If your bladder seems to have a personal vendetta against your sleep, you're not alone — 55% of men and 60% of women aged 50 wake at least once in the night, with a further 20% waking at least twice (Cornu et al., 2012). Why does it happen, and what can you do to reclaim your uninterrupted rest?
Why Does Nocturia Happen?
Nocturia—the frequent need to wake up at night to urinate—is more than just a nuisance; it can significantly disrupt sleep patterns and affect overall well-being. While commonly associated with aging, nocturia can result from a variety of physiological, hormonal, and lifestyle factors. Understanding these underlying causes is key to managing the condition effectively.
Poor sleep patterns and sleep disorders
A major factor can be poor sleep patterns and sleep disorders. Irregular sleep schedules, excessive blue light exposure before bed, poor sleep hygiene and conditions such as sleep apnoea can fragment sleep cycles, increasing nighttime awakenings. When sleep is interrupted or you are not in ‘deep sleep’, individuals become more aware of bladder sensations, even when the bladder isn’t full. Therefore, it can be hard to establish if your bladder or your poor sleep is to blame for getting up.
Stress and anxiety
These contribute to nocturia by activating the body's fight-or-flight response. When the nervous system is in a heightened state, both sleep quality and the bladder can be impacted. Individuals struggling with stress and anxiety may experience intensified nerve signalling to the bladder which may cause frequent and urgent urination during the day as well as impact night waking (Lai et al., 2018).
Excessive night-time urine production
Another key cause of nocturia is excessive night-time urine production (nocturnal polyuria), which occurs when the body produces more urine at night than it should. This can result from decreased levels of antidiuretic hormone (ADH)—a hormone that signals the kidneys to retain water and reduce urine production overnight. As we age, ADH secretion may decline, leading to increased nocturnal urine output. Moreover, consuming large amounts of fluids, particularly diuretics like caffeine and alcohol, before bed can exacerbate this effect. Studies indicate that individuals with reduced nocturnal ADH levels experience more frequent awakenings due to bladder fullness (Nair et al., 2018).
Drinking large quantities of fluid
Drinking lots of fluid, eating a lot of high water content foods or ingesting known bladder irritants (read more about bladder irritants and bladder friendly alternatives) and high quantities of sodium in the later afternoon and evenings can also lead to excess nighttime urine production.
Bladder dysfunction and structural changes
Conditions such as overactive bladder (OAB), benign prostatic hyperplasia (BPH) in men, pelvic organ prolapse in women, and even chronic constipation can contribute to nocturia by either reducing bladder capacity or increasing the urgency to void. BPH, for example, leads to incomplete bladder emptying, causing residual urine to trigger frequent urination. In women, weakened pelvic muscles due to pregnancy, childbirth, or menopause can result in bladder instability, making nocturia more common (Abrams et al., 2020).
Underlying medical conditions
Beyond these factors, underlying medical conditions such as heart disease, diabetes, urinary tract infections (UTIs), neurological disorders (such as Parkinson’s disease or Multiple Sclerosis), and fluid retention can contribute to nighttime urination. Congestive heart failure (CHF), for instance, leads to fluid accumulation in the lower limbs during the day, which is then reabsorbed into circulation when lying down, increasing urine production at night (Ulu-Kilic et al., 2019).
Pregnancy
Pregnancy is another common cause, as hormonal changes and increased uterine pressure on the bladder naturally lead to frequent urination, including during the night. Lastly, poor pelvic floor muscle function can result in incomplete bladder emptying, which increases the likelihood of needing to urinate multiple times overnight.
What You Can Do About It
Fortunately, there are many strategies to help manage nocturia and improve sleep quality:
Practice relaxation techniques before bed – Mindfulness, deep breathing, Yin Yoga and light stretches can help calm the nervous system, reducing bladder sensitivity and urgency.
Regulate fluid intake and dietary irritants – Avoid drinking, particularly caffeine and other bladder irritants, at least two hours before bedtime to minimise nighttime urine production.
Address fluid retention – If you experience swollen feet or puffy ankles, elevate your legs in the evening and incorporate movement throughout the day to reduce fluid buildup that later shifts when lying down.
Consult a healthcare provider – It’s essential to rule out underlying medical conditions such as diabetes, heart disease, neurological disorders or UTIs, as these can exacerbate nocturia.
Assess your sleep health – If you frequently wake up throughout the night, consider screening for sleep apnoea or other sleep disorders that may be contributing to your symptoms. Reviewing and adopting healthy sleep hygiene habits is also good practice.
Review your medications – Some medications, including diuretics and certain cardiac drugs, can increase urine production. Speak with your doctor about potential adjustments to medication timing, dosage or alternative treatments.
Adopt healthy bladder habits – Avoid “just in case” urination during the day, which can train the bladder to signal urgency prematurely. Ensure complete bladder emptying before bed.
Manage constipation – A full bowel can press on the bladder, exacerbating nocturia. Increase fibre intake, hydrate adequately, and maintain regular physical activity to support bowel health (learn more about the link between constipation and urinary incontinence).
Maintain a healthy weight – Excess weight can place pressure on the bladder and abdominal structures, impacting bladder sensitivity due to increased intra-abdominal pressure. Engaging in regular exercise and a balanced diet can help.
Strengthen your pelvic floor – Pelvic floor exercises, beyond just Kegels, can significantly improve bladder control. Studies show that High-Intensity Focused Electromagnetic (HIFEM) therapy , such as the Emsella treatments offered at Lift and Revive , effectively strengthens pelvic floor muscles, improving urinary incontinence and nocturia symptoms (Sammer et al., 2022). This non-invasive therapy stimulates deep pelvic muscle contractions, enhancing bladder support and function.
Conclusion
Nocturia is more than just an inconvenience—it can disrupt sleep, impact daytime functioning, and indicate underlying health concerns. By understanding the root causes and implementing targeted lifestyle changes, bladder retraining techniques, pelvic floor strengthening and, if necessary, medical interventions, you can work toward achieving a full night’s rest. If you would like to find out how Lift and Revive might be able to help you reduce your night time toilet trips get in touch.
References
Abrams, P., Andersson, K. E., Birder, L., et al. (2020). Fourth International Consultation on Incontinence Recommendations: Overactive Bladder and Nocturia. Neurology and Urodynamics, 39(1), 17-30.
Cornu J., Abrams P., Chapple C., et al. (2012). A contemporary assessment of nocturia: definition, epidemiology, pathophysiology, and management – a systematic review and meta-analysis. European Urology, 62(5), 877-90.
Lai, H. H., Rawal, A., Shen, B., et al. (2018). Relationship Between Anxiety and Overactive Bladder Symptoms: Insights from Functional Brain Imaging. The Journal of Urology, 199(1), 185-193.
Nair, R., Salvatore, S., & Freeman, R. (2018). Nocturia and Aging: The Role of Antidiuretic Hormone and Circadian Rhythm. Clinical Interventions in Aging, 13, 2505-2518.
Sammer, U., Kessler, T. M., & Engeler, D. S. (2022). Pelvic Floor Muscle Training and HIFEM for Nocturia: A Review of Emerging Therapies. World Journal of Urology, 40(3), 589-601.
Ulu-Kilic, A., Dogan, H., Yildirim, E., et al. (2019). Heart Failure and Nocturnal Polyuria: Pathophysiology and Management Strategies. International Journal of Cardiology, 283, 82-89.
