Understanding Nocturia : Why Do You Feel the Need to Pee When Lying Down?

All of us know how annoyed we feel when we have to get up to urinate at night. Interrupted sleep can be frustrating, and it is absolutely understandable to feel frustrated when something as simple as a trip to the bathroom disrupts our sleep. However, regularly feeling the need to pee when lying down can be a common feeling for many people in the world, and there are many medical conditions that can be responsible for this annoying feeling that should not be ignored. Keep reading to find out why do you feel the sensation of needing to urinate when lying down.

When you lie down at night, the fluid that has pooled in your legs is able to circulate through the body with much more ease than when you remain standing throughout the day. Your kidneys then filter out this fluid and send it down to the bladder. However, if you have a medical condition that impairs this circulation, such as diabetes or congestive heart failure, it can cause excessive edema or swelling in your legs that causes your bladder to fill up faster. Many people tend to experience a higher need to pee when they lie down in bed at night. This condition is known as nocturia.^(1,2)

Nocturia is a medical condition that is characterized by the need to urinate frequently during the night, which can often disrupt sleep and also lead to daytime fatigue. It is a common condition, especially in older adults, and it can be caused by a variety of factors, including urinary tract infections, enlarged prostate, and certain medications. Nocturia can also be a symptom of underlying medical conditions, such as diabetes or heart failure. Treatment for nocturia typically involves identifying and addressing the underlying cause, as well as lifestyle changes, such as limiting fluid intake before bedtime or using medication to reduce the need to urinate at night. As mentioned, nocturia gets more common with age and it is estimated that the condition affects over 50 percent of all men and women over the age of 60 years. While it is not a disease by itself, but it can be a symptom of many other conditions. At the same time, it has been noticed that people who have obesity are almost two to three times more likely to experience nocturia.^(3,4,5)

Here are some of the reasons why you feel the sensation of needing to urinate when lying down.

1. Urinary Tract Infections

   Urinary tract infections (UTIs) are common bacterial infections that can affect any part of the urinary tract, including the bladder, urethra, and kidneys. Symptoms of a UTI can include a frequent urge to urinate, painful urination, and lower abdominal pain. Nocturia can have many different causes, including urinary tract infections.^(6,7,8)

   In the case of a urinary tract infection, nocturia, or the feeling that you need to pee when lying down, tends to occur because the infection irritates the bladder, making it feel like it needs to be emptied more frequently. At the same time, remember that there are far lesser distractions about at night as compared to the day, which makes you focus more on the sensation of needing to pee at night when you lie down. This feeling can become especially problematic at night when the body is trying to rest and sleep. Treating the underlying UTI can often alleviate the symptoms of nocturia. Some people may actually find that lying down relieves their discomfort from the UTI, though in others it often makes the discomfort far more noticeable.

   It is also important to know that UTIs are actually far more common in women than men and nearly 40 to 60 percent of women get at least one urinary tract infection in their lifetimes.⁽⁹⁾

   If you are experiencing symptoms of a UTI or nocturia, it is important to see a healthcare provider for an accurate diagnosis and appropriate treatment. Untreated UTIs can lead to more serious complications, such as kidney damage, so it is important to seek medical attention promptly.

2. Diabetes

   One of the most common symptoms of diabetes is the sensation to pee more frequently because of the increased levels of blood sugar. Feeling the need to wake up and urinate at least once during the night can be a common symptom of diabetes in people who have poorly controlled blood sugar levels.

   When blood sugar levels are high, the kidneys work to eliminate the excess glucose from the blood by producing more urine. This can result in more frequent urination, including at night. Additionally, high blood sugar levels can damage nerves that control bladder function, leading to bladder problems that can cause nocturia.

