When was the last time you slept through the night without getting up to urinate? If you’re a man over the age of 50, it may have been a while. As you age, nighttime trips to the toilet often become frequent. Half of men in their 70s will have to get out of bed 2 or more times each night, according to estimates from Harvard.
That’s more than a mild annoyance. Missed sleep can lead to daytime drowsiness, or worse. Poor sleep has been tied to accidents and chronic health conditions such as heart disease, diabetes and depression. (If you have an ongoing health issue, the Optum Perks mobile app can help you save money on your medication.) So, what’s behind all that nighttime urination? And what can you do about it?
Why your prostate makes you want to pee
The technical term for the sleep-stealing urge to urinate is nocturia. While both men and women experience it with aging, men often experience it more severely. Blame falls on the male-specific organ that sits just below a man’s bladder.
“Nocturia is most commonly caused by an enlarged prostate,” says Alex Shteynshlyuger, MD, director of urology at New York Urology Specialists in New York City. “Most men experience the need to wake up to urinate as a consequence of prostate enlargement in their 50s and 60s. However, some men start to experience the symptoms in their early to mid 30s.”
The condition behind the swelling is called benign prostatic hyperplasia, or BPH. It’s a normal part of aging for men. But if it’s waking you up, it’s something you should take seriously. “Nocturia can cause significant collateral damage, including feelings of tiredness, decreased energy levels, a decrease in libido and a drop in work performance,” says Dr. Shteynshlyuger.
How does BPH influence urination? For starters, an enlarged prostate can alter bladder function, effectively limiting how much liquid it can hold, says Dr. Shteynshlyuger. At the same time, it irritates your bladder, and it can squeeze your urethra. That results in a constant urge to urinate and an inability to feel complete relief. (Your urine can reveal a lot about your health. Learn more here.)
Is increased urination a problem?
If you’re not sleeping, that’s a problem in itself. But in some cases, increased urination frequency is a sign of other health issues.
Diabetes is one risk factor. Excessive blood sugar leads to an increased volume of urine, says Dr. Shteynshlyuger. “Often, frequent urination at night is the first sign that brings patients to a urologist and leads to a new diagnosis of diabetes.” Men with diabetes often find they can sleep longer between urinating when they begin managing their diabetes. (Check out these 6 other early warning signs of type 2 diabetes.)
Nocturia could also indicate other problems. Among them are congestive heart failure, obstructive sleep apnea and other sleeping disorders. In some cases, it could also signal prostate cancer.
If your frequent urination is more than just occasional, schedule an appointment with your physician, says Dr. Shteynshlyuger. You want to get it checked out. But at the same time, don’t panic. In many cases, you might be able to manage the problem without medical intervention.
Cutting back on sodium can help with frequent urination. So can drinking less fluid at night. If you’re in the habit of drinking a mug of tea or a beer before bed, that could be the problem. Caffeinated or alcoholic beverages are particularly good at making you urinate.
Medication might also contribute to nocturia. Diuretics, or water pills, are a common cause. Many people take them to manage high blood pressure.
To get to the bottom of what’s behind your nocturia, your doctor will discuss the details of what you experience, perform a physical exam and review your current medications. You’ll have your blood pressure evaluated and your prostate checked. Your doctor will also measure your urine flow and perform an ultrasound of your bladder and prostate.
Treatment options for an enlarged prostate
The first-line defense is often behavioral, says Dr. Shteynshlyuger. As mentioned above, you might find relief by decreasing your sodium intake and drinking less fluid before bed. That might also require you to adjust other activities associated with nighttime fluid consumption, such as late dinners or exercise.
For more severe urination problems, your doctor may prescribe tamsulosin (Flomax®). The medication relaxes the muscles that put pressure on your urethra, the tube that carries urine away from your bladder.
If nothing else works, there are surgical options. Dr. Shteynshlyuger points to UroLift® and Rezūm® as examples of innovative, minimally invasive procedures that ease the symptoms of BPH. UroLift compresses prostate tissue so that it does not block your urethra, while Rezūm uses steam to reduce excess prostate tissue and improve urination.
Whatever the cause of your increased urination, it’s important to make a plan with your doctor. That’s how you get back to sleeping easy.
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