Getting up at night to urinate is called nocturia. Doing it now and then is normal, but when it happens two or more times almost every night, sleep suffers and you feel tired during the day. It is very common after 50, and many men immediately think of the prostate. Sometimes it is… and often it is not.
The most common causes
1. Producing too much urine at night
One of the most common causes, and it has nothing to do with the prostate:
- Drinking a lot in the afternoon or evening, especially coffee, tea or alcohol.
- Taking diuretics late in the day.
- With age, the body concentrates urine less at night.
- Swollen legs during the day: when you lie down, that fluid returns to the circulation and is passed as urine.
- Some conditions, such as heart failure or poorly controlled diabetes.
2. A bladder that fills up “too early”
- Benign prostatic hyperplasia (BPH): the enlarged prostate makes emptying harder and urine stays in the bladder.
- Overactive bladder: sudden urges even when there is little urine.
- Urinary infection or, less often, stones.
3. Poor sleep for another reason
Sleep apnoea or insomnia wake you up, and once you are awake, you go to the toilet.
When does it point to the prostate?
The prostate is more likely to be the cause if, besides getting up at night, you notice:
- A weak or interrupted stream
- Difficulty starting to urinate
- A feeling that the bladder is not fully empty
- Dribbling at the end
- Needing to go again shortly after urinating
Read more on Benign prostatic hyperplasia.
A simple trick: the bladder diary
For 2 or 3 days, write down when you urinate, how much (using a measuring jug) and what you drink. This shows whether you produce a lot of urine at night or pass small amounts often (more typical of the bladder or prostate). Bring it to your appointment: it saves tests and helps choose the right treatment.
What you can do from today
- Drink normally during the day, but cut down on fluids in the 2–3 hours before bed.
- Avoid coffee, tea and alcohol in the evening.
- Urinate just before going to bed.
- If your legs swell, raise them for a while in the late afternoon.
- If you take diuretics, ask your doctor whether the timing can be changed (do not change it yourself).
When should you see a urologist?
- If you get up two or more times almost every night and it affects your rest.
- If you also have urinary symptoms (weak stream, urgency, incomplete emptying).
- If there is blood in the urine, fever or pain.
- If you are very thirsty and pass a lot of urine during the day too.
- Go to A&E if you cannot pass urine.
How do we assess it?
In clinic we review your symptoms and bladder diary, carry out an examination and, depending on the case, a urine test, PSA, an ultrasound to check prostate size and the urine left in the bladder, and uroflowmetry (stream strength). Treatment depends on the cause: an obstructing prostate is not the same as producing too much urine at night.
Frequently asked questions
Is it normal to get up once at night?
From a certain age, getting up once can be usual if it does not stop you resting. If it is two or more times every night, it is worth looking into.
Is drinking less water the answer?
Only in the evening and at night. During the day you need to stay well hydrated: drinking too little concentrates the urine and can irritate the bladder.
Do prostate tablets cure nocturia?
They can help when the prostate is the cause. If the problem is producing too much urine at night, they are not enough and the cause needs treating.
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