The nocturnal habit impacting negatively on your health

Getting up at night to pee? There’s a reason for that. In fact, there are a whole lot of possible reasons – and the good news is that most of them have solutions.

Nocturia is the medical term for needing to wake up at night to urinate. It’s a common condition, estimated to affect around 40 per cent of the adult population.

Annie Fenwicke, a consultant at Sydney University, recalls “being the person who needed to go to the toilet” whenever she was asked at school, especially when she was nervous, such as before an exam or a performance.

“I would always feel like I needed to go to the bathroom, and then as soon as I’d been, I’d feel like I needed to go again.”

Fenwicke was diagnosed with an overactive bladder (OAB). Nocturia became a bigger issue when she hit menopause a few years ago.

“It did become very disruptive to my sleep. That has settled somewhat now, but I still go at least once, probably twice or three times a night.”

Impacting quality of life

Nocturia can have quite an impact on quality of life. The interrupted sleep can cause daytime tiredness and reduced ability to concentrate. In elderly patients, getting in and out of bed brings an increased risk of falls. And it’s not just you that it affects — nocturia also disturbs the person sleeping next to you.

“I decided to consult my GP about this issue after a couple of long-haul flights back from Europe, which were absolute nightmares,” says Fenwicke. “I was up and down to the bathroom very regularly. When you’re climbing over people and it’s in the middle of the night, that can be very disruptive and even distressing.”

Types of nocturia

Cases of nocturia can be allocated into three groups: global polyuria, when you produce too much urine (day and night); nocturnal polyuria, where you produce too much urine (greater than 20 per cent of your 24-hour urine volume) at night; and bladder storage disorders such as Fenwicke’s OAB and, in men, prostatic obstructions.

“It’s an extremely common cause of problems in the ageing male,” says Professor Henry Woo, a urologist with the Urological Society of Australia and New Zealand (USANZ). “As men get older, there are two waterworks issues that are very common. One is prostate blockage, and the other is OAB. And you can get both of them occurring together. But you need to rule other things out as well.”

Here are some of the other causes:

1. Diabetes

When blood sugar levels are high, the kidneys work harder to filter out the excess glucose, which leads to increased urine production, including at night.

“Diabetes is the most common cause of global polyuria,” says Woo. “If you’re going to the toilet a lot during the nighttime, as well as during the daytime, we need to ask the question, is it due to diabetes?”

2. Sleep apnoea

Snoring not only disrupts your sleep, but it can also affect kidney function, leading to an increase in urine production at night.

“The excessive carbon dioxide levels in your bloodstream trigger off a whole chain of events that ultimately lead to you producing too much urine,” says Woo.

3. Medication

Some medications, such as diuretics, anticholinergics and SSRIs can increase urine production and cause overactive bladder symptoms. Make sure your doctor knows about any meds you’re taking when you discuss nocturia.

4. Water retention

When fluid accumulates in the legs during the day, it is reabsorbed into the bloodstream when you lie flat at night, which leads to increased urine production.

“Because the extra fluid is no longer pooling in your legs, the vascular system perceives that as being excess fluid in your body, and sends the message down to the kidneys to start manufacturing more urine,” explains Woo.

5. Drinking too much water

Sometimes it’s as simple as this. Drinking too much, especially before bed, means you’ll need to empty your bladder before morning.

“What you define as excessive is pretty arbitrary,” says Woo. “But I’ve seen people carrying three-litre bottles at the gym and I think, ‘you’ve got to be joking’. Nothing in excess is good for you. It’s all about moderation.”

6. Drinking alcohol

Alcohol is a diuretic, which increases urine production, and because the majority of people drink in the evenings, that’s when it affects us most. (It also disturbs your sleep, so you may wake up thinking you need the bathroom when ordinarily you’d have slept through.)

Is it a problem?

While nocturia may seem like more of an inconvenience than a medical issue, it’s worth getting it checked out, says Wendy Bower, director of research strategy at Continence Health Australia. Research has flagged significant interactions between getting up to pee at night and metabolic, cardiovascular, hormonal, mental health, sleep and inflammatory changes.

“The risk of serious illness and death is significantly higher in people who pass urine twice per night as opposed to people who do not wake to void,” she says. “Talk to someone. Continence Health Australia has a helpline, which is a good place to start. Take notice of how many times you need to wake up, how long you are asleep before first needing to pass urine and measure how much urine you make overnight (including the first void the next morning).

“Ask your GP to complete a diagnostic set of questions known as TANGO to help you understand the factors that may be causing your nocturia.”

After a treatment program including lifestyle changes, acupuncture, cystoscopy and posterior tibial nerve stimulation (PTNS) with varying success, Annie Fenwicke is about to embark on a trial for SmartPatch, which was created by its chief executive Nicky Agahari, after his grandfather developed urinary incontinence and fell and broke his back while hurrying to the toilet at night.

“I’m incredibly grateful for the large amount of treatment that I’ve received,” says Fenwicke. “OAB has had an impact on my life and I’d love to see it improve.”

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