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Are you frequently waking up in the middle of the night to use the toilet? You're not alone.
Nocturia, the medical term for excessive night-time urination, affects millions of people across the United Kingdom.
According to a study published in the British Journal of Urology International, approximately 8.9% of adults in the UK experience nocturia, with the prevalence increasing with age [1].
Age plays a significant role in the occurrence of nocturia. Research shows that while only 2-3% of young adults (20-40 years) experience nocturia, this rises to 28-62% in older adults (70-80 years) [2].
For women, childbirth can also increase the risk of nocturia. A study in the European Journal of Obstetrics & Gynecology and Reproductive Biology found that women who had given birth vaginally were more likely to experience nocturia compared to those who had not given birth [3].
We're going to look at the causes, consequences, and most importantly, the natural solutions to help you get a good night's sleep without those bothersome trips to the toilet.
Nocturia isn't just about disrupted sleep. It can have significant impacts on your overall health and quality of life. Research and NHS reports indicate that frequent night-time urination can lead to:
Increased risk of falls, especially in older adults [4]
Daytime fatigue and decreased productivity [5]
Mood disturbances and irritability [6]
Reduced quality of life [7]
Moreover, nocturia can be a symptom of underlying health conditions such as diabetes, heart disease, or prostate issues in men [8]. That's why it's crucial to address this problem and seek medical advice if it persists.
For men, particularly those over 50, prostate problems can be a significant cause of nocturia. The prostate is a small gland located just below the bladder, surrounding the urethra (the tube that carries urine out of the body).
As men age, the prostate often enlarges, a condition known as benign prostatic hyperplasia (BPH) [23].
It's important to note that this enlargement is a normal part of the aging process in men, as the prostate continues to grow throughout adulthood [29]. While not all men will experience significant symptoms, BPH can lead to urinary issues, including nocturia, in many cases.
Bladder obstruction: The enlarged prostate can press against the urethra, partially blocking the flow of urine. This can make it difficult to fully empty the bladder, leading to more frequent urination, including at night [24].
Overactive bladder: BPH can cause the bladder muscle to become overly sensitive, leading to sudden and frequent urges to urinate [25].
Reduced bladder capacity: Over time, the bladder may work harder to push urine past the enlarged prostate, causing the bladder wall to become thicker and reducing its capacity to hold urine [26].
It's important to note that while BPH is a common cause of nocturia in men, it's not the only possible cause. Other conditions, such as urinary tract infections, diabetes, or neurological disorders, can also lead to increased night-time urination in both men and women [27].
If you're a man experiencing nocturia, especially if accompanied by other symptoms like difficulty starting urination, weak urine stream, or feeling that your bladder isn't completely empty after urinating, it's crucial to consult with your GP.
They may refer you to a urologist for further evaluation and treatment, which could range from lifestyle changes and medications to minimally invasive procedures or surgery, depending on the severity of your symptoms [28].
1. Fluid Management: Timing is Everything
One of the simplest yet most effective strategies is managing your fluid intake. The key is not to reduce your overall fluid consumption but to time it wisely.
Reduce evening fluids: Try to consume the majority of your daily fluids before 6 pm [9].
Avoid bladder irritants: Cut back on caffeine, alcohol, and fizzy drinks, especially in the evening [10].
A study from the British Association of Urological Surgeons found that 61% of patients with nocturia saw improvement by simply adjusting their fluid intake timing [11].
2. Dietary Tweaks for a Drier Night
What you eat can significantly impact your bladder habits. Consider these dietary adjustments:
Lower salt intake: Excess sodium leads to increased urine production. The NHS recommends no more than 6g of salt per day for adults [12].
Reduce bladder irritants: Spicy foods, acidic fruits, and artificial sweeteners can irritate the bladder, increasing urge and frequency [13].
3. Lifestyle Modifications: Small Changes, Big Impact
Simple changes to your daily routine can make a world of difference:
Elevate your legs: Spend 30 minutes before bed with your legs slightly elevated to encourage fluid reabsorption [14].
Compression stockings: Wearing these during the day can prevent fluid buildup in your lower extremities [15].
4. Pelvic Floor Exercises: Strengthen Your Control
Kegel exercises aren't just for women! Both men and women can benefit from strengthening their pelvic floor muscles. The NHS provides detailed guides on how to perform these exercises correctly [16].
5. Bladder Training: Teach Your Bladder Patience
Gradually increasing the intervals between urination during the day can help increase your bladder capacity. Start by holding for an extra 5 minutes and gradually increase the time [17].
While these natural strategies can be effective, it's important to know when to consult a healthcare professional. The NHS recommends seeing your GP if:
Nocturia persists despite lifestyle changes
You're experiencing other urinary symptoms like pain or difficulty urinating
You notice blood in your urine
You have unexplained weight loss or excessive thirst [18]
1. How common is nocturia in the UK?
According to UK studies, about 8.9% of adults experience nocturia, with the prevalence increasing to over 30% in those aged 65 and older [1].
