Frequent nighttime urination is most commonly caused by three things: your body producing more urine at night, your bladder holding less than normal or signaling that it is full sooner than normal, or a medical condition and/or medication that affects either of these two situations. While occasional nighttime urination is common in older people and does not in itself mean that there is a health problem, frequent nocturia can interfere with sleep and require medical evaluation when it occurs two or more times per night for a period of time.

Prolonged time in bed can pose additional problems for seniors, including falls due to stiffness and balance problems. Blood pressure that drops when standing can also cause falls in people who get up at night to use the bathroom. For family members of seniors, including spouses and adult children, the long hours of overnight care can also take a toll, leaving them fatigued and often caring for the senior by day as well.

Most people understand that as we get older we tend to have to get up more during the night for urination. This is often referred to as “nocturia.” However, what causes this increase in nocturnal voiding and how can it be alleviated? This article will address the reasons for increased nocturnal urine production and how it can be decreased. In addition, we will discuss situations in which medical treatment is necessary and the many ways in which Home Health Care can assist seniors who have to get up during the night for urination.

Common Causes of Nighttime Urination in Seniors

It is rare that only one factor causes the senior to get up during the night to urinate. Rather, there are usually 2-3 factors that are working in tandem. This is why a physician would make a effort to understand the senior’s array of symptoms in trying to arrive at a proper diagnosis.

Age-Related Changes in Nighttime Urine Production

Normally, our bodies produce less urine at night than during the day. This is because of the body’s natural production of an antidiuretic hormone (ADH) called vasopressin. Vasopressin is produced by the body’s hypothalamus and then transported to the pituitary gland where it is released into the blood stream. The blood then carries the vasopressin to the kidneys where it causes the kidneys to make more concentrated urine. As we age, the production of vasopressin at night decreases. Therefore, the kidneys of an older adult produce urine of a similar concentration to that produced during the day. In addition, an older adult’s bladder may hold less urine than it did when they were younger. As a result, what was once considered “normal” frequency of urine production at night can become problematic for an older adult.

Overactive Bladder and Enlarged Prostate

When an overactive bladder occurs, the detrusor muscle contracts prior to the bladder reaching a normal filling capacity, and therefore causes sudden urge to void prior to completion of bladder filling. This condition can occur at any time of day, not just during waking hours.

Similar symptoms are experienced by older men with benign prostatic hyperplasia (BPH), more commonly referred to as an enlarged prostate. The enlarged prostate presses against the urethra which is the tube that carries urine out of the body. This compression causes partial emptying of the bladder and causes the bladder to signal fullness at an earlier time than it normally would. Because of this, men with BPH often get up at night to urinate. In fact, studies have shown that in men over the age of 65, 29% to 33% have BPH and experience symptoms of this condition including nighttime urination.

Diabetes and Urinary Tract Infections

High blood sugar leads to an increase in urine production in an attempt by the kidneys to dissolve and excrete excess glucose. The additional urine contributes to increased frequency of urination as well as increased thirst that in turn contributes to frequency.

Urinary Tract Infections (UTIs) can cause frequent urination as well as the sensation of urinating even after urine has left the body. UTIs can become symptomatic at any age but are especially common in the elderly as they can present with non-specific symptoms such as increased frequency of urination and a change in alertness. If left untreated UTIs can lead to serious complications. Learn more about why seniors experience delirium with a UTI.

Older adults are also more vulnerable to infections, which may sometimes cause symptoms that are easy to overlook. Learn more about common bacterial infections in seniors and how to prevent them.

Certain Medications, Leg Swelling, and other Health Conditions

Many of the medicines used to treat high blood pressure include diuretics that increase urine production. Even if taken during the day, the effects of these medicines can last into the night, causing increased urine production.

Swelling in the lower legs, such as in patients with heart failure or kidney disease, causes fluid that has accumulated in the ankles during the day to return to the circulatory system at night. The kidneys process this fluid and it is excreted as urine several hours later. Also, the consumption of caffeine or alcohol in the evening can cause increased urine production at night.

How Can Seniors Reduce Nighttime Bathroom Trips?

Small changes to daily routines can help lower the frequency of trips to the bathroom at night. These changes are not a substitute for medical evaluation but rather something to work with your doctor.

• Limit Caffeine During the Day: Coffee, tea, and even some colas and chocolate contain caffeine which stimulates the bladder and could cause more frequent trips to the bathroom throughout the day. Try to avoid caffeine in the afternoon and evening.
• Shift more fluid intake to morning and afternoon and cut off fluid several hours before bedtime. Remember that seniors dehydrate easily and that their resulting problems can be far worse than the frequency of urination at night.
• Ask your doctor about the time of day that you take your diuretics. If you take them at night, your doctor may be able to change the prescription to an earlier time in the day.
• Keep a track of the frequency of bathroom trips throughout the day by making a note of time of consumption of fluids throughout the day and time of each bathroom trip in the bladder diary ( offered by the NIDDK to download and print) to help determine whether or not the body is producing too much urine at night time or if the senior’s bladder is not able to hold the urine to facilitate proper sleep.

How to Make Nighttime Bathroom Trips Safer for Seniors

There are a few changes that can be made in order to try to reduce the frequency of a senior’s bathroom visits at night, but there are some visits that just cannot be avoided. In order to help a senior make these visits safely, there are a few things that can be done in order to try to prevent falls and to give elderly parents peace of mind. For people looking to help an elderly parent with nighttime bathroom trips, these are a few changes to consider making in order to help make their senior’s bathroom visits safer.

