Page 8 - Urological Health

3. Why do I have to get up so often at night to urinate?

Waking up at night because you need to urinate is an especially common and especially bothersome
symptom, because it interrupts your sleep and can leave you feeling tired or unrefreshed in the
morning and throughout the day. This symptom is called nocturia. It is also one of the more difficult
urinary symptoms to manage.

The first issue is to distinguish between waking up because of the need to urinate and waking up
for other reasons and then deciding to go to the bathroom. The second problem may be unrelated to
urination, and may be best managed by improvements to your sleep and sleep habits.
The issues leading to nocturia may be similar to the issues that affect your voiding during the day.
Please see the chapter on Lower UrinaryTract Symptoms and Prostate Health for details. If the bladder
empties sluggishly or incompletely during the day, it will likely do the same at night. Other changes at
night may contribute to nocturia, however, some of which you can modify to decrease the problem.

Many people will have some amount of fluid in the tissues that pools in the legs or ankles during
the day, when we spend our time upright. This may be noticeable as ankle swelling, or may go
unnoticed. At night when you lie down, this fluid is no longer trapped in the legs and feet, and can
redistribute back into the bloodstream, where the kidneys eventually filter it into urine. Some people
may also make less of a certain hormone (antidiuretic hormone or ADH) at night. Both of these
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problems will result in more urine being produced at night, and consequently the need to wake up to
urinate.

The answer may be simpler than this, however. If you drink a significant amount of fluid in the
evening before bed, this will result in more urine production during the night. If you do not empty
your bladder at bedtime, you will also be more likely to wake in the night. These are hints at a strategy
to reduce the amount and burden of nocturia.
If you are bothered by nocturia, then a few steps may be helpful. The first is to limit the amount
of fluid intake after dinner. Of course, this cannot always be totally avoided, as in the case of evening
medications. Making sure you urinate immediately before bed will ensure as empty a bladder as
possible, and the best chance at uninterrupted sleep. Sometimes medications taken to help improve
the urinary stream (see the chapter on Lower Urinary Tract Symptoms and Prostate Health) can
improve bladder emptying and increase the time before you next have to void. In some cases, changing
the amount or timing of other medications you take (such as diuretics or “water pills”) can be helpful
in changing your urine production and urination. Always talk to your prescribing doctor before
considering this.

Some people have also found that keeping a urinal next to the bed can help. It will not change the
number of times you wake to urinate, but it can save the trip out of bed to the bathroom. If you are slow
moving in the night or prone to unsteadiness or falls, this may be helpful.

4. Why do I dribble urine after I urinate?

A common problem some men experience is the dribbling of a small amount of urine after you have
finished in the bathroom. This can simply be annoying, or can be troublesome if there is enough
leakage to make your underwear feel uncomfortable, or to show through your pants.

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