I have to pee in the middle of the night, sometimes more than once. Is something wrong with my bladder?
This annoyance may be commonly associated with old men (and pregnant women), but you don’t have to be of advanced age or knocked up to experience it. Overnight bathroom visits could be an indicator of another health problem or simply a matter of your habits, says Lisa Hawes, M.D., a board-certified urologist at Chesapeake Urology in Fulton, Maryland.
For instance, if you tend to work out in the evening and you chug a huge bottle of water afterward, that could be the culprit. If you like to have wine or tea after dinner, you’re basically asking for more pee breaks. Alcohol and caffeine can make urine more acidic, which irritates the lining of the bladder, Dr. Hawes says, meaning you’ll have to go more frequently or more urgently.
But maybe you’re the type of person who just goes a lot by nature — or as a result of your aggressive hydration routine. “If you have frequency during the day, it’s not surprising that you might be getting up a lot at night,” she says. Exactly how often is considered frequent? Dr. Hawes says that most people probably go about four to six times a day; peeing eight times is a lot. She points out that the bladder holds 10 to 15 ounces, so if you’re putting away something like 100 ounces of liquid a day (about three liters) you’re bound to hit the bathroom as often as the water cooler. “That’s not frequency because of a problem, that’s simple math.”
Some simple biology could be at work if you don’t go No. 2 very often: Dr. Hayes says being constipated can make it harder to empty the bladder. (And if lots of peeing is a new, sudden issue and you also have pain or burning when you go as well as cloudy urine, it could be a good, old urinary tract infection.)
There are also medications that can make you relieve yourself more often so you should time them appropriately. If your doctor has you on a diuretic for something like high blood pressure or polycystic ovary syndrome (PCOS), it’s best to take that in the morning, Dr. Hawes says. These so-called water pills tend to last for about six hours so even if you pop them in the early afternoon, you should be safe.
Dr. Hawes will ask patients who complain of nocturia — the official name for middle-of-the-night bathroom trips — if their ankles or calves swell during the day. Fluid that builds up in the legs gets sent back into the bloodstream when a person lies down, increasing their blood pressure. In response, the heart kicks the kidneys into gear to make more urine to help get rid of this fluid. Cue you waking up from a beautiful sleep.
Sleep apnea can also make the kidneys go into overdrive. The disorder, where breathing stops and starts during sleep, is more common in obese people but can also be the result of the anatomy of your airway. Snoring is a common sign. People with sleep apnea make a lot of urine at night, she says, so she’ll ask if nighttime pee-ers have it; if they do and have been prescribed a CPAP sleep mask, then they need to wear it.
And now for an Inception-esque consideration: Are you waking up because you have to pee or are you peeing because you’re already up? Maybe you’re lying awake in bed, either because you can’t fall asleep or you woke up for some reason, and you feel a faint urge to go — this is a different beast entirely.
If you often wake up from a dead sleep with a pressing need to go to the bathroom and it’s not explained by something like a few glasses of wine or a medication, it may be time to call your doctor. If you’re frustrated by it, that is. “It’s a quality-of-life issue,” Dr. Hawes says. “If someone gets up once a night and they fall right back to sleep and it doesn’t bother them, fine. But if you get up once and you’re up for two hours afterward, that’s a problem.”