Bladder Interrupting Your Sleep? It Could Be A Canary In A Coal Mine!
This month, we hand our blog over to Shan Morrison to discuss a matter that affects most of us at one stage or another - waking up at night to head to the toilet.
Shan really knows her stuff! Shan Morrison is a fellow of the Australian College of Physiotherapists and Specialist Women’s, Men’s & Pelvic Health Physiotherapist. She has practiced exclusively in pelvic health for 30 years and is the director of Women’s & Men’s Health Physiotherapy, where she proudly leads an all-female team of Pelvic Health Physiotherapists. Shan’s clinical focus is integrating psychologically-informed, whole person care to those with a range of pelvic health conditions, particularly persistent pelvic and sexual pain. Over to you Shan…
Waking overnight to urinate, also known as nocturia, can be annoying and frustrating, resulting in you feeling tired and unrefreshed. Many people assume urinating overnight is a normal part of ageing, but this isn’t necessarily true. Just like a canary was used to detect imminent danger in a coal mine, nocturia may be a sign of other underlying health problems.
What Is Nocturia?
Nocturia is being woken from sleep to urinate.
Waking once is common at any age and won’t usually affect your health.
Waking more than once has been found to be associated with other underlying health concerns and should be investigated.
Nocturia can be a component of a bladder condition called overactive bladder, where people experience a strong urge to go to the toilet, but it can also occur as a stand-alone condition.
Underlying Causes Of Nocturia
Nocturia can be caused by a number of different factors – and often people suffer from a few different issues at once1,2.
1. Age: Age is the most common contributing factor. As you age, night time urine production increases and bladder function deteriorates.
2. Bladder: A smaller bladder capacity, recurrent urinary tract infections, strong bladder urges or not emptying properly can lead to more frequent emptying both day and night.
3. Kidneys: Your kidneys should generally produce less urine overnight, compared to the day. A change in the function of your kidneys can increase the production of urine overnight.
4. Hormones: Hormones, eg oestrogen and testosterone can increase how much urine you produce at night.
5. Sleep: Sleep disorders such as obstructive sleep apnoea affect your blood pressure at night, meaning your kidneys will produce more urine overnight. Being a light sleeper, or being woken at night for other reasons (ie pain, children, restless legs) can also contribute to nocturia.
6. Heart: High blood pressure, heart failure or swelling in your legs also make your kidneys produce more urine.
7. Fluid and Food Intake: There is no conclusive evidence that reasonable caffeine and alcohol intake is related to nocturia, but how much you drink and when you drink will affect how much urine your kidneys produce overnight. Excessive salt, protein and sugar in your diet, especially in the evenings, can also affect your urine production.
8. Obesity: Many studies have shown a relationship between obesity and nocturia, with some studies showing a three times increased risk in women and double the risk in men.
9 Pregnancy: Nocturia is extremely common during pregnancy due to the reduced capacity of the bladder to hold urine.
10. Medications: Certain medications may increase urine production or disrupt sleep.
What Can Be Done To Help?
Nocturia can improve, requiring a team approach to get the best results. Important members of the team may be a GP, Urologist and Pelvic Floor Physio. A/Prof Wendy Bower and her research team developed a quick and easy questionnaire (called the TANGO questionnaire) to assist Health Care Professionals screen for the contributing factors causing nocturia. You can find the questionnaire here.
Your GP or Urologist will assess general health, medications, kidney function, heart health, blood pressure, sleep habits and hormones and may also refer to other medical specialists (eg Cardiologist) or for a sleep study.
How Can A Pelvic Health Physio Help?
Your Pelvic Health Physio will perform a detailed assessment of general health, bladder and bowel function, pelvic floor muscles and lifestyle to work out what is causing your nocturia. Some common things a Pelvic Health Physio may suggest are:
1. Bladder diary: measuring your urine output and fluid intake identifies how much urine your kidneys are producing, how much urine your bladder can hold and how much fluid you are drinking.
2. Bladder ultrasound: an ultrasound performed in the physiotherapy clinic can assess if the bladder is emptying properly.
3. Rule out UTI: a urine sample can be tested in the physiotherapy clinic to screen for possible urinary tract infection and can indicate a need for further investigation with your GP.
4. Fluid and dietary modification: based on your bladder diary and ultrasound, your Physio will recommend adjustments to fluid intake (volume & timing), reducing excessive caffeine/alcohol intake or modifying the amount or timing of salt/protein intake. Optimising weight can also help.
5. Bladder training: if you have a small bladder capacity or are experiencing stronger than normal urge messages, bladder training strategies can help your bladder hold more urine both day and night.
6. Pelvic floor muscle training: if your pelvic floor muscles are too weak or too tense, this can affect how much urine your bladder can hold. Exercises and strategies to improve the pelvic floor muscles can help.
7. Treat constipation: a full bowel impacts your bladder capacity. Treating constipation can help improve your bladder function.
8. Improve sleep: education on strategies to improve the quality of your sleep (also known as sleep hygiene) can help you get to sleep and stay asleep.
9. Exercise advice: general exercise has been shown to improve nocturia.
Improve Your Long Term Health - Seek Help For Nocturia
If your sleep is interrupted by your bladder, it is important that you speak with a Health Care Professional. Our experienced clinicians at Women’s & Men’s Health Physiotherapy will work with you, your GP and/or Urologist to identify the specific factors contributing to your nocturia and develop an individualised pelvic health treatment plan.
Getting a good night’s sleep can lead to better health and a longer life expectancy. Seek help for nocturia so that you can live your best life.
Contact the team at Women’s & Men’s Health Physiotherapy for more support or information here.
References
1. Bower, W., Everaert, K., Ong, T., Ervin, C., Norgaard, J., Whishaw, M. (2018). Questions to ask a patient with nocturia. AJGP VOL. 47, NO. 7.
2. Wagg A. Incontinence In Frail Older Adults. In: Cardozo L, Rovener E, Wagg A, Wein A and Abrams P. Incontinence 7th Ed. 2023. pp1523-1526