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The Midnight Bathroom Run: Why It Happens and How to Stop It

If you’re waking up at night to pee, you’re not alone, and you’re not doomed to a lifetime of restless sleep. Nocturia, or nighttime urination, is one of the most common and under-discussed sleep disruptors, affecting both men and women, especially as we age. But according to Dr. Joseph Dall’Era, a urologist at Vail Health, it’s not something you have to simply “live with.”

“Usually, we imply nocturia if the urge to urinate is what actually wakes people up,” Dall’Era explains. “For most people, getting up once a night isn’t a big deal. But if it starts to interfere with sleep quality or you notice a change in how often it’s happening, that’s worth a closer look.”

What Causes Nocturia?

The culprits vary, but Dall’Era says diet is often the first place he looks.

“Fluid intake, caffeine and alcohol, especially if consumed at dinner or in the evening, can lead to diuresis, or increased urine production, during the night,” he says.

As people age, hormonal changes and certain medical conditions can also play a role. For men, benign prostate enlargement (BPH) is a common cause. For women, bladder overactivity, hormonal shifts or pelvic floor issues can be the trigger. “Nocturia can affect both men and women,” Dall’Era says. “Some causes, like BPH in men, are gender-specific, but many, such as dietary factors, sleep apnea and diabetes, are not.”

Sometimes, however, nighttime urination can signal something more serious. Heart failure, diabetes, sleep apnea and kidney disease can all lead to excess urine production at night. In rare cases, prostate or bladder cancer may also be to blame. If nocturia is accompanied by other symptoms, like swelling, fatigue, pain or blood in the urine,  that’s a good reason to visit an urologist or primary care physician. 

Children can experience nocturia or even bedwetting, but that’s usually a behavioral or developmental issue, and not the same condition adults face.

When to Seek Help

There’s no strict medical definition for “too much” nighttime urination, but Dall’Era offers a practical guideline: “Most of us consider getting up more than once a night to be an issue,” he says. “Even if it’s only once, but it’s new for you, that’s something we can address.”

Fatigue is often the red flag. “If you’re tired during the day because your sleep is being interrupted, that’s a problem regardless of the number of times you’re up,” he says. He also advises patients to pay attention to sudden changes in frequency or new symptoms like burning or blood in the urine, which could indicate infection or another underlying condition.

If nocturia is bothersome or worsening, start with your primary care provider, or go directly to a urologist. “We usually begin with a dietary evaluation and sometimes avoiding dairy,” Dall’Era explains. “That’s simply a log of your fluid intake and output throughout the day.”

This exercise can be eye-opening. “Active people often drink more than they need, or they drink caffeine or alcohol in the evening,” he says. “When they see that on paper, it makes sense why they’re up at night.”

If lifestyle factors aren’t the main culprit, Dall’Era looks deeper for causes such as sleep apnea or diabetes, both of which can trigger nocturia.

Strategies for Better Sleep

Regardless of how many times you get up in the night, if it’s interfering with your daytime functioning or you’ve noticed increased frequency or urgency, Dall’Era recommends seeking medical advice.

For those with no underlying medical condition, he also has some refreshingly simple tips:

• Limit caffeine, especially after lunch, and alcohol.
• Avoid large amounts of fluid in the evening.
• Address medical conditions, like sleep apnea or diabetes, that may be contributing.

For men, a prostate evaluation may be in order. “Prostate enlargement is a very treatable cause of nocturia,” he says. “We have medications and minimally invasive procedures that can help.”

For both men and women, overactive bladder is another common diagnosis, one that often responds well to treatment. “Diet can play a role here too,” Dall’Era notes, “but we also have medications or even procedures like bladder Botox that can significantly improve symptoms.”

Botox works through a neurologic mechanism to cause relaxation of spastic muscle contraction, Dall’Era explains. It can be injected into the bladder muscle through an office procedure to help treat symptoms of overactive bladder (urinary urgency, frequency, some forms of incontinence).

The Bottom Line

Waking up occasionally to urinate isn’t necessarily cause for concern. But if it’s interfering with your sleep or daily energy, there’s no reason to suffer through it. “If you’re bothered by the number of times you get up at night, or you notice it worsening, get evaluated,” says Dall’Era. “We have many ways to help.”

Dr. Joseph Dall'Era is board-certified urologist at Colorado Mountain Medical and has extensive experience in all aspects of urology including the treatment of benign prostate enlargement, stone disease, urologic cancers, urinary incontinence and overactive bladder. He strongly believes in developing a partnership with his patients, emphasizing their preferences and goals in formulating personalized treatment plans.