Are you getting up at night to pee?
It’s just past 4 a.m., and the house is quiet. For the third time tonight, you are quietly getting out of bed to pee, knowing that if you’re lucky, you’ll get two more hours of sleep before the alarm buzzes. It’s not exactly a restful night, but it’s nothing new, and you don’t see it changing in the future. This is life with nocturia.
You’ve tried diet changes and drinking less water before bed, but you’re wondering if you have a more serious medical condition. If you’ve complained about it to your friends, you’ve likely discovered that these nighttime bathroom visits are common. At least 20% of people over age 50 share the same struggle. For those older than 70, up to half are getting up two or more times a night.
What exactly is nocturia?
The nocturia definition is waking up one or more times at night to void your bladder. This medical term comes from Latin and Greek words meaning “night” and “urine”. For individuals who are waking multiple times per night, this condition is not only annoying but can be unhealthy. Nocturia leads to sleep deprivation, which can cause exhaustion, mood changes, sleepiness, and impaired productivity. Lack of sleep also increases the risk of falling and becoming seriously injured during these nighttime bathroom visits.
Frequently, nocturia is referred to as nighttime overactive bladder (OAB), however, this is not an accurate description. OAB is related to uncontrolled bladder spasms that can happen day or night. Individuals with OAB can have nocturia, but there are numerous causes for nocturia that are not related to OAB. Nocturia is also different than adult bed-wetting, or nocturnal enuresis, in which urine is involuntarily released during sleep.
These are the three main reasons for nocturia:
- The body produces more urine than normal.
- The body produces a normal amount of urine during the day, but the production is too high at night.
- The bladder and pelvic structures aren’t able to hold a normal amount of urine.
Why is this happening?
Several underlying causes contribute to nocturia. Common underlying causes include:
- High fluid intake. Drinking liquids before bedtime, particularly caffeinated and alcoholic beverages, can lead to a full bladder later in the night.
- Diabetes. The body produces a higher level of urine as it works to excrete excess glucose.
- Medications. Numerous medications are diuretics, meaning they cause your body to create excess urine.
- UTI or bladder infection. Not surprisingly, if your urinary tract is infected, your body produces excess urine in an effort to flush out the infection.
- Sleep apnea. Research suggests that the irregular breathing of sleep apnea patients can trigger a physiologic response that leads to nocturia.
- Excess weight. While you sleep, some of your body weight creates pressure on your bladder. This is particularly true for pregnant women who have a little person pressing on (and sometimes kicking) the bladder.
- Childbirth. Delivering a baby is traumatic to a woman’s pelvic floor muscles, which are hugely important in preventing bladder leaks. Some women recover and the nocturia goes away, but for others, it can become a persistent problem.
- Pelvic prolapse. Pelvic organ prolapse (lowering of the organs) affects the pelvic floor in a way that’s similar to childbirth. The tissues required for proper function aren’t in the correct place or condition.
What are my treatment options?
After diagnosing the cause of your nocturia, your doctor may recommend a medication. These medications are designed to reduce urine production, calm unwanted bladder contractions, or treat infections. Your doctor may also recommend lifestyle changes, including weight reduction, reduced evening fluid consumption, and taking naps to recover your lost sleep. If your nocturia is caused by a structural problem, there may be surgical options.
New Research: Pelvic Floor Muscle Training and Nocturia
Electrical stimulation (E-stim) of pelvic floor muscles is widely used to treat both urge and stress incontinence. However, the direct impact of E-stim treatment on nocturia has not been widely studied. Recently, a team of experienced incontinence researchers published a study in which they evaluated two non-drug nocturia treatments. The first technique, called tibial nerve stimulation, electrically stimulates a nerve near the ankle to remotely calm bladder muscles. Patients achieved a significant improvement in sleep quality. The second treatment was pelvic floor muscle training (PFMT). The subject performed weekly in-clinic Kegel exercises under the supervision of a physical therapist and daily Kegel exercises at home. Patients receiving PFMT achieved an even greater improvement in sleep quality.
In another report, PFMT was used with biofeedback to help women suffering from stress and urge incontinence, and who were bothered primarily by nocturia. Treatment reduced their nighttime bathroom visits to 1–2 per week, which tremendously improved their quality of sleep.
Although neither report investigated exactly how the therapies acted to treat the nocturia, the favorable clinical outcomes support the need for further investigation. Most medications seek to reduce urine production or calm the bladder muscles, however, PFMT could improve the function of the muscles that control bladder leakage. Given the common occurrence of nocturia during and after pregnancy, this outcome is intuitive. By improving pelvic floor muscle function, the bladder accommodates greater urine volume resulting in less frequent nighttime voiding.
How do I train my pelvic floor muscles?
Pelvic floor physical therapists are specialists who can diagnose and treat functional problems with your pelvic floor. PFMT teaches your pelvic muscles how to contract and relax properly, which is achieved through a variety of interventions. You can read more about pelvic floor physical therapy HERE.
Another option is to use a medical device to strengthen pelvic floor muscles. Some of these devices include vaginal weights and biofeedback devices, as well as internal and external muscle stimulators. For additional information on available devices, click HERE.
Can ELITONE® help?
Yes, ELITONE treats stress urinary incontinence in women by using an externally applied pelvic floor muscle stimulator. The device gently exercises the pelvic floor muscles. Little known, the device ALSO sends signals for urgency in each cycle! You can use it anytime and anywhere because it’s worn under clothing so no one will know you’re using it. Learn more HERE. If your urinary incontinence is bothering you at night, ELITONE may be a good solution.
With ELITONE, I can wear it under my clothes and watch a movie. It’s so easy to use! PLUS, before ELITONE, I struggled to sleep through the night. Now I get more rest. — Teresa, 47