Dr. Blaivas explains that getting up in the middle of the night to urinate is called nocturia. Reasons for nocturia include the bladder not holding enough to allow the patient to sleep through the night, and the patient’s kidney potentially making more urine than the bladder can hold. Nocturnal polyuria is when too much urine is produced overnight, therefore causing the patient to get up in the middle of the night to urinate.
Jerry Blaivas, MD: Getting up in the middle of the night to urinate is called nocturia. Nocturia is very very common, in fact most people get up once or twice at night to urinate starting in the teenage years even.
If you think about it, there is only two possible reasons why someone would get up in the middle of the night to urinate. One is that their bladder does not comfortably hold enough to allow them to sleep through the night, and, two, you make more urine, that it is to say your kidney is making more urine then your bladder cannot comfortably hold overnight.
The second condition, we called nocturnal polyuria. The nocturnal means nighttime and poly means too much and uria means urine. So nocturnal polyuria means that you make too much urine overnight and that is probably the commonest cause of nocturia.
The most common cause of that even is just drinking too much before you go to sleep. So if you have a couple of beers or you have wine before dinner and then you take a glass of water with some pills, all of that fluid that you ingest will then overnight be converted by the kidneys to urine and then if you make more urine overnight than your bladder can hold, then of course you have to get up to urinate.
So nocturnal polyuria is the commonest cause and the other cause, the bladder not holding enough urine, has many many many causes. Probably the most common one is, temporary problem is, urinary tract infection. It can be caused by blockages by the prostate. It can be caused by bladder cancer, by all kinds of other irritable kind of conditions so thinking back then we have these two different causes, making too much urine at night or the bladder not holding enough at night. So, then what to do about it.
Well the first thing you need to do about it is to diagnose it. How do we diagnose it? Very – very simply! We have you keep a bladder diary, that is to say you record the time and amount of urine, time and amount of each urination that you make in a 24-hour period, then we simply see how much you urinate at night, how much you urinate for the 24-hours and through some mathematical formula, we can figure out if you are making too much urine at night.
Generally, people make less than a third of their urine during sleep hours. If you make more than that then you have this nocturnal polyuria and we look for the causes of that. I briefly alluded to what they were in the beginning but now to get more complete, the most common cause is simply drinking too much.
Probably the second most common cause is people that take medications at night that can have a diuretic like effect. Another cause is anything that causes your legs to swell up, so people with varicose veins or from prior surgery, if your leg swell up during the day that the swelling is actually fluid and when you lie down at night, your body resorbs that fluid, that fluid gets into your system and the kidneys make more urine.
Another common cause is something called sleep apnea, people who snore, best diagnosed by going to a sleep lab and if you have sleep apnea, then that is what causes the problem and the treatment of the sleep apnea is the problem.
The bladders that do not hold enough urine, again we first determine that by the bladder diary and then we look for the common causes, common causes of urinary tract infection, prostatic obstruction, dropped bladder in women, overactive bladder, sometimes bladder cancer, bladder stones, no matter what they cause though, once the diagnosis is clearly understood then treatment of the underlying condition that is causing the nocturia is very often effective, it is usually effective.
However, just having nocturia, just getting up at night to urinate by itself does not demand any treatment.
So if you get up once or twice at night or three times and you are not bothered by it, there is no need for any treatment at all. If there is a need for treatment, if you are bothered by it, rest assured there just about always an effective treatment.
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