Robert MacDermott - Consultant Gynaecologist
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  KIMS Hospital
  Kent, ME14 5FT
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Nocturia (Getting up at night to pass urine)

This leaflet is written for women who have to get up at night to pass urine. Doctors call this problem "Nocturia". It is normal to have to get up once but is considered to be a problem if it is necessary to pass urine twice or more during the night - this affects:

1 in 30 women aged under 30 years.

1 in 14 women aged 30-59 years.

1 in 4 women aged over 60 years.

Most women aged over 70 years.

 What causes nocturia?

Excessive production of urine during the night.

Excessive drinking in the evening will cause nocturia. Some drinks cause extra urine to be produced are called diuretics - examples include tea and coffee which contain caffeine, and alcoholic drinks.

In women who do not drink excessively, ankle swelling (oedema) is the most common cause of nocturia. Such swelling is usually less noticeable in the morning and increases as the day progresses because of gravity. The swelling reduces during the night because the legs are level with the rest of the body, allowing fluid to return to the blood stream. This extra fluid is removed from the blood stream by the kidneys which produce urine.

Ankle swelling commonly occurs in women as they get older and may occur when the heart doesn't beat efficiently. Some drugs for high blood pressure (Amlodipine, Nifedipine) can cause ankle swelling.

Small bladder capacity

This is often the result of an overactive bladder (see below). Women with this condition usually pass frequent small volumes of urine during both the day and the night. They may also have episodes of leakage associated with a strong urge to pass urine.

Some women have a large bladder capacity but never empty the bladder completely, a condition known as "Chronic urinary retention" (see below). These women pass frequent small volumes of urine.

Bladder infections (cystitis) cause the frequent passage of small volumes of urine during both the day and night. They are usually associated with a burning sensation when passing urine. Bladder infections are diagnosed by sending a mid-stream urine sample to the laboratory.

Poor sleep (insomnia)

People who do not sleep well often get out of bed and go to the toilet when they wake up. This has a different treatment from people who wake up because they need to pass urine. Information is available at NHSDirect.

 How can nocturia be treated?

Simple measures for all women
  • Reduce fluid intake in the evening. In severe cases, drink nothing after 6 pm.

  • Do not drink alcohol after 6pm.

  • Do not have any teat or coffee after 4pm.

  • Do a bladder diary for 48 hours where you measure the amount of urine passed each time using a jug and write this, with the time, on a chart. If, in 24 hours, more than one third of the urine is passed between midnight and waking in the morning (including the first passage of urine on waking), then you have excessive production of urine during the night.

 How can the volume of urine produced during the night be reduced?

As well as the simple measures above, there are other things that can be done to treat ankle swelling:
  • Put your feet up for 2-3 hours in the early evening - this will allow some of the fluid to be passed (as urine) before you go to bed.

  • Support stockings can prevent ankle swelling but it is important to have the correct size. You may find it more comfortable to remove the stockings when you are in bed.

  • If you are on a drug that causes ankle swelling there may be an alternative, but you must discuss this with your GP before stopping the drug.

  • A short-acting diuretic (a drug that makes you pass urine) taken 6 hours before bedtime gives significant relief to about 50% of women with nocturia. Blood tests are required to monitor such treatment.

 How is an overactive bladder treated?

This is usually treated with tablets which can be very effective in some (but not all) women. Side-effects are common but are usually not serious eg. dry mouth and constipation. Care needs to be taken to make sure that women treated with these tablets do not have chronic urinary retention (by performing a simple bladder scan to measure the volume of urine left in the bladder after passing urine).

 How is chronic urinary retention treated?

Your doctor will assess whether any of the medicines that you are taking could be causing the problem. Treatment usually involves passing a catheter (tube) into one's own bladder several times a day. This procedure is easy to learn and perform.

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