Waking up in the middle of the night for a trip to the bathroom throws a wrench in your quest to get a good night's sleep — and it's only harder to get quality zzzs if it happens multiple times each night.
It's not a major concern if the need to pee at night occurs every once in a while.
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"In a patient with a perfectly healthy bladder, I would expect they either don't wake up at night to urinate, or occasionally wake up once if they were drinking fluids up to their bedtime," says James Anaissie, MD, a urologist at Memorial Hermann in Houston.
But when nighttime urination (aka nocturia) becomes more frequent, it could point to an underlying health concern.
"Waking up at night to urinate can be really disruptive to a good night's sleep, and is often a sign that your bladder is struggling," Dr. Anaissie says.
Causes of Frequent Urination at Night
There are many, many different potential reasons behind nocturia — here's a look at some of the most common:
- Late-night beverages: "[Nocturia is] going to be normal, for a person who drinks a lot of fluids at night," says S. Adam Ramin, MD, urologist and medical director of Urology Cancer Specialists in Los Angeles.
- Cardiovascular issues: If you have a heart condition such as hypertension, you'll retain fluids throughout the day. "Then what happens is, at night, when they're laying flat, all that fluid turns into urine," Dr. Ramin says.
- Enlarged prostate: For people with a prostate, frequent peeing during the night is "a sign that your bladder is fighting to empty but blocked by an enlarging prostate," Dr. Anaissie says.
- Overactive bladder: More commonly in people assigned female at birth (AFAB), nighttime urination could be "a sign of an overactive and hypersensitive bladder," Dr. Anaissie says.
- Aging: If you never used to pee at night, but find it's common now, it could simply be that you're getting older. "Nocturia is more common with age, which is partially due to dysregulation of a hormone called arginine vasopressin that occurs with aging," says Tess Crouss, MD, FACOG, urogynecologist at Axia Women's Health.
- Other health conditions: Along with cardiovascular conditions, overactive bladder and an enlarged prostate, other health conditions — including sleep apnea, sleep disorders, a urinary tract infection, kidney disease and diabetes — can be a factor in nocturia, Dr. Crouss says. Pregnancy can also lead to nighttime urination, she says. And there can be a psychological component that contributes, she adds.
- Medications: There are also some medications, such as diuretics and steroids, that can lead to nighttime peeing, Dr. Crouss says.
The good news: "All of them have some treatment," Dr. Ramin says. Some can be treated well, while others can only be mitigated, he notes.
Here, a look at some simple at-home remedies to consider, as well as when to see a doctor.
1. Drink Less Before Bed
The most obvious solution tops the list: Restrict fluids at nighttime.
"Sometimes people are too busy to hydrate well throughout the day, and when things finally slow down when they get home, they overcompensate and end up waking up to empty their now-full bladder," Dr. Anaissie says. If you recognize yourself in that description, change the habit: Drink throughout the day, then cut yourself off from fluids in the evening.
"I always tell my patients to hydrate well throughout the day by carrying a refillable water bottle, so that when they come home, they don't have to overdo it right before bed," Dr. Anaissie says.
Cut down on fluids for the three to four hours prior to your bedtime, Dr. Crouss says — so, if you turn the lights out at 11 p.m., that means drinking less starting at 7 or 8 o'clock.
One other tip: Pee before you slip between the sheets. "Emptying your bladder before bed, sometimes even twice before bed, can help with nighttime urination," Dr. Crouss says.
How Many Times a Day Should You Pee?
Logically enough, how often you pee throughout the day depends on a few factors — including how much you drink. Guzzle water all day long, and you’ll understandably visit the bathroom more frequently than someone who only has a morning cup of coffee.
Peeing about five to seven times a day is considered normal, Dr. Crouss says. “We diagnose patients with nocturia who complain of being awoken from sleep to urinate one or more times during the night,” she adds.
2. Stay Away From Bladder Irritants
Here are some of the big offenders when it comes to things that irritate the bladder, according to the Mayo Clinic:
- Carbonated beverages
- Acidic or spicy foods
And consider this yet another reason to quit smoking. "Smoking has been linked to bladder irritation and can contribute to nocturia," says physical therapist Jennifer Self Spencer, PT, DPT, of Magic City Physical Therapy in Alabama.
