Waking once in the night to pass urine is common as men get older. Waking two, three or more times is a different matter. Broken sleep can leave you tired, affect your mood and increase the risk of falls in the dark. The medical name for this is nocturia, and it often has more than one cause.
What counts as nocturia
Nocturia means waking from sleep one or more times to pass urine. Most doctors start to consider it a problem when it happens twice or more each night, or when it is affecting your quality of life.
It is worth separating nocturia from simply going to the toilet because you happen to be awake. True nocturia is when the need to pass urine is what wakes you.
How the prostate can cause it
An enlarged prostate can cause nocturia in two main ways:
- Incomplete emptying: if the prostate narrows the urethra, the bladder may not empty fully. It then fills up again more quickly.
- An overactive bladder: working harder to push urine past the prostate can make the bladder muscle thicker and more sensitive, so it signals that it is full sooner.
Men with prostate-related nocturia often notice other symptoms too, such as a weak flow, hesitancy or urgency during the day. Our guide to what an enlarged prostate is explains these.
Other common causes
Nocturia is not always caused by the prostate. Other possible reasons include:
- Producing too much urine at night: the body normally makes less urine overnight. With age, this can change, and some men make a third or more of their daily urine at night.
- Drinking late in the evening: especially tea, coffee or alcohol.
- Medicines: such as water tablets taken later in the day.
- Heart conditions: fluid that collects in the legs during the day can return to the bloodstream when lying down and be passed as urine.
- Diabetes: high blood sugar can increase urine production.
- Sleep apnoea: breathing problems during sleep can affect hormone levels and increase urine output.
Because of this, a good assessment looks at the whole picture rather than the prostate alone.
Keeping a bladder diary
One of the most useful things you can do is keep a bladder diary for three days. Record:
- what and how much you drink, and when
- each time you pass urine and roughly how much
- any leaks or urgent trips
This helps a specialist see whether the problem is mainly the bladder, the prostate or the amount of urine you produce at night. Bladder and Bowel UK offers free bladder diary templates.
Things you can try at home
Simple changes help many men:
- Reduce drinks in the two hours before bed, while keeping total daily fluid healthy.
- Cut down on caffeine and alcohol, especially in the evening.
- Raise your legs for an hour or two in the afternoon if your ankles swell.
- Empty your bladder twice before bed, waiting a few minutes between attempts.
When to see a specialist
Speak to your GP if nocturia is affecting your sleep or daily life, or if you also notice:
- a weak or slow flow
- difficulty starting to pass urine
- blood in the urine
- pain on passing urine
- being unable to pass urine at all
The NHS guide to an enlarged prostate lists the symptoms that need prompt attention.
Treatment if the prostate is the cause
If an enlarged prostate is contributing, treatment may include tablets to relax or shrink the prostate, or a procedure to relieve the blockage. Options such as Aquablation therapy and iTind can improve flow and help the bladder empty more fully, which often reduces night-time trips.
Professor Prokar Dasgupta assesses men with nocturia and other urinary symptoms at The London Clinic. Please contact the clinic to arrange a consultation.