Women's Health Services | Nighttime Urinary Voiding

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Urinary Frequency and Night-Time Voiding (Nocturia)

Nighttime Voiding

What is Nocturia?

It is normal to go to the bathroom to urinate approximately every 3 hours. However, this depends on how much and what type of liquid you drink. It also depends on whether or not you take diuretic pills (‘water-pills’).

If you drink a lot of water, caffeinated beverages, or alcohol, you may go to the bathroom more frequently. Some women drink at least 8 glasses of water a day which results in going to the bathroom often. If you do not drink many fluids during the day, you may go less often.

A common reason for going to the bathroom frequently is excessive fluid intake. It is important to determine if this is the reason. You will likely be asked to complete a voiding diary. The voiding diary measures how much you drink, what type of beverage you drink, and what time you drink it. It also measures how much urine you pass (we give you a ‘hat’ to collect the urine and measure it), what time you go to the bathroom, and whether or not you had an urge to go, or if you went to the bathroom ‘just because it was convenient to go’.

Some people go to the bathroom frequently because they are afraid they may have a leakage accident, or because they may be leaving home and are unsure as to when they will be able to get to a clean restroom. Some people go frequently just because they are in that habit of going frequently. It is normal to wake up once or twice at night to go to the bathroom.
When you wake up at night, are you waking up because of the URGE to go to the bathroom? Or, are you waking up for other reasons (hot flashes, restless legs, snoring, environmental disturbances) and then you go to the bathroom because you ‘may as well’?

There are a few reasons for waking up more than twice per night. A common reason is drinking fluids in the evening hours (what goes in must come out!) A late afternoon or early evening ‘cocktail’ has alcohol in it. Alcohol acts like a diuretic (makes the kidneys pass more urine.) Depending on what time you go to sleep, you should avoid drinking fluids for 4 hours prior to going to sleep to avoid awakening many times at night.

Another reason is that during the daytime, excess fluid in your body accumulates in your ankles and calves because you are standing and sitting throughout the day. Once you go to sleep at night and lay down flat, that extra fluid that has been in your ankles and calves now goes up to the kidneys (where it should go) and then out to the bladder. In this circumstance, you may notice that you go to the bathroom more often and empty more urine in the night time as compared with the daytime. This is not really a ‘bladder’ problem, but more of a fluid-balance problem. One way to improve this problem is to keep your legs up in the late afternoon to allow the extra fluid that builds up in the ankles to reach the kidneys more easily. Then the kidneys can filter out that extra fluid in the early evening instead of while sleeping.

Women who snore or who have sleep apnea may also get up during the night to go to the bathroom. This may be because the levels of carbon dioxide and oxygen in the body change and cause a urine-producing-diuretic hormone to rise. This results in increased urination at night. Again, this is not a bladder problem, but a fluid-balance problem. If snoring and sleep apnea can be improved, night-time urinary frequency will be improved as well.

Under normal circumstances, the brain produces a hormone at night called anti-diuretic hormone (ADH). This hormone sends a message to the kidneys to ‘quiet-down’ and not make as much urine at night. This makes sense, because we’re supposed to sleep at night! The kidneys should do most of their work during the daytime hours. When a woman gets older (over 70 years), sometimes the amount of this hormone is reduced. Therefore, if there no longer is this hormone around to tell the kidneys to ‘quiet down’ at night, then the kidneys go to work, and often times they work extra-hard! This means that a lot more urine is made at night-time, and therefore, urinary frequency at night-time occurs. Again, this is not the bladder’s fault. This happens because the kidney’s get their days-and-nights mixed up. The kidneys may work just fine, but they work more at night than they do during the day. (Mother Nature certainly is not fair here!)

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Treatment Options

Unfortunately, there is not much we can do in this situation. If a patient takes a diuretic (a water-pill) in the morning, she can try and take it at 4:00 pm, so that it pushes the kidneys to do their work in the evening before bedtime. This is not always effective. Most of the ‘overactive-bladder’ medications that are advertised are not very effective, either, because it’s not the bladder’s fault. The kidneys are giving the bladder a lot of urine; the bladder can only hold so much. If there is a lot of urine in the bladder, the bladder should empty (that is what it is supposed to do!)

In certain circumstances when the night-time frequency cannot be improved, obtaining a bedside-commode may at least make it easier to go to the bathroom without risking a fall or a leak on the way to the toilet.

Often times changes in lifestyle and behavior help reduce urinary frequency and night-time voiding. Sometimes medication is needed. Sometimes improvement is not always possible.

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Physicians Specializing in Urogynecology

Name Specialties Location
Kershen, Richard Todd, MD
860.947.8500
  • Urology
  • Female Pelvic Medicine and Reconstructive Surgery
  • Reconstructive Urology
  • Urogynecology
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  • West Hartford
  • Plainville
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LaSala, Christine Ann, MD, FACS, FACOG, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
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  • Hartford
  • Avon
  • Glastonbury
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Mellen, Colleen E., APRN
860.972.4338
  • Urogynecology
  • Female Pelvic Medicine and Reconstructive Surgery
Show Less
  • Hartford
Steinberg, Adam C., DO, FACS, FACOG, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
Show Less
  • Hartford
  • Avon
  • Glastonbury
  • West Hartford
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Tulikangas, Paul Kevin, MD, FACOG, FACS, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
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  • Hartford
  • Avon
  • Glastonbury
  • West Hartford
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Tunitsky-Bitton, Elena, MD, FACOG, FFPMRS
860.972.4338
  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology
Show Less
  • Hartford
  • Avon
  • Glastonbury
  • West Hartford
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