You can cut these items out of your life entirely for a brief period — like a week — to see if it makes a difference, then add one item back every few days after that to see if it's a culprit, per the Mayo Clinic. You may not have to remove alcohol and chocolate or other items entirely; you can also try reducing how much you have.
And consider the timing, too: Spencer recommends avoiding these bladder irritants in the afternoon and evening in particular.
3. Try Compression Stockings
Here, it helps to think about one of the causes of nighttime urination: retaining fluid. Edema can occur for several reasons, from medication side effects to heart failure to being premenstrual to eating salty foods, per the Mayo Clinic.
At night, as you lay flat, the fluid that was retained (frequently in the legs and feet) turns into urine, Dr. Ramin says.
The solution: elevating your legs. Another option: wearing compression stockings during the day. This helps prevent fluids from building up in your legs and helps you go more.
"If you can circulate excess fluid earlier in the day, less fluid will be loaded into your bladder overnight," Dr. Crouss says.
Look for stockings that are thigh-high, Dr. Ramin recommends. One option: Jomi Compression Stockings ($37.99, Amazon).
4. Get Some Exercise
Exercising during the day also helps cut down on nightly bathroom visits. Cardiovascular exercise is particularly helpful, Dr. Ramin says (think: walking, jogging, playing tennis or anything else that gets your heart pumping).
"A sedentary lifestyle can contribute to fluid retention in the body, leading to increased urine production and nocturia," Spencer says.
One caveat: Avoid nighttime exercising and moves that put pressure on the bladder or prostate (like riding a bike), Dr. Ramin says.
5. Do Kegel Exercises (but Check With Your Health Care Provider First)
Kegel exercises "can help reduce bladder overactivity" for everyone, Dr. Ramin says. And you can do them whenever you want — not just before bedtime. Aim to do 30 to 40 Kegels a day, Dr. Ramin recommends.
Here's how to do it, according to the National Library of Medicine:
- Sit or lie down in a comfortable position (make sure your bladder is empty)
- Tighten your pelvic floor muscles (the ones you use to stop your urine flow), and hold for three to five seconds. Make sure you're not also tightening your stomach, thighs, butt or chest muscles
- Relax for three to five seconds, then repeat. Do three sets of 10 Kegels each.
This advice comes with caveats: if someone has an enlarged prostate and incomplete bladder emptying, Kegel exercises can lead to retaining fluid, Dr. Ramin notes. They'll also worsen symptoms in other scenarios, such as if you have hyperactive or "tight" pelvic floor muscles, Dr. Crouss says.
The upshot: "Kegel exercises are recommended in some patients, but not in others," Dr. Crouss says — so before using every moment waiting at a red light to squeeze those muscles, check in with your health care provider.
6. Adjust the Timing of Your Medications
In some cases, medications (such as diuretics, aka water pills) can lead to nighttime urination. If that's the case, talk to your health care provider about when you take these meds, Dr. Crouss says.
"They could explore switching the timing of their medication to afternoon hours to increase urination right before bedtime and not during sleeping hours," she says.
What About Medications for Nocturia?
One option is to try taking a non-habit-forming sleep medication (think: Benadryl) to help you sleep through the urge to get up and use the restroom, Dr. Ramin says. But try this tactic only if you’re finding yourself waking up once a night for the bathroom (and avoid it if you wake up multiple times per night), he says.
Plus, you can get a prescription for phenazopyridine, Dr. Anaissie says. Along with easing symptoms like pain and burning, this medication can also reduce urgent and frequent urination, per the National Library of Medicine.
But be cautious about medications — they’re a bandaid on the problem and don’t address the root cause, Dr. Anaissie says. In the long run, that can “delay appropriate treatment,” he says. (Of course, the appropriate long-term treatment may require medications to treat the underlying cause of your nocturia.)
What About Drinking Apple Cider Vinegar?
There's no evidence that apple cider vinegar can ease nighttime urination. "If anything, it's going to put a lot of acid in the bladder, and cause irritation to the bladder," Dr. Ramin says.
Indeed, vinegar, apples and apple juice can all be bladder irritants, according to the Cleveland Clinic.
What About Drinking Cranberry Juice?
