by S. ADAM RAMIN, M.D.
Do you wake up multiple times a night to go to the bathroom? PHOTO/Getty Images
There’s a name for the condition that causes people to wake from sleep due to the urge to urinate.
There are plenty of light sleepers who wake up in the night and decide to go pee before falling back asleep. Perhaps it was a nightmare or a neighbor’s barking dog that woke them. In these cases, it wasn’t the urge to urinate. A condition called nocturia is different. It means waking up with an urge to urinate, strong enough that it forces a person to leave the bed and go to the bathroom.
For those suffering from this condition, these nighttime wake-up calls may be once a night or more. Once a night nocturia may be considered normal for individuals over the age of 45. However, the more times a night a person gets up to void their bladder, the more severe the nocturia is considered.
Nocturia stems from a number of broad categories:
1. Central Nervous System Disorder
Once the bladder fills up close to capacity, it will instinctively want to contract to empty itself. This is a natural reflex of the bladder muscle. However, our brains have learned from childhood to inhibit these natural contractions until we’re in the bathroom. If the brain’s capacity to inhibit the bladder becomes weak or destroyed, a person would have frequent urges to urinate and possibly leak urine before reaching the bathroom. This increased urge and increased frequency of urination can exist in patients with disease processes that affect brain function. These include dementia, Parkinson’s disease, brain tumors, history of brain stroke, radiation to the brain, brain surgery and sleep apnea. Why sleep apnea? This is currently a hot topic of research in medicine. It is thought that sleep apnea patients have decreased oxygen flow to their brain, as they stop breathing intermittently during sleep. Decreased blood flow then causes brain malfunction, leading to less inhibition of the bladder, which finally leads to more urges to urinate at night.
2. Cardiovascular Disorders
Our heart and vascular system has to successfully pump blood to the kidneys in order for the kidneys to filter the blood and produce urine during the waking hours. If our cardiovascular system fails to pump enough blood to the kidneys, the body tends to retain a great deal of fluid during the day time. During the waking hours, we’re mostly in a sitting or standing position. A weakened cardiovascular system may not be able to pump blood against gravity from the lower part of the body (legs) to the heart. Therefore, the legs get swollen and lots of fluid is retained in the body during the day time. Once the person lays flat to sleep, however, the weakened cardiovascular system is no longer working against gravity. All the fluid that was accumulated in the lower body gets back in the blood stream and pumped to the kidneys, which go into overtime filtering and making lots of urine. Many people with this problem notice that they tend to make more urine at night than during the day. Since there is an increase in production of urine at night, they tend to naturally wake up more often to urinate, therefore resulting in nocturia. The most common types of disease that cause this problem are heart failure and severe varicose vein disease (known as lower extremity venous insufficiency).
3. Bladder Muscle Disorders
This category is also know as “over active bladder.” Under normal circumstance, as the bladder fills with urine, it expands and fills up like a balloon. If the pressure continues to increase at low volumes before overfilling, it will by reflex contract, giving the person a severe urge to urinate and empty itself before one reaches the bathroom. Disorders of the bladder muscle will lead to a decreased capacity to hold urine. Therefore, the person will get an urge to urinate more frequently (i.e. at a lower-than-normal amount of urine inside the bladder). This increase in frequency due to bladder muscle disorder translates into frequency of urination during the day and at night. The bladder muscle can become disordered in many disease processes. Such conditions include diabetes, bladder cancer, cystitis, urinary tract infection, bladder stones, pelvic prolapse, pelvic tumors, age-related atrophy of bladder muscle and benign prostatic hyperplasia or enlarged prostate.
The most common disease process that causes this problem in men is an enlarged prostate. Enlarged prostate leads to thickening of the bladder wall, as the bladder wall muscle has to push against the obstruction of prostate to empty. Thickening of the bladder wall leads to reduce bladder capacity, reduced bladder elasticity and, therefore, frequency of urination day and night. In women, there is a natural decrease in the capacity of the bladder over time.
No matter the cause, if you’re suffering from nighttime urges to urinate that are disrupting your sleep, be sure to set up an appointment with a urologist to get to the bottom of what’s going on and get back to your ZZZs.
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