Urine production decreases at night-time – allowing a good 6-8 hours’ worth of sleep without interruption. However, some people feel the need to go to the toilet in the middle of the night, sometimes frequently. This can severely disturb their sleep patterns, which may produce further health issues.

Nocturia is a condition where people have to pee at least twice a night. This affliction is most common in the over-60s.

Peeing a Lot Before Bed - Why?

There are several reasons why certain individuals may be peeing a lot at night time.

• Firstly, drinking too much in the evening, particularly alcoholic and caffeinated drinks, will increase the production of urine.
• Alternatively, it may indicate an underlying health issue, such as diabetes, diabetes insipidus, chronic kidney failure, heart failure, high blood calcium, an enlarged prostate gland or a urinary infection.
• Certain medications may also cause frequent urination at night such as diuretics (water pills).
• Nocturia has also been associated with sleep conditions, such as obstructive sleep apnea. Once the sleeping disorder has been treated, the nocturia may be cured.
• Aging is a major factor in frequent peeing. As we get older, our levels of anti-diuretic hormone, which helps us to conserve fluid, decrease, so we may produce more urine. The bladder muscles may also weaken with age, making it harder to retain urine in the bladder at night.
• Pregnancy and childbirth can also weaken the bladder and pelvic floor muscles, causing urine retention problems in women.

Peeing a Lot Before Bed - What to Do

To help identify the cause of frequent urination at night only, it is useful to keep a record of how much you have had to drink, how often you urinate at night and how much you urinate. You may also want to check your weight daily for any changes – it is important to weigh yourself on the same set of scales at the same time each day.

As it can indicate a serious underlying cause, you need to see a doctor if:

• You are worried about the amount you urinate at night
• You are urinating at night with increasing frequency
• You have a burning sensation when you pee

What the Doctor Will Do

The doctor will enquire about the frequency of your night-time urination, how long you have been experiencing this condition and about your usual evening activities. After asking about your symptoms, the doctor will conduct a physical examination. He/she may also perform certain investigations, such as:

• Urine analysis, to look at the chemical compounds in the urine
• Measuring urine concentration to determine whether the kidneys are working properly
• Assessing the amount of residual urine in the bladder after you pee – this will require an ultrasound scan of the pelvic area

These measurements will determine the functioning of your kidneys and whether peeing a lot at night time is due to an underlying condition, such as diabetes, kidney disease or dehydration. If this is suspected, the following further tests may be performed:

• Blood sugar levels
• Blood urea nitrogen
• Serum electrolyte
• Blood osmolality (the concentration of various chemicals in the fluid portion of the blood)
• Creatinine clearance

Treatment for Frequent Night Urination

The actions you take to alleviate night-time urination depend on the underlying cause of the condition. However, there are some general steps you can take that may help.

• Firstly, you should restrict the amount of fluids you drink in the evening to make sure your bladder is as empty as possible before you go to bed.
• Caffeinated and alcoholic drinks act as diuretics, increasing urine production, so try to avoid these.
• Other foods and drinks, such as acidic or spicy foods, citrus or cranberry juices, chocolate and artificial sweeteners, may irritate the bladder and these should be limited, particularly in the evening.
• To make sure you are well-rested before going to bed, you may want to take an afternoon nap. This may help relieve peeing a lot before bed because you won't be easily awaken. 
• Increasing the circulation of fluids through the body, by wearing compression stockings or keeping the legs elevated during the day, can also help.
• Kegel exercises are specific drills you can use to develop control in an overactive bladder. A relaxation reflex in the bladder is triggered by contracting and then releasing the muscles around the opening of the urethra. The exercises can be practiced by starting urination and then interrupting the flow for 6-10 seconds. Three sets of 8-12 contractions carried out 3-4 times per week is a good starting place.

How to Do Kegel Exercises for Bladder Control:

Advice from Someone Who Has Similar Experience

“I can identify with this. I’ll lie in bed and read for a bit after going to the bathroom, but won’t be able go to sleep until I’ve gone to pee again, even if there’s only a small amount. However, some nights I can overcome the need to urinate and get to sleep. I think the condition may be more serious if you frequently need to pee during the day, with only a little urine each time, as this could indicate a problem with the urinary tract or bladder. If you only do this at night, it may be due to obsessive compulsive disorder. In this case, you’ll probably be okay without any professional intervention, unless it’s really affecting your life. A counselor or a hypnotherapist may be able to help you.”