2. Are there any NHS-recommended apps to help with bladder training?
Yes, the NHS recommends several free apps for pelvic floor exercises and bladder training, available on their website [19].
3. Is it normal to urinate once during the night?
For many people, one trip to the bathroom at night is considered normal, especially as we age. However, if it's affecting your quality of life, it's worth addressing [20].
4. Can weight loss help with nocturia?
Yes, maintaining a healthy weight can reduce pressure on your bladder and potentially decrease night-time urination [21].
5. Are there any specific dietary recommendations from the NHS to help with nocturia?
The NHS recommends a balanced diet low in salt and high in fibre. They also suggest limiting caffeine and alcohol, especially in the evening [22].
This article is for general information only and is not intended to treat or diagnose medical conditions. If in doubt please check with your GP first.
References:
[1] Irwin DE, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306-14.
[2] Bosch JL, Weiss JP. The prevalence and causes of nocturia. J Urol. 2010;184(2):440-6.
[3] Alling Møller L, et al. Risk factors for lower urinary tract symptoms in women 40 to 60 years of age. Obstet Gynecol. 2000;96(3):446-51.
[4] Nakagawa H, et al. Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol. 2010;184(4):1413-8.
[5] Asplund R. Nocturia: consequences for sleep and daytime activities and associated risks. Eur Urol Suppl. 2005;3(6):24-32.
[6] Kupelian V, et al. Nocturia and quality of life: results from the Boston area community health survey. Eur Urol. 2012;61(1):78-84.
[7] Tikkinen KA, et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol. 2010;57(3):488-96.
[8] NHS. Frequent urination. https://www.nhs.uk/conditions/frequent-urination/
[9] Weiss JP, et al. Nocturia: new directions. Neurourol Urodyn. 2011;30(5):700-3.
[10] Madersbacher S, Cornu JN. Nocturnal polyuria: a review of pathogenesis, diagnosis, and treatment. Eur Urol Focus. 2020;6(6):1230-1237.
[11] British Association of Urological Surgeons. Nocturia. https://www.baus.org.uk/patients/conditions/12/nocturia
[12] NHS. Salt: the facts. https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/salt-nutrition-labels-on-food/
[13] Dallosso HM, et al. Diet as a risk factor for the development of stress urinary incontinence: a longitudinal study in women. Eur J Clin Nutr. 2004;58(6):920-6.
[14] Cho SY, et al. Effect of combined systematized behavioral modification education program with desmopressin in patients with nocturia: a prospective, multicenter, randomized, and parallel study. Int Neurourol J. 2014;18(4):213-20.
[15] Pellerin C, et al. Compression therapy in the management of nocturia: a systematic review. Neurourol Urodyn. 2019;38(8):2037-2045.
[16] NHS. Pelvic floor exercises. https://www.nhs.uk/common-health-questions/womens-health/what-are-pelvic-floor-exercises/
[17] Burgio KL. Behavioral treatment of urinary incontinence, voiding dysfunction, and overactive bladder. Obstet Gynecol Clin North Am. 2009;36(3):475-91.
[18] NHS. Urinary incontinence. https://www.nhs.uk/conditions/urinary-incontinence/
[19] NHS. Health apps library. https://www.nhs.uk/apps-library/category/healthy-living/
[20] Bosch JL, Weiss JP. The prevalence and causes of nocturia. J Urol. 2013;189(1 Suppl):S86-92.
[21] Subak LL, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481-90.
[22] NHS. Urinary incontinence - Treatment. https://www.nhs.uk/conditions/urinary-incontinence/treatment/
[23] Agarwal A, et al. What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women. Eur Urol. 2014;65(6):1211-1217.
[24] Günes M, et al. Nocturnal polyuria in men with lower urinary tract symptoms: a urodynamic analysis. Int Neurourol J. 2016;20(2):132-138.
[25] Oelke M, et al. Nocturia: state of the art and critical analysis of current assessment and treatment strategies. World J Urol. 2014;32(5):1109-1117.
[26] Yoo TK, et al. The prevalence of lower urinary tract symptoms in population aged 40 years or over, in South Korea. Investig Clin Urol. 2018;59(3):166-176.
[27] National Institute for Health and Care Excellence (NICE). Lower urinary tract symptoms in men: management. Clinical guideline [CG97]. https://www.nice.org.uk/guidance/cg97
[28] NHS. Prostate enlargement. https://www.nhs.uk/conditions/prostate-enlargement/
[29] McVary KT. BPH: epidemiology and comorbidities. Am J Manag Care. 2006;12(5 Suppl):S122-8.