can hold.

Lifestyle and Diet

The need to urinate at night can also be diet-related. These factors can trigger nocturia either directly (by causing the body to make your urine) or indirectly (by compressing the bladder).

Some of the most common dietary factors that contribute to urinating more at night are:

• Alcohol and caffeine: Coffee, soda, and other beverages with caffeine, as well as alcoholic drinks, have diuretic properties that stimulate urine production.
• Dietary salt: Excessive salt (sodium) can trigger nocturia in people with obesity or poor cardiac output. Sodium increases fluid retention. The fluid might be released at night when the bladder is full.
• Hyperhydration: Drinking too much water before bedtime can easily trigger a middle-of-the-night bathroom visit.
• Low-fiber diet: Chronic constipation can happen if your diet lacks dietary fiber. At night, the buildup of stool can cause the bowel to stretch and put pressure on the bladder, giving you the urge to pee.

Pregnancy

Nocturia can occur during all stages of pregnancy but for different reasons. The times when nocturia is most common in pregnant people are:

• Early pregnancy: In early pregnancy, levels of the hormone progesterone rise, promoting bloating and water retention. This makes nighttime urination more likely. In some cases, nocturia can be an early sign of pregnancy.
• Later pregnancy: During the second and third trimesters, it is not uncommon for people to have frequent urination because the womb has started to compress the bladder. At night, certain body positions can intensify the compression and trigger nocturia.
• After pregnancy: People will sometimes develop bladder and pelvic organ prolapse after delivery, meaning the organs have shifted out of place. Both can put pressure on the urinary tract.

Medications

Nocturia can also be a side effect of certain medications. This can happen in a few ways:

• A drug can promote the release of a compound called acetylcholine that can provoke bladder contractions.
• A drug can impair the release of norepinephrine, a hormone that helps relax the bladder and other organs with smooth muscles.
• A drug can have a diuretic effect, meaning it encourages the kidneys to get rid of more salt and water from the body.

Some of the drugs commonly associated with frequent urination at night include:

• Darvon (propoxyphene)
• Declomycin (demeclocycline)
• Dilantin (phenytoin)
• Diuretics, such as Lasix (furosemide)
• Lanoxin (digoxin)
• Lithium
• Penthrox (methoxyflurane)
• Excessive amounts of vitamin D (for example, from a supplement)

Acute Conditions

Nocturia can be a symptom of acute conditions of the urinary tract (urologic), such as:

• Kidney stones or bladder stones
• Bladder infection (interstitial cystitis)
• Kidney infection (pyelonephritis)
• Urinary tract infection (UTI)

With acute conditions, inflammation can trigger the sudden need to urinate due to contractions in the urinary tract (urinary urgency). Nocturia is often the continuation of urinary urgency that a person has during the day.

Once the cause of the inflammation is treated, the nocturia will usually get better.

Chronic Conditions

Nocturia can also be a symptom of a chronic condition. In these cases, it can go on for a long time and be hard to treat. Some of the causes are related to the urinary system and others are not.

The most common chronic causes of frequent urination at night include:

• Benign prostatic hyperplasia (BPH)
• Bladder cancer
• Congestive heart failure (CHF)
• Diabetes
• Hypertension
• Multiple sclerosis (MS)
• Overactive bladder (OAB)
• Parkinson's disease (PD)
• Sleep apnea
• Overweight/obesity
• Neurogenic bladder

There are a few ways that chronic conditions cause the need to urinate more at night:

• Nocturia can be associated with reduced cardiac output and increased fluid retention, which often occurs in CHF.
• Hypertension and sleep apnea both put pressure on the heart and stimulate the release of a compound (atrial natriuretic peptide) that triggers the release of sodium and water.
• Other conditions cause nighttime urination by compressing the bladder (e.g., BPH, obesity), reducing its capacity (e.g., bladder cancer), or overstimulating the organ and making it more sensitive (e.g., MS, OAB, PD).
• MS, Parkinson's, brain or spine infections, and other diseases that cause damage to nerves can lead to bladder symptoms (neurogenic bladder). Some people are born with conditions that affect the nerves and muscles that control the bladder (e.g., spina bifida). People who have an overactive bladder from nerve damage often need to pee more at night.
• High blood sugar levels also promote nighttime urine production.

Summary

If you have to get up at night to pee, it can be disruptive to your sleep. While nocturia can be caused by something as simple as having a drink too close to when you went to sleep or having a small bladder, it can also be caused by some medications and health conditions. Chronic diseases like MS that damage nerves can also lead to bladder problems.

In some cases, making some changes to your lifestyle (like losing weight or cutting back on alcohol) might help with nocturia. There are also treatments for many conditions that can cause it that you can discuss with your provider.  

If you’re finding that your sleep is being affected by having to get up to pee frequently, talk to your provider. They can figure out what is causing nocturia and make sure you get the right treatment.