How many times should you pee at night?

Left unchecked, nocturia is not just a minor nuisance. It can lead to broken sleep, daytime fatigue and, in older adults, a higher risk of falls on the way to and from the bathroom

So, where is the line between "normal" and "too much?"

Read: Check- up: The essential tests you should have

Dr Carnjini Yogeswaran, a consultant urological surgeon, says waking up more than two times to pee is considered abnormal, especially when it is causing sleep disturbance.

The body actually produces less urine at night due to an evening surge of a hormone called anti-diuretic hormone. This surge decreases with age and with some medical conditions like sleep apnoea.

"Nocturia is more common in older men and women and it is also associated with increased falls and injury in the elderly," she says.

Some medical conditions that cause frequent night-time urination include incomplete bladder emptying due to an enlarged prostate, overactive bladder, urinary tract infections (UTI), diabetes, sleep apnoea, kidney failure, heart failure and drugs such as diuretics.

"While menstruation and ovulation does not affect urination, pregnancy does often due to the enlarged uterus pressing on the bladder." 

Additionally, Dr Carnjini explains that caesarean sections and vaginal births also do not directly damage the bladder but, pelvic organ prolapse – which is more common after vaginal delivery – can affect how the bladder functions. 

Leakage of urine

"This may lead to leakage of urine, a condition known as urinary incontinence."
 
Coils too may cause or exacerbate bladder pain. On the other hand, recurrent infections do not usually permanently change bladder behaviour.

It is often the underlying condition causing the infections that affects how the bladder functions.

"UTIs are more common in women than men because the female anatomy makes them more prone to ascending infections from the vagina or anus," she explains. 

Also read: Pelvic floor disorder Help! How do I stop my urine leakage?

In men, infections occur in older age often when there are problems associated with incomplete bladder emptying due to an enlarged prostate.

She adds: "Younger men almost never get a UTI and should this happen, it must be investigated for an underlying cause. This is important as I see many younger men age 20-40 years being mis-diagnosed with UTIs. Sexually Transmitted Infections (STIs) are far more common in this age group and can have similar symptoms."

Can nocturia ever be a sign of prostate cancer?

"Nocturia is rarely a direct symptom of prostate cancer. Many men with prostate cancer have an enlarged prostate which may cause nocturia."

But, nocturia can be a symptom of an enlarged prostate and men with such may have erectile dysfunction. To assess a patient who reports frequent nocturnal urination, Dr Carnjini says a full urological assessment is done.

"This would entail a history, examination and tests like urine microscopy, culture and sensitivity, prostate-specific antigen (PSA) in men, kidney function tests and an ultrasound of kidney, bladder and prostate. Sometimes a bladder diary may be requested.

In the same measure, non-medication approaches that work include avoiding drinking after a certain time in the evening depending on when bedtime is and avoiding a large thermos of tea in the evening is also effective.

Also, Dr Carnjini says if you are going to have some alcohol in the evening then you should expect to wake up a few times at night.

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