In my private practice as a urologist, I recently saw a 64-year-old patient who I’ve been treating for several years for recurrent kidney stones. At this visit, however, she said that she now wakes up to urinate up to five times over the course of the night. The loss of sleep, she said, was causing major problems during the daytime in terms of her mood and productivity. She said she felt tired, depressed and was worried that the frequent trips to the bathroom might be a symptom of something more serious.
Some urinary conditions or diseases can have multiple symptoms, one of them being nocturia, or the need to wake up several times during the night to urinate. The word nocturia comes from the Latin “nox” for night, and the Greek word for urine, “ouria.”
Nocturia is more common as we age and affects both men and women. Women can start to experience nocturia as early as age 30. Beginning in their 50s and 60s, men and women experience nocturia at the same rate, regardless of their sex.
About 1 in 3 people experience nocturia in their lifetime, and it is normal to wake up at some point during the night to urinate. Waking up several times a night, however, can affect your quality of life and, in some cases, be indicative of another problem, or a need for certain lifestyle changes.
If you’re waking up during the night because you’re thirsty, anxious, or are in pain and also go to the bathroom — that’s not the same as nocturia.
Nocturia itself is easy to diagnose because it is simply the need to wake up several times at night to urinate over a period of time (not one night where you drank a lot of liquids, for instance). Nevertheless, it is more complicated to determine why a person needs to urinate frequently during the night, and depending on the underlying cause, it can range from easy to difficult to treat.
I regularly see patients with mild to major anxiety and a list of possible ailments they are worried they may have after spending a night searching their symptoms on the Internet, going down a rabbit hole of information that can be anxiety producing for someone without a medical background.
The causes of nocturia can include a wide variety of underlying conditions. It can be as simple as caffeine and alcohol intake, medications, sleep conditions, a urinary tract infection or complications related to diabetes. In some cases, it can be indicative of a more serious condition such as congestive heart failure, kidney failure, or a bladder, urethra or a prostate tumor, among other possibilities.
My 64-year-old patient ended up having a cystocele, otherwise known as a fallen or prolapsed bladder. We are now in the process of determining what is the best course of treatment for her, which can range from physical rehabilitation to surgery.
Nocturia can be a difficult issue to discuss because people often feel embarrassed bringing it up or are fearful of what might be wrong. While as a medical doctor I have to always consider the most serious potential causes of nocturia such as cancer or congestive heart failure, it could also be an enlarged prostate, a urinary tract infection or a symptom of a sleep condition.
If the nocturia is caused by an enlarged prostate, there are a variety of ways to treat the condition. I have some patients with an enlarged prostate whom I treat with medication and others who require surgery. Treatment for urinary tract infections involves medication and dietary changes.
Physicians walk a fine line between worrying patients unnecessarily and keeping them informed of the process of diagnosis and treatment. So, I always tell my patients that nocturia is, at a minimum, an annoyance that sometimes points to something more serious, which requires closer treatment and follow-up. Nocturia is a symptom that should not be taken lightly, but fearing the worst is a terrible reason not to see a doctor.
If you or a loved one are experiencing nocturia, I suggest seeing a urologist about the symptoms before your quality of life is affected. The physical, mental and emotional toll taken on us when we don’t know what is going on with our bodies is much worse than a trip to the doctor’s office to find out what’s happening and what we can do about it.
Marcos Del Rosario-Santiago is a urologist in the Mexican navy and a member of the American Urological Association.