If you're prone to urinary tract infections (UTIs), you've likely read the advice to guzzle cranberry juice. There's a kernel of truth in that pure cranberry juice — which is incredibly tart and not easily digestible — can sometimes help in early UTIs, Dr. Ramin says.
But the cranberry juice you buy in the store is mostly apple juice, sugar and water (with a tiny percentage of actual cranberry juice), he points out. What's more: There's no evidence it can help with nocturia.
What About Taking Supplements?
It's always wise to tread carefully when it comes to supplements, and that's true when it comes to ones that might ease frequent urination at night, too.
"The American Urologic Association has not found any supplements that treat this problem just yet," Dr. Anaissie says.
That said, there are some that might be worth considering:
- Saw palmetto: Studies have shown that taking saw palmetto may reduce urination frequency, per Mount Sinai. For instance, one smaller double-blind study that examined the effects of saw palmetto on 44 men found that it relieved urination-related symptoms, according to August 2020 results in Food Science & Nutrition. This is only appropriate for people assigned male at birth (AMAB), per Dr. Ramin.
- Beta-sitosterol: Another recommendation for people AMAB only. This supplement may be helpful with nocturia, per Consumer Lab.
Is It Due to an Overactive Bladder or an Enlarged Prostate?
Frequent urination at night — and also during the day — can be a sign of an overactive bladder (OAB), Dr. Anaissie says.
“It’s a very common problem that I treat all the time,” he says. It's more commonly seen in people AFAB, and especially those who are older, but it can happen to anyone. Other symptoms of OAB include frequent urination and urgency incontinence, according to the Mayo Clinic.
“A lot of people suffer for too long with this issue, but there are some easy things we can do to reduce it significantly,” Dr. Anaissie says. This includes procedures (such as Botox injection in the bladder), daily medications and behavioral treatments, he says.
Another reason for frequent urination is an enlarged prostate. (Note: This small gland, which helps make semen and increases in size with age, is only present in people AMAB, per the National Cancer Institute.)
Both the causes and treatment of overactive bladder and enlarged prostate are different. “Overactive bladder is due to the bladder muscle or nerves being hypersensitive, while on the other hand with a big prostate, the flow of urine is blocked and the bladder is working overtime to force all the urine out,” Dr. Anaissie explains.
An enlarged prostate can be treated through medication or same-day surgery, he says.
When to See a Doctor
Here are a few indicators that it's time to check in with your health care provider about nighttime peeing:
- It's disrupting your sleep. Nighttime urination can mess with both your sleep quality and quantity — and that's reason enough to see a doctor. Or think bigger. Here's when Dr. Anaissie recommends seeing a doctor about nocturia: "Whenever it starts to bother you." He counsels that people should listen to their body. "If you feel like it's getting bothersome, it's likely your body telling you that something is wrong with your bladder," Dr. Anaissie notes — and when left untreated for a while, bladder problems can cause permanent bladder damage, he says.
- It's a change in your peeing habits. If you went from never peeing at nighttime to doing so every night, make an appointment. "If you have sudden changes in your urination habits, blood in your urine, bladder pain or other unusual symptoms I would recommend seeing a clinician right away," Dr. Crouss says.
- Simple fixes aren't working. Maybe you never used to wake up at night to urinate, and now you do — so you've tried adjusting your hydration habits, avoiding certain foods or wearing compression stockings, but aren't seeing a difference. It's good to do all the things on this list, Dr. Ramin says. "But if none of these are helping, or the nighttime urination is more than once or twice, it's important to see a health specialist and determine the baseline reason for these problems," he says.
You can start with your primary care doctor, or reach out to a urologist or urogynecologist.
- Mayo Clinic: "Edema"
- Cleveland Clinic: "Bladder-Irritating Foods"
- Mount Sinai: "Saw palmetto"
- Food Science & Nutrition: "Effects of saw palmetto fruit extract intake on improving urination issues in Japanese men: A randomized, double‐blind, parallel‐group, placebo‐controlled study"
- Consumer Lab: "9 Supplements That May Help Reduce Nighttime Urination (And 4 That May Not)"
- National Cancer Institute: "Understanding Prostate Changes: A Health Guide for Men"
- Mayo Clinic: "Overactive bladder"
- National Library of Medicine: "Kegel Exercises - Self-care"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.