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Urinating more at night

Definition

Normally, the amount of urine your body produces decreases at night. This allows most people to sleep 6 to 8 hours without having to urinate.

Some people wake up from sleep more often to urinate during the night. This can disrupt sleep cycles.

Causes

Drinking too much fluid during the evening can cause you to urinate more often during the night. Caffeine and alcohol with or after dinner can also lead to this problem.

Other common causes of urination at night include:

• Infection of the bladder or urinary tract

• Drinking a lot of alcohol, caffeine, or other fluids before bedtime

• Enlarged prostate gland (benign prostatic hyperplasia, BPH)

• Pregnancy

Other conditions that can lead to the problem include:

• Chronic kidney failure

• Diabetes

• Drinking excessive amount of water

• Heart failure

• High blood calcium level

• Certain medicines, including water pills (diuretics)

• Diabetes insipidus

• Swelling of the legs

Waking often during the night to urinate can also be linked to obstructive sleep apnea and other sleeping disorders. Nocturia may go away when the sleeping problem is under control. Stress and restlessness can also cause you to wake up at night.

Home Care

To monitor the problem:

• Keep a diary of how much fluid you drink, how often you urinate, and how much you urinate.

• Record your body weight at the same times and on the same scale daily.

When to Contact a Medical Professional

Contact your health care provider if:

• Waking to urinate more often continues over several days.

• You are bothered by the number of times you must urinate during the night.

• You have a burning sensation when urinating.

What to Expect at Your Office Visit

Your provider will perform a physical exam and ask questions such as:

• When did the problem start and has it changed over time?

• How often do you urinate each night and how much urine do you release each time?

• Do you ever have "accidents" or bedwetting?

• What makes the problem worse or better?

• How much fluid do you drink before bedtime? Have you tried limiting fluids before bedtime?

• What other symptoms do you have? Do you have increased thirst, pain or burning on urination, fever, abdominal pain, or back pain?

• What medicines are you taking? Have you changed your diet?

• Do you drink caffeine or alcohol? If so, how much do you consume each day and when during the day?

• Have you had any bladder infections in the past?

• Do you have a family history of diabetes?

• Does nighttime urination interfere with your sleep?

Tests that may be performed include:

• Blood sugar (glucose)

• Blood urea nitrogen

• Fluid deprivation

• Osmolality, blood

• Serum creatinine or creatinine clearance

• Serum electrolytes

• Urinalysis

• Urine concentration

• Urine culture

• You may be asked to keep track of how much liquid you take in and how much you void at a time (voiding diary)

Treatment depends on the cause. If excessive nighttime urination is due to diuretic medicines, you may be told to take your medicine earlier in the day.

References

Carter C. Urinary tract disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 40.

Elsamra SE. Evaluation of the urologic patient: history and physical examination. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 1.

Gharavi AG, Landry DW. Approach to the patient with renal disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 100.

Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline Amendment 2019. J Urol. 2019;202(3):558-563. PMID: 31039103 pubmed.ncbi.nlm.nih.gov/31039103/.

Samarinas M, Gravas S. The relationship between inflammation and LUTS/BPH. In: Morgia G, ed. Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia. Cambridge, MA: Elsevier Academic Press; 2018:chap 3.

Review Date: 7/1/2023

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.