"Aargh, I need to Go to the Toilet Again!"

By Associate Professor Dr Ong Teng Aik (Consultant Urologist) | University Malaya Medical Centre | Tue Feb 27, 2018 5:31pm

Oh no, not another urge to pee! If you find yourself constantly awakened from sleep because you have to go, you may have a condition called nocturia.1

Associate Professor Dr Ong Teng Aik explains that nocturia describes a condition in which a person wakes up one or more times from sleep to urinate. It can affect both men and women of all ages, although it is more common in older people.1

Do you know?
Dr Ong shares that it was reported that 58% of men and 66% of women in the general population aged 50-59 years old experience nocturia. The number rises to 72% among men over 80 and 91% among women over 80.2


According to Dr Ong, there are many possible causes of nocturia. Here are some of the more common ones.

What You Consume

  • Excessive amounts of caffeine and/or alcohol.2
  • Drinking a large amount of fluids shortly before bedtime.2
  •  Certain medications may cause nocturia as a side effect.2

The Changes in Your Body

  • Pregnant women may experience nocturia because their womb may press against their bladder. The condition usually goes away naturally once the baby is born.2
  • Underlying health conditions that affect the hormones involved in the body’s fluid regulation can also cause nocturia.2


Bladder-Related Issues

  • Normally, the body produces less urine when the person sleeps. Someone with nocturnal polyuria experiences the reverse: the body produces an excessive amount of urine during the night and less during the day.2
  • Nocturia can occur if the bladder is unable to store enough urine, or if it is unable to empty completely during each toilet session. In men, this could be due to an enlarged prostate gland.2
  • Dr Ong adds that other bladder issues such as stones, overactive bladder, loss of bladder control or bladder tumour can be a cause.


Sleep Problems

Dr Ong also adds that obstructive sleep apnoea (obstruction in the airways cutting off oxygen supply to the brain and forcing the body to become awake) and other sleep problems can trigger nocturia. This is because the act of waking up can trigger an instinctive urge to urinate.2


Other Underlying Medical Conditions

Dr Ong points out that, often, nocturia occurs alongside other health conditions that a person may already have. Some examples have already been mentioned earlier, and he adds that diabetes can also be a possible cause for nocturia. Heart problems can also be another factor (see “Sign of a Broken Heart?”). Therefore, if you are not diagnosed with any chronic (long-term) diseases, but you have bothersome nocturia, it may be a good idea to see a doctor to find out if you may have any of these conditions.



Dr Ong advises seeing a doctor if your nocturia begins to affect you in the following ways:

  • Lack of good quality sleep begins affecting your ability to focus as well as your energy levels during the day. If left unchecked, this can put you at risk of accidents.
  • Your emotions (or your partner’s – your constant waking up at night could also affect his or her ability to sleep) are affected, leaving you more prone to being grumpy and losing your temper. Such bad moods can affect your relationships.

Dr Ong reiterates that nocturia could also be a sign of an underlying medical condition. If left undetected, this condition may become more severe and hence more difficult to treat or manage.

So, trust your instincts: see a doctor if you believe that nocturia is a sign that something may not be right with you.


Sign of a Broken Heart?

When the heart experiences a problem that causes less blood to be pumped to other parts of the body, especially to farther locations such as the legs, fluid will begin to collect in those places (especially the ankles). When the person lies down and sleeps, fluid will seep back and collect in the bladder, leading  to nocturia.



Dr Ong explains that treating nocturia invariably involves addressing the issues that give rise to the condition. As there are so many possible causes, careful diagnosis – which involves taking a detailed medical history, conducting thorough check-ups and tests, and having the patient keep a urine diary – is important.

Dr Ong shares that some behavioural adjustments may be helpful in the meantime,  to keep nocturia in check. For example, reducing the amount of fluid drunk from the afternoon onwards and restricting caffeine to mornings only. If nocturia is caused by accumulation of fluids in the legs (see “Sign of a Broken Heart?”), taking afternoon naps with the legs elevated (place a pillow under them) can help reduce the urge to urinate at night. The actual advice offered by the doctor ultimately depends on the cause of the condition, so once again, Dr Ong shares that you should see a doctor if your nocturia becomes bothersome.



For more information, please seek advice from an urologist or urogynaecologist.


References: 1. Sleep Health Foundation (Australia). Nocturia (the need to get up in the night to urinate). Retrieved on Sept 6, 2017 from http://www.sleephealthfoundation.org. au/pdfs/Nocturia-0713.pdf 2. Van Kerrebroeck P., et al. (2002). The standardization of terminology in nocturia: report from the standardization subcommittee of the International Continence Society. BJU Int.;90 Suppl 3:11-5.


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The original version of this article was first published in October HealthToday 2017.




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