What is it?  Getting up to urinate two or more times per night.

What causes it?   There are many causes for frequent nighttime urination.  It is essential to determine the cause in order to order the proper treatment. There are two basic types of nocturia, high-volume and low-volume.  The cause and treatment is different for each type.

How is it evaluated? You will be asked to keep a fluid diary for 3 days.  This will involve measuring and recording all liquids you take in as well as all the urine you produce.  It is very important to keep accurate records to the extent possible in order to determine the cause. If you are having urine loss either during sleep or on the way to the bathroom, you will record that on the diary and note whether the amount is large or small.   A urinalysis and urine culture will be done if not already performed. You may need additional testing including blood and special urine tests, a cystoscopy, radiologic studies, urodynamics, or in some cases, an evaluation by another specialist such as a cardiologist, pulmonologist, or ENT (otolaryngologist).  

How is it treated?  Depending upon the cause of the nocturia, you may need pelvic physical therapy, modification of your fluid intake, medications, or in some cases, special procedures.  Basic, first line treatment involves reducing your evening fluid intake. If you have any swelling or blood pressure issues, elevating your legs above the level of your heart for an hour before bedtime and then emptying your bladder may be somewhat helpful.  Taking your medications with applesauce, yogurt or other, more solid foods instead of water may help if you take pills at night.  

If you have insomnia and awaken often during the night, and go to the bathroom out of habit, and your urine volume is low, you may be able to retrain yourself to avoid going to the bathroom when you awaken.  Treatment of your insomnia should resolve the problem.  

If you have diabetes, you should endeavor to control your blood sugar as an elevated blood sugar can cause you to produce more urine at night.  

If you have difficulty with moving or walking to the bathroom, a bedside commode may be the most practical solution to problems with leaking on the way to the bathroom.  

Linda Kiley, MD Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.

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