What is nocturia?

Nocturia is waking up one or more times during the night because of the need to urinate.

This means that if you wake up during the night — for instance, because you are thirsty, hear noises, worry, or feel pain — and you decide to visit the toilet in the meantime, you do not have nocturia. You also do not suffer from nocturia if you go to the toilet first thing in the morning.

Waking up once in a while to urinate is common and is generally not very bothersome. However, if you regularly wake up two or more times a night, it can affect your quality of life and general health. The more times you wake up each night, the more it impacts your wellbeing.

Nocturia disrupts your sleep and may cause you to be more tired than usual during the day. This can make it difficult to concentrate at work and carry out your daily activities. Your lower energy levels could also affect your social life.

How common is nocturia?

Nocturia affects both men and women, and becomes more common as you grow older. In adults under 30, more women than men suffer from nocturia while over the age of 50, it affects men more often. Over the age of 60, the chances of suffering from nocturia rapidly increase for men and women alike.

What causes nocturia?

  • In some people the kidneys produce too much urine. If the kidneys only overproduce at night, this is called nocturnal polyuria
  • There are several conditions which can cause overproduction of urine, such as diabetes type I or II or primary polydipsia, the sensation that your mouth is dry which leads you to drink too much
  • Some people have a smaller bladder which is filled to capacity more quickly and cannot store the urine all night
  • If you have a bladder or prostate condition, such as benign prostatic enlargement (BPE), you may not be able to empty your bladder completely before going to bed. As a result, the bladder fills more quickly and may not store the urine all night

Other possible causes of nocturia are:

  • Overactive Bladder Symptoms (OAB, see EAU Patient Information on Overactive Bladder)
  • A decrease in the production of the hormone vasopressin
  • Obstructive sleep apnoea, or snoring
  • Swelling of the ankles and legs, a condition known as peripheral oedema
  • Lower urinary tract symptoms (LUTS)
  • Congestive heart failure

Understanding what causes your nocturia will help your doctor to offer the best possible treatment option for your individual situation.

Interesting Fact

While nocturia literally means “urination at night”, it may also occur during the day, for those who work night shifts and sleep in the daytime.

Diagnosis

Your doctor may order a series of tests to understand what causes your symptoms. This is called a diagnosis. The diagnosis of nocturia is relatively simple, but understanding the underlying causes is much more complex. This is because nocturia may be a symptom of other medical conditions, including lower urinary tract disorder (LUTD).

First, the doctor or nurse will take your medical history and do a physical examination. If needed, other tests will be performed, depending on:

  • your age
  • the impact the symptoms have on your daily life
  • other medical conditions you may suffer from (in particular heart, kidney neurological or psychiatric conditions)
  • your current medications

Based on the results of your evaluations, your doctor will identify the cause of your nocturia and recommend the right treatment. This section offers general information about the diagnosis of nocturia and situations may vary from country to country.

Physical examination

Your doctor or nurse will do a physical examination. They will be looking for:

  • A distended bladder (your bladder may stretch if it does not empty completely)
  • Swelling to your ankles and legs (known as peripheral oedema)
  • Skin damage on your genitals (a sign of urinary incontinence)
  • Discharge from the urethra (a sign of infection)
  • Abnormalities in the genitals
  • Prostate (digital rectal) examination in men

Your doctor or nurse may also do a pelvic examination in women, test your blood pressure, and look for signs of heart, lung, or neurological conditions. Also, he or she may do more tests to see if there is lower urinary tract dysfunction. This can include urine analysis in the lab, voiding analysis with a uroflowmeter, or ultrasound examination of the bladder and/or prostate.

Bladder diary

Your doctor may ask you to keep a bladder diary.

Questionnaires

Your doctor may ask you to fill out a questionnaire to better understand your symptoms and their impact on your quality of life. The most common questionnaire is Nocturia-Quality of Life (N-QoL).

Treatment

Your doctor may suggest treatment to improve your nocturia. This section describes different treatments.

Together with your doctor, you can decide which approach is best for you. Factors which influence this decision include:

  • Your medical history
  • Any other medication you are taking
  • Drugs available in your country
  • Your personal preferences and values

This section offers general information about treatment and situations can vary in different countries.

