Nocturia: Understanding those Nighttime Bathroom Visits

Are you getting up at night to pee?

It is just past midnight, the house is quiet, and you are quietly getting out of bed to pee.  2 am… again you are shuffling to the bathroom. 4 am… one last quick trip, knowing that if you’re lucky you’ll get two more hours of sleep before the alarm rings. It’s not exactly a restful night, but it’s like this almost every night. Unfortunately, you don’t see it changing in the future.

You’ve tried drinking less water before bed, trying to sleep through the need to pee doesn’t work. You’re wondering if you have some more serious medical condition.

If you’ve complained about it to your friends you’ve likely found that these nighttime bathroom visits are quite common. At least 20% of people over 50 share the same struggle. For those over 70, up to half are getting up two or more times a night. This medical condition is called Nocturia.

What is Nocturia?

The nocturia definition is waking one or more times at night to void your bladder. This medical term, derived from the Latin and Greek words, means “night” and “urine”. For individuals who are waking multiple times per night the effects can be extremely bothersome, and in some cases unhealthy. It leads to sleep deprivation, which can cause exhaustion, mood changes, sleepiness, and impaired productivity. There is even an increased risk of falling (and becoming seriously injured) during these nighttime bathroom visits.

Nocturia is sometimes called nighttime overactive bladder (OAB), but 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 not all do, and there are numerous other causes for nocturia that are unrelated to OAB.

Individuals with nocturia typically have one of three conditions. (1) The body produces more urine than normal, (2) the body produces a normal amount of urine throughout the day, but at night the production is too high, or (3) the bladder and pelvic structures aren’t able to hold a normal amount of urine.

Why is this happening?

There are a number of underlying causes for nocturia. The more common 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 the infection away.
  • 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) their bladder.
  • Childbirth – Delivering a baby is traumatic to a women’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.
  • Prolapse – Pelvic organ prolapse (lowering of the organs) has a similar effect as 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. Some are designed to reduce urine production, calm unwanted bladder contractions, or treat infections. Your doctor may also recommend lifestyle changes, including reduced nighttime fluid consumption, weight reduction, and taking naps to recover your lost sleep. If your nocturia is caused by a structural problem there may me surgical solutions.

New Research: Pelvic Floor Muscle Training and Nocturia

Electrical stimulation of the pelvic floor muscles is widely used to treat both urge and stress incontinence. However, the direct impact on nocturia has not been widely studied. But recently, a team of experienced incontinence researchers published a study in which they evaluated two non-drug nocturia treatments [1]. 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 [2], 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 the quality of their sleep.

An Intuitive Approach

Although neither report investigated how exactly the therapies acted to treat the nocturia, the favorable clinical outcomes support the need for further investigation. Whereas most medicine treatments seek to reduce urine production or calm the bladder muscles, the pelvic floor muscle training approach could improve the function of the muscles acting to resist 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 and less frequent nighttime voiding.

How do I train my pelvic floor muscles?

Pelvic floor physical therapists are specialists and are well suited to diagnose and treat functional problems with your pelvic floor. Pelvic floor muscle training trains muscles to contract and relax properly.  It includes a variety of interventions and is one of their primary treatment tools. You can read more about pelvic floor physical therapy HERE.

A variety of medical devices train pelvic floor muscles, including vaginal weights, biofeedback devices, internal and external muscle stimulators. For additional information on available devices read HERE.


Can ELITONE® Help?

ELITONE treats urinary stress incontinence in women with an externally applied pelvic floor muscle stimulator. Worn 20 minutes a day, it gently exercises the pelvic floor muscles. You can use it anytime and anywhere you like. Wear under clothing so no one will know you’re using it. Learn more HERE. If your stress urinary incontinence is bothering you at night, ELITONE may be a good solution.

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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, not hiding in the bedroom, and can finally get more rest at night 

 

Elitone: Product of the Year

 

Other links that may be of interest include:

 


References

[1] Furtado-Albanezi D, Jurgensen SP, Avila MA, Correia GN, Driusso. Effects of two nonpharmacological treatments on the sleep quality of women with nocturia: a randomized controlled clinical trial. Int Urogynecol J. 2019 Feb;30(2):279-286. doi: 10.1007/s00192-018-3584-8

[2] Hill A, Alappattu. Quality-of-Life Outcomes Following Surface Electromyography Biofeedback as an Adjunct to Pelvic Floor Muscle Training for Urinary Incontinence: A Case Report. J Womens Health Phys Therap. 2017 May;41(2):73-82. doi: 10.1097/JWH.0000000000000065