Urination - excessive at night

• Alternative Names

  Nocturia

• Considerations

  Normally, urine decreases in amount and become more concentrated at night. That means, most people can sleep 6 to 8 hours without having to urinate.

  But, persons with nocturia get up more than once during the night to urinate. Because of this, those who have excessive urination at night often have disrupted sleep cycles.

• Common Causes
  • Benign prostatic hyperplasia
  • Certain drugs including diuretics, demeclocycline, lithium, methoxyflurane, phenytoin, and propoxyphene
  • Chronic or recurrent urinary tract infection
  • Chronic renal failure
  • Congestive heart failure
  • Cystitis
  • Diabetes
  • Drinking too much fluid before bedtime, particularly coffee, caffeinated beverages, or alcohol
  • High blood calcium level
  • Obstructive sleep apnea and other sleeping disorders
• Home Care

  Keep a diary of how much fluid you drink, how often you urinate, and urine output. Record your body weight at the same times and on the same scale daily.

• Call your health care provider if

  Make an appointment with your health care provider if:

  • Excessive nighttime urination continues over several days, and is not explained by medications or increase of fluids before bedtime
  • You are bothered by the number of times you must urinate during the night
• What to expect at your health care provider's office

  Your health care provider will perform a physical examination and ask questions about your nighttime urination, such as:

  • When did it start?
  • How many times does this occur each night?
  • Has there been a change in the volume of urine produced?
  • Do you ever have "accidents" or bed wetting?
  • How much urine is voided each time?
  • What makes the problem worse? Better?
  • How much fluid do you drink before bedtime? Have you tried restricting fluids before bedtime?
  • What other symptoms are also present? Do you have increased thirst, pain or burning on urination, fever, abdominal pain, or back pain?
  • What medications are you taking?
  • How much caffeine do you consume each day?
  • Have you had any bladder infections in the past?
  • Do you have a family history of diabetes?
  • Does nighttime urination interfere with adequate sleep and rest?
  • Do you drink alcoholic beverages and, if so, how much each day?
  • Have you changed your diet recently?

  Diagnostic tests that may be performed include:

  • Blood urea nitrogen
  • Serum creatinine or creatinine clearance
  • Fluid deprivation
  • Osmolality
  • Serum electrolytes
  • Blood sugar (glucose)
  • Urinalysis
  • Urine concentration
  • Urine culture

  Treatment depends on the cause. If excessive nighttime urination is due to diuretic medications, you may be told to take your medication earlier in the day.

• References

  Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 3.

Review Date: 9/30/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.