Understanding nocturia

What is nocturia?

Nocturia is the medical term for waking up at night to pass urine. It is normal for adults to wake once a night to urinate, and this often increases with age.

For example, someone over 80 years old may need to get up three times a night, which is considered normal.

How is nocturia assessed?

If you’ve spoken to a healthcare professional, they may have performed a full continence assessment, which could include:

• A detailed history of your urinary symptoms.
• A urine test to rule out infection.
• A bladder scan to check if your bladder is emptying properly.
• A bladder diary to monitor your fluid intake and urination patterns.

Based on this, the cause of your nocturia will likely have been identified as one or a combination of the following:

1. Nocturnal polyuria

This occurs when more than a third of your daily urine output is produced at night.

2. Small functional bladder capacity

If your bladder can only store a small amount of urine, you may feel the need to empty it frequently. Possible causes include an overactive bladder, bladder irritation (from stones or infection), or a small-capacity bladder. Poor bladder emptying can also lead to more frequent trips to the toilet at night.

3. Secondary nocturnal voiding

This refers to waking for reasons such as anxiety, pain, or insomnia and emptying your bladder while awake, even if it isn’t full.

Managing nocturia

Once the cause of your nocturia is identified, the following strategies may help reduce how often you need to get up at night:

If you have nocturnal polyuria

• Limit your daily fluid intake to 1.5 litres (6–8 mugs) of non-irritant fluids.
• Reduce fluid intake in the evening and avoid drinking during the night.
• Take a rest in the afternoon (at least one hour) with your legs raised above heart level to improve circulation and reduce fluid build-up in the lower body.
• If you have swollen ankles, wearing support stockings may help.
• A diuretic (water pill) taken earlier in the day may increase daytime urine output. Speak to your healthcare provider about this.
• Drinking nettle tea during the day may act as a diuretic, but avoid it if you have high blood pressure or diabetes.
• If you are already on a diuretic, adjusting the type or time you take it may help—consult your healthcare provider.
• In some cases, medication such as Desmopressin can be prescribed to reduce urine production at night. However, this may not be suitable for those over 65 or with heart conditions.

If you have a small functional bladder capacity

• Limit your daily fluid intake to 1.5 litres (6–8 mugs) of non-irritant fluids.
• Reduce evening fluid intake and avoid drinking during the night.
• Cut back on caffeine, which can irritate the bladder and increase the need to urinate.
• Avoid going to the toilet “just in case” during the day.
• If you have an overactive bladder, consider following a bladder retraining programme to reduce nighttime frequency (ask your healthcare provider for guidance).
• Medications like anticholinergics may help reduce urgency and frequency—ask your healthcare provider if these are suitable for you.
• If your bladder does not fully empty, using an intermittent catheter before bed may help. Speak to your healthcare provider about this option.

If you have secondary nocturnal voiding

• Break the habit of waking up to urinate if it has become routine.
• Address environmental factors that might disturb your sleep, such as light, noise, or an uncomfortable bed.
• Avoid daytime naps if they affect your ability to sleep at night.
• Reduce stimulants like caffeine and nicotine before bedtime.
• If pain is waking you, speak to your healthcare provider about better pain management.

By following these strategies, you may find relief from nocturia and improve your sleep quality. Always consult your healthcare provider before making changes to your medication or care routine.