Watchful waiting

If your symptoms are only bothering you a little, watchful waiting can be an option. This means that you see your doctor regularly (usually every year) or when the symptoms become worse.

Prostate medication and surgery

Because of the relationship between the prostate and the bladder, some men are prescribed medication to relax the muscle within the prostate gland or reduce the size of the prostate. This may improve their lower urinary tract symptoms (LUTS) but is less effective in improving nocturia.

In some cases, transurethral resection of the prostate (TURP) is recommended to improve the symptoms of benign prostatic enlargement (BPE) when it affects bladder function (Fig. 1 and 2). The surgery unblocks the bladder outlet by cutting away parts of the prostate. However, unless you have urinary symptoms during the day was well, TURP is unlikely to improve nocturia.

Fig. 1a: A healthy prostate in the lower urinary tract.
Fig. 1a: A healthy prostate in the lower urinary tract.
Fig. 1b: An enlarged prostate compressing the urethra and bladder.
Fig. 1b: An enlarged prostate compressing the urethra and bladder.

Lifestyle Advice for Nocturia

Nocturia is usually bothersome and can have a negative impact on your quality of life. It disrupts your sleep and may cause you to be more tired than usual during the day.

General lifestyle changes can help manage your symptoms and improve your quality of life:

  • Maintain a good sleep routine:
    • Go to bed and wake up around the same time 7 days a week
    • Stay in bed as long as you need to be alert and active the next day. If you stay in bed too long or too short, the quality of your sleep may diminish
    • Avoid taking naps during the day
    • Sleep in an environment which is free from disturbing light and noise, and has a comfortable temperature
  • Drink less in the late afternoon and evening to avoid getting up at night to urinate
  • Drink at least 1-1.5 litre every day and discuss with your doctor if you can drink more
  • Reduce alcohol and caffeine, because they may increase urine production and irritate the bladder. Remember that even drinks marked as decaffeinated, such as tea, coffee or soft drinks, may have some caffeine
  • Avoid eating large meals shortly before you go to sleep. Also, certain foods can worsen nocturia. It may be helpful to reduce chocolate and spicy foods, especially in the evenings
  • Avoid smoking because nicotine is a stimulant and can affect your sleep
  • If recommended by your doctor, encourage yourself to “hold it” longer when you feel the urgency to urinate. This will train your bladder to keep more urine so that you will urinate less often
  • Reduce swelling in your ankles and legs. During the day, water in your body may flow down to your legs, causing swelling. This condition is called peripheral oedema. When you lie down or elevate your legs for several hours, the fluid returns to the kidneys. Your body will then get rid of it when you urinate. If this happens at night, it causes nocturia. Lying down or elevating your legs in the afternoon may allow you more hours of uninterrupted sleep.
  • Self-management sessions as part of watchful waiting can also help improve your symptoms and quality of life.

Living with nocturia

Nocturia is a major problem for many adults. It is defined as waking up one or more times per night to urinate. It can last for a long time and there is no simple cure. Different people cope differently with their symptoms and the possible side effects of treatment. The impact of nocturia on your life should not be underestimated.

Quality of life involves both physical and psychological health. It is important not only to feel healthy but also
to feel free of the psychological pressure of living with nocturia.

There are many ways to keep the symptoms under control. They should not stop you from being happy in your relationships and participating in the social, cultural, and economic life of your community. Read about changes in your habits which may improve your nocturia in the section Lifestyle advice for nocturia.

Nocturia can have a negative effect on your personal relationships. It can be difficult to feel attractive and confident when you do not always feel in control of your body. Do not be embarrassed to seek help if your symptoms bother you: consult your family doctor, general practitioner, or a urologist.

This information was produced by the European Association of Urology (EAU), January 2014.

  • Prof. Christopher Chapple, Sheffield (UK)
  • Dr. Jean-Nicolas Cornu, Paris (FR)
  • Prof. Stavros Gravas, Larissa (GR)
  • Dr. Diane Newman, Philadelphia (USA)
  • Prof. Andreas Skolarikos, Athens (GR)
  • Mr. Nikesh Thiruchelvam, Cambridge (UK)

Updated by the EAU Patient Information Working Group, March 2018:

  • Dr. Sarah Ottenhof, Amsterdam (NL)
  • Dr. Marta Sochaj, Warsaw (PL)