Nocturia – using the toilet at night
This leaflet is a guide to night-time waterworks. It explains what is normal and
abnormal, common causes of needing to go to the toilet (voiding) at night and some
ways to help.
How common is this?
If you wake with the need to pass urine, this is called nocturia. About a third of adults
get up once at night to pass urine. As you get older this can increase. By 70 years of
age you can get up twice, by 80 three times and by 90 four times. This is typical night
time activity. It is also usual to pass most of your urine during the day and little at
night.
Reasons caused by your bladder
There are four main reasons why you may need to pass urine at night that are
directly caused by your bladder:
A low compliant bladder
If your bladder capacity is smaller than average it may be unable to store enough
urine to get through the night so you will need to get up to pass urine more often.
Common causes include habit and diabetes.
Poor bladder emptying
If your bladder does not empty properly (residual urine) it may not be able to store
enough urine. This means you will have to get up to pass urine more often. Common
cause include: constipation, enlarged prostate gland, multiple sclerosis and diabetes.
An overactive bladder
Before your bladder is full it starts to contract and you get sudden urges to pass
urine. This can disturb your sleep, as you will have to keep getting up to pass urine.
The cause is unclear in some people but it increases with age and is common with
multiple sclerosis.
An irritated bladder
If you have a urinary tract infection, cystitis or bladder stones, this can cause your
bladder to be sore and cause you to pass urine more often.
Other reasons
There are three main reasons why you get up to the toilet at night that are not directly
caused by your bladder:
Secondary nocturnal voiding
If you are awake at night for other reasons and decide to go to the toilet, this is called
secondary nocturnal voiding. Common causes include: snoring, stress, worry,
smoking, noise, pain, uncomfortable bed, too hot, taking naps during the day,
insomnia (not being able to sleep) and high fluid intake at night.
Nocturnal polyuria
If you produce more than a third of your urine during the night, this is called nocturnal
polyuria. Common causes include heart disease, high blood pressure, circulation
problems and swollen legs and feet.
Age related nocturia
For example at 72 years of age it is normal to get up twice to the toilet at night.
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ
Tel: 01634 382777
Registered in England and Wales, Company number: 07275637
What can be done to help?
Sometimes the reasons for passing urine at night are complex, caused by several of
the problems listed above. There are a number of things that can be done to identify
the cause or causes of your problem:
Urinalysis to check your urine for any abnormalities
Simple ultrasound of your bladder to see if it empties properly
Special tests on your bladder called urodynamics.
What can I do about it?
Here are some ideas to help you with your night time bladder problem:
If you have a low compliant bladder
Bladder retraining may help to expand your bladder capacity and reduce the time
you go to the toilet during the day and night
If you have poor bladder emptying
Check the side effects of any medication you take as some may cause bladder
emptying problems.
Limit your fluid intake for two hours before going to bed and during the night.
Treat constipation.
Medication for men with prostatic enlargement may help to shrink the gland.
Using a catheter (fine tube which goes into your bladder to drain urine) may
empty your bladder and reduce your symptoms.
In some men a Urologist may need to perform an operation to remove any
prostatic obstruction.
If you have an overactive bladder
Cut down or stop your caffeine intake as it increases overactivity of the bladder.
Try to avoid caffeine based drinks (eg coffee, tea, cola) for about five hours
before bedtime.
Medication may help; for example oxybutynin, which reduces the urge to pass
urine. (*Please note: there can be side effects and there are contraindications).
Bladder retraining may help to expand your bladder capacity and reduce the time
you go to the toilet during the day and night. When combined with medication (eg
Oxybutynin) the results can be better.
If you have an irritated bladder
Drink extra water to dilute your urine if it is dark (concentrated urine causes
irritation).
Try self help remedies for cystitis.
Get a course of antibiotics to treat urinary infection.
A Urologist will advise on the treatment of bladder stones.
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ
Tel: 01634 382777
Registered in England and Wales, Company number: 07275637
If you have secondary nocturnal voiding
Consider what may be disturbing your sleep. Try to change this by self help
measures or talk to your doctor.
If you have nocturnal polyuria
Restrict your fluid intake for two hours before going to bed and during the night.
Try to cut your salt intake down as this can cause you to retain fluid.
Each day during the afternoon lie down with your feet higher than your heart for at
least one hour. This improves the blood supply to your heart and kidneys. It may
increase your urine output during the afternoon and evening.
In some cases your doctor may prescribe a diuretic (water pill) to increase your
daytime urinary output and reduce the night time output.
One cup of nettle tea taken late afternoon may have the same effect as a diuretic.
Nettle tea is not advised if you have blood pressure problems.
If you use nettle tea or a diuretic you must have your blood checked to ensure
you do not lose too much potassium on a regular basis.
If you have swollen legs, support stockings may help.
Other sources of information are:
The Bladder and Bowel Foundation
SATRA Innovation Park, Rockingham Road, Kettering, Northants NN16 9JH
Tel: 01536 533255
Email : [email protected]
Website : www.bladderandbowel foundation.org
PromoCon (Continence Products)
Disabled Living, St Chad’s Street, Manchester, M8 8QA.
Tel: 0161 834 2001
Fax: 0161 214 5961
Email : [email protected]
Website : www.promocon2001.co.uk
Who to contact if you have any questions about this information:
Continence Care, Keystone, Gun Lane, Strood, Kent ME2 4UL. Tel: 01634 719252
Customer care Please send any comments about Medway Community Healthcare
services to: Customer care manager, Medway Community Healthcare
7-8 Ambley Green, Bailey Drive, Gillingham, Kent, ME8 0NJ
p: 01634 382266 f: 01634 382700
[email protected] All contact will be treated confidentially.
Sharing your information
Your information will only be disclosed to those who have a genuine need to know
and who agree to keep your information confidential. For your direct care we often
share information with NHS hospitals and clinics, GPs and social care.
Leaflet reference: MCH306
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ
Tel: 01634 382777
Registered in England and Wales, Company number: 07275637
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ
Tel: 01634 382777
Registered in England and Wales, Company number: 07275637