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How many trips to the toilet at night is one too many and should start worrying you?
IT’S a nightly nuisance many of us are familiar with: waking up, getting out of bed and going to the toilet because we need to pee.
For some it’s not just one trip to the toilet, but two, three, four, or even five.
Waking up more than once each night to pass urine can create a great deal of psychological stress, as it robs you of restful sleep.
In the following Q&A, two experts answer central questions about the condition, the medical term for which is nocturia.
What causes nocturia?
Going to the toilet at night sometimes has nothing to do with pressure on your bladder.
“Your sleep quality may be poor, and to pass the time as it were, you get up and go to the toilet,” says urologist Dr Daniela Schultz-lampel, director of the South-west Continence Centre at Schwarzwald-baar Hospital in Villingen-schwenningen, Germany.
In many cases, however, there’s indeed pressure on your bladder.
There are various possible causes, which include:
> Heart problems
Heart failure may be behind nocturia, says urologist Dr Guan Zhenghua, who works at the St Elisabeth Medical Care Centre in Bad Kissingen, Germany.
If your heart doesn’t pump blood properly, fluid can build up in your legs during the day.
At night, when you’re lying down, the fluid is absorbed into the bloodstream, filtered by your kidneys and then fills your bladder as urine. > Medications
“Taking a heart medication too late in the day can also lead to nocturnal urinary urgency,” says Dr Schultz-lampel.
Diuretics (water tablets), which help the body remove excess fluid and salt, and are often prescribed to treat high blood pressure, are a frequent culprit.
Other antihypertensive agents, namely ACE (angiotensin-converting enzyme) inhibitors and AT1 (angiotensin II receptor type 1) receptor blockers, can cause frequent urination at night too.
> Reduced bladder capacity
This usually has nothing to do with size, but means your bladder is unable to fill or empty fully, triggering an urge to urinate more often.
It can be due to a bladder outlet obstruction.
“In men, nocturnal urinary frequency can indicate an enlarged prostate gland,” Dr Guan says.
The prostate pressing on your urethra – the tube that carries urine from the bladder out of the penis – prevents your bladder from emptying properly, so you need to pee more often.
In women, an overactive bladder can be caused by pelvic organ prolapse, a condition in which one or more pelvic organs (e.g. the uterus) sag because of weakened pelvic floor muscles and tissues due – for example – to childbirth or ageing.
> Psychological issues
Stress, anxiety, pre-exam jitters, unprocessed experiences, etc can also lead to an overactive bladder that disrupts your sleep.
> Polyuria
Your body producing an excessive amount of urine is another possible cause of nocturia.
It can be a sign of poorly managed, or as yet undetected, diabetes.
Do certain behaviours affect having to get up to pee at night?
Yes.
“If you drink a comparatively small amount of fluids during the day and then two litres after 6pm, feeling pressure on your bladder multiple times a night shouldn’t surprise you,” Dr Schultz-lampe says.
Keeping a bladder diary can help.
For two days at least, record how much you drink and when, and how often you pee and when.
This will quickly show links between the two and point to adjustments you could make to your fluid intake habits.
Dr Guan advises: “From about two or three hours before bedtime, you should drink little to nothing.”
When is it advisable to consult a doctor about nighttime urination?
Getting up once or twice a night to pee is normal, according to Dr Schultz-lampel.
But if you regularly have to get up more often, she says you should have your general practitioner (GP) determine the cause.
It will help if you’ve kept a bladder diary.
What can you do yourself to curb the urge to urinate at night?
A good way to start is to evenly distribute your fluid intake throughout the day.
And be careful what you drink in the evening.
“Some teas and fizzy drinks can have a diuretic effect and are therefore best avoided in the evening,” Dr Schultzlampel says.
They include peppermint and nettle tea, and cola on account of its caffeine content. Beer can also act as a diuretic.
Other things you can do depend on what’s causing your need to pee at night.
If you take a prescribed diuretic medication in the evening, you should ask your doctor whether you can take it earlier in the day.
And for women, Dr Guan says that “special pelvic floor muscle exercises can help to counteract an overactive bladder”.
Under an instructor’s supervision, you learn to prolong intervals between trips to the toilet by contracting these muscles.
What medical treatments are available?
“Medications can help in cases of an overactive bladder or enlarged prostate gland,” says Dr Guan.
Botox injections can also be effective in subduing an overactive bladder.
A urologist injects Botox into your bladder, relaxing the muscles there.
The effects last for several months, after which the procedure must be repeated.
If your body makes too much urine at night, you can take a medicine with the active agent desmopressin before bedtime.
A synthetic analogue of a hormone produced in the body, it acts on the kidneys to reduce the flow of urine.
“This requires regular blood checks and shouldn’t be given to elderly persons and those with heart conditions though,” Dr Schultz-lampel says.
Is it OK to simply hold in your urine and go back to sleep?
Better not.
“It’s unhealthy since over time, it causes your bladder muscles to lose their elasticity,” warns Dr Guan.
Then your bladder is no longer able to contract and fully empty, which can have painful consequences. – dpa
Publication:The Star Malaysia
Author:By SABINE MEUTER