• Night-lights or plug-in lights are best located from the bed to the toilet, such as motion-activated lights.
• Grab bars installed by the side of the toilet are far more effective than a towel rack to support body weight.
• Clear the path of throw rugs, cables, shoes and stacks of laundry.
• Consider a bedside commode to decrease trips to bathroom.
• Sitting on the edge of the bed for a few seconds before standing also helps.

When Should Frequent Nighttime Urination Be Checked?

We recommend that you make an appointment in a timely fashion if a senior is getting up 2 or more times per night for prolonged periods of time (more than a few weeks), and are feeling fatigued, or unsteady as a result of their lack of sleep and consequent increased frequency of urination.

Call for same day appointment if:

• Pain or burning with urination
• Blood in the urine, or urine that looks pink, red, or cola-colored.
• A sudden increase in the number of times that a senior must get up during the night to use the bathroom (e.g. from once a night to five times a night).
• New leg swelling, even if it is worsening, and severe thirst in addition to the need to urinate frequently.
• New confusion or a clear change in behavior

An emergency room visit or 911 call is warranted if a senior is unable to urinate, has a fever and chills and back or side pain, has become confused and is difficult to awaken, or is experiencing chest pain or difficulty breathing. A nighttime fall and subsequent injury to the head or suspected broken bone warrants an immediate emergency room evaluation or 911 call as well.

This article is for general information purposes only. An accurate assessment of the cause(s) of symptoms described above can only be made by a physician familiar with the patient’s medical history. More information on diseases of the urinary and reproductive systems can be found on the NIDDK’s urologic diseases pages.

How Overnight Caregivers Can Help Seniors

The overnight caregiver will not treat the senior with nocturia, but can assist with the safe and healthy management of their nighttime bathroom trips. The family will rest assured that their loved one is safe and being cared for while they are receiving treatment for their symptoms or getting used to new ailing.

A caregiver who stays awake through the night can:

• Support the senior in getting up from bed by night. Help them walk to the toilet, to help prevent falls.
• Steady them while standing for bathroom use and assist with walking to the bathroom by providing support for walking with a walker or by placing a belt around their waist for support.
• Help a senior to transfer onto and off of a toilet and help them to use a bedside commode at night.
• Assist client with hygiene, use of appropriate incontinence product(s) and clean client up after an accident. Also, change client’s clothing and bedding as needed.
• Help them get back into bed and reposition them in the bed if necessary.
• A note of how many times your loved one got up and any other observations could be recorded by the caregiver and given to the family to bring to the doctor’s attention.

Pride is a powerful force and many people would rather fall than have to call on a son or daughter to get up and answer nature’s call in the middle of the night. Having someone already awake and available to assist an older parent or spouse can reduce the need for that senior to restrict fluids in fear of having to get up and go to the bathroom in the middle of the night. It can also alleviate the fear that causes a family caregiver to wake up frequently during the night in fear that their parent/spouse will have to get up frequently during the night.

Additionally, the support provided to the family caregiver is invaluable. Frequently, the family caregiver is also awakened multiple times throughout the night when their elderly parent or spouse gets out of bed to use the bathroom. This frequent disruption from sleep can have negative effects on the family caregiver over time. Even occasional nighttime care by an Assisting Hands Home Care caregiver could provide much-needed relief to the family caregiver.

Assisting Hands Home Care serves the Fox Valley South area of Batavia including seniors in and around Buchanan, North Aurora, Green Valley, and Bartlett. Our Non-Medical Overnight Care services include preparation of clients for bed, overnight care and personal services as needed, assistance with getting client up in morning, bathing, dressing, and more.

Frequent Nighttime Urination in Seniors FAQs

Is frequent urination at night normal in seniors?

Getting up once a night is common in older adults and often isn’t a concern. Two or more trips on most nights is common too, but it shouldn’t be written off as normal aging. It deserves a conversation with a doctor because the cause is often treatable.

Can diabetes cause nighttime urination?

Yes. High blood sugar makes the kidneys produce more urine, so frequent urination day and night, paired with increased thirst, can be a sign of undiagnosed or poorly controlled diabetes. A doctor can check for it with a blood test.

Should seniors drink less water before bed?

Staying well hydrated and limiting fluids in the 2-3 hours before bedtime is reasonable as long as the person is drinking plenty of fluids throughout the rest of the day. Reducing the total amount of fluids a person drinks can be problematic as it can cause dehydration which has its own risks to older adults. A person with fluid restrictions due to heart or kidney failure should follow the recommendations of their physician.

How many times should a 70-year-old pee at night?

A 70-year-old adult may urinate once or twice during the night, although nighttime bathroom habits vary. Getting up more than twice regularly, especially when it interrupts sleep, may indicate an underlying issue such as an overactive bladder, diabetes, prostate enlargement, or medication side effects. A healthcare provider can help determine whether treatment is needed.

How do I stop nighttime urination in the elderly?

To reduce nighttime urination in older adults, limit fluids in the two to three hours before bedtime, avoid caffeine and alcohol in the evening, and use the bathroom right before going to sleep. Elevating swollen legs in the afternoon may also help reduce nighttime urine production. If frequent urination continues, consult a healthcare provider to identify possible medical causes.

What is the natural remedy for frequent urination at night?

Natural ways to manage frequent nighttime urination include reducing evening caffeine, avoiding large drinks close to bedtime, maintaining a regular bathroom schedule, and elevating the legs in the afternoon if swelling is present. These habits may help reduce nighttime bathroom visits, but persistent symptoms should be evaluated by a healthcare provider. Older adults should not restrict fluids excessively because dehydration can cause other health problems