Monday 16 September 2019

Dear Dr Nina: My full bladder keeps waking me at night, what can I do to stop it happening?

Waking up at night to pass urine is referred to as 'nocturia'
Waking up at night to pass urine is referred to as 'nocturia'

Nina Byrnes

Question: I'm in my mid-40s and find that I'm waking up a lot at night with a full bladder, which is disrupting my sleep. I drink a lot of water during the day and limited caffeine. Is there a cut-off point for when I should stop taking liquids? Or is it just a part of getting older?

A Waking up at night to pass urine is referred to as 'nocturia'. We all may wake up from time to time, but if this is a new symptom and particularly if it is increasing in frequency, then it is worth taking note. This symptom is more common as people age and is thought to occur in up to 80pc of people over the age of 80. However, frequent nocturia would not be as common in your 40s.

Nocturia will result from an increased amount of fluid entering the bladder at night or an inability of the bladder to hold urine for a prolonged period. Inability to hold urine may be due to pressure on the bladder or due to overactivity of the nerves supplying the bladder wall

You mention that you drink a lot of water. Certainly, if you are drinking a lot of fluid in the hours before bed, then you are likely to awake needing to go to the toilet. It is normally a good idea to keep fluids to a minimum in the hours before bedtime.

Caffeine should be avoided from late afternoon. It is a diuretic and will cause you to pass urine. It will also disrupt sleep. Alcohol also has a diuretic effect and can lead to nocturia.

There are various medications that act to increase the flow of urine. If you have been prescribed these, make sure you take them in the morning or early afternoon and not in the evening, as this will cause nocturia. Blood pressure tablets and those used in heart failure, along with some contraceptive pills, can have a diuretic effect.

Pressure in the pelvis will also make nocturia more likely. Pregnant women often find they have to get up at night in the latter stages of pregnancy. Some women find this habit persists even after pregnancy has ended. Constipation or other bowel issues can irritate the bladder, making nocturia more likely.

In assessing the cause, it's important to consider other factors. You don't mention if you are male or female. Nocturia can be a sign of prostate or bladder outflow problems. Other symptoms to watch out for are urinary frequency during the day or a feeling that your bladder never quite empties properly. Hesitation on starting to pass urine and dribbling after passing and a weaker urine stream can also be significant. Stinging or burning when passing urine may suggest and underlying infection, which could be easily treated.

It is worth discussing your symptoms with your GP. Lifestyle change may be all you need. If the problem is down to the storage ability of your bladder, medication may help. Either way, it's worth addressing, as the prolonged sleep disturbance from nocturia may have a significant impact on your quality of life.

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