Why am I leaking urine at night (nocturia)?
Urine leaks at night or waking up at night to urinate are common complaints, but that doesn't make it normal. Women younger than 45-50, should not wake up at night to urinate. After menopause, it is normal to wake up at one time at night but more than that is not normal. If you're pregnant, it is different, you get to wake up because you have a little human sitting on your bladder.
For men, if you are younger than 50 you shouldn't have to wake up in the middle of the night to pee. But as men age, the prostate can enlarge causing that sense of urgency that wakes you up in the middle of the night.
Regardless of whether you are male or female, if your bladder is spasming and waking you up at night to urinate, this is called nocturia.
What is Nocturia?
Nocturia, or waking up at night to urinate occurs because your bladder is spasming, which indicates that you need to go to the bathroom. This urge to urinate, or urgency, is due to either over tightening or weakness of the pelvic floor muscles, indicating that your pelvic floor muscles are unhealthy.
Your bladder can shrink, especially if throughout the day you have gotten to a point where you can't hold it for 2 to 3 hours and you're going too frequently, you can shrink the size of your bladder. That is going to cause your bladder spasm in the middle of the night, and make you get up frequently.
If your muscles are too tight around your pelvic floor that can also be contributing. As can leaking in the middle of the night; if you're leaking lying down then you have some serious pelvic floor muscle weakness that needs to be addressed by a Pelvic Floor Physical Therapist. If you are waking up, and leaking while seated or standing, or leaking with urgency as you try to get to the bathroom, that's probably just your bladder spasming, which again means poor control, but isn’t quite as serious as urine leaks while lying down.
How do I Stop Leaking Urine at Night?
If you want to stop leaking urine at night, or stop nocturia, you need a healthy pelvic floor. Remember that except for during pregnacy, no one under 50 years old should need to get up to go the bathroom in the middle of the night. If you're getting in the later decades of life you get once to wake up, that’s what we consider normal.
If you're leaking urine, what usually happens is people get up because they have a full bladder, they can't make it to the bathroom and then they leak. We will address leaking urine in bed separately.
Your bladder is a muscle, by going too frequently during the day you're shrinking the size of your bladder by not working it out. This causes your bladder spasms, which wakes you to signal that you have to go to the bathroom.
To not leak urine at night you have to start with holding your frequency for 2 to 3 hours during the day. This will ensure your bladder has sufficient capacity. You do want to stop drinking fluids by 7-8:00 at night, or 2-3 hours before bedtime. If you are on a diuretic, like Lasix, you want to put your feet up, so that fluid can get into your bladder before you go to bed. Most importantly, you need to have strong pelvic floor muscles. The stronger your pelvic floor muscles are the stronger a Kegel you can do, which will inhibit the muscle around the bladder from spasming to wake you up.
There are always going to be the special cases where people have just really unfortunate diagnoses, so it is a good idea to see your urologist or your urogynecologist if things are really bad especially but barring that it's poor control of your pelvic floor muscles. If you have any other questions about nighttime leaks or nocturia, don't hesitate to ask (OKC@FYZICAL.com).
-Dr. Lauren Collier Peterson, PT, DPT
FYZICAL Therapy & Balance Centers of Oklahoma City provides pelvic floor physical therapy in Lakeside, The Village, Nichols Hills and surrounding NW Oklahoma City. Our pelvic floor physical therapists are specially trained to treat all types of pelvic floor dysfunction including incontinence in men and women. Our practitioners take a patient-centered individualized approach that focuses on your pelvic health needs. If you are unsure about your pelvic health, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.