   Diabetes can also cause other health problems that can be contributing factors to nocturia, such as kidney damage and heart disease.^(10,11)

   At the same time, diabetes is also linked with several other health conditions that cause an increase in edema in the lower half of the body, which leads to an increased need to pee when lying down. These conditions may include:

   • Kidney disease
   • Cardiovascular disease
   • Obesity
   • Poor circulation
   • Side effects of diabetes medications

   Another reason why diabetes can increase the need to urinate is that it weakens the immune system, increasing the risk of developing a urinary tract infection. A study carried out in 2014 compared 89,790 pairs of participants who had diabetes and did not have diabetes. The study found that people with diabetes went on to get 65 percent more bladder infections during the duration of the study.⁽¹²⁾

   If you have diabetes and are experiencing nocturia, it is important to work with your healthcare provider to manage your blood sugar levels and address any underlying health conditions that may be contributing to your symptoms. This may include changes to your diet, medication adjustments, and lifestyle modifications to help manage your diabetes and improve your overall health.

3. Excessive Swelling in the Legs or Leg Edema

   Leg edema, or excessive swelling in the legs, is a condition in which excessive fluid begins to accumulate in the legs. This causes swelling and discomfort. There are many potential causes of leg edema, including heart, liver, or kidney disease, circulation problems, hormonal imbalances, and certain medications. Heart disease, in particular, can cause leg edema because the heart is responsible for pumping blood throughout the body. If the heart is not functioning properly, blood can back up in the veins, causing fluid to leak into surrounding tissues and leading to edema. Liver and kidney disease can also contribute to leg edema by impairing the body’s ability to remove excess fluid and waste products from the body. Hormonal imbalances, such as those seen in pregnancy or menopause, can also cause fluid retention and edema. Cirrhosis, damage to the blood vessels, conditions that impact the lymphatic system, and even protein deficiency are all medical conditions that can cause leg edema as a symptom.^(13,14,15)

   Leg edema and nocturia can sometimes be related, as both can be caused by underlying health conditions such as heart, kidney, or liver disease. When excess fluid accumulates in the legs due to edema, it can put pressure on the bladder and result in increased urinary frequency, especially at night when you lie down. When you move from a sitting or standing position to a lying position, the excess fluid in the lower extremities of the body is able to more easily enter your circulatory system, from where it reaches the bladder through your kidneys.⁽¹⁶⁾ Additionally, certain medical conditions that cause leg edema, such as heart failure, can also cause nocturia by affecting the body’s ability to eliminate excess fluid and waste products.

   Conditions that can lead to mild edema in the legs include:

   • Pregnancy
   • Certain types of medications
   • Being inactive for a long period of time
   • Consumption of too much salt
   • Being in the premenstrual stage of your cycle

4. Cardiovascular Disease

   A study carried out in Seoul in 2018 found that nearly 50 percent of people with heart failure experience involuntary bladder leakage along with an overactive bladder.⁽¹⁷⁾ While nocturia can be a symptom of many different conditions, many studies have suggested that there might be a strong connection between nocturia and cardiovascular disease.^(18,19)

   One possible explanation for this connection is that both conditions may be related to inflammation. Chronic inflammation can damage the endothelial cells that line blood vessels, leading to cardiovascular disease. At the same time, it can cause irritation to the bladder, which causes nocturia.⁽²⁰⁾ People with heart failure are also not able to clear the edema or swelling from their lower body properly due to the weakness of the heart muscles. However, when they lie down, the heart muscles do not have to work as hard as they do when a person is standing since it does not have to go against gravity. Due to this, the swelling can circulate and the fluid from the edema reaches the bladder easily causing a need to pee when you are lying down at night.

   Another possible explanation is that both nocturia and cardiovascular disease could be related to autonomic dysfunction. The autonomic nervous system helps regulate the body’s internal functions, including the heart and bladder. Dysfunction in this system could lead to both cardiovascular disease and nocturia.⁽²¹⁾

   There is also some evidence to suggest that obstructive sleep apnea (OSA), a condition in which a person’s breathing is repeatedly interrupted during sleep, might be a contributing factor to both cardiovascular disease and nocturia. Obstructive sleep apnea has also been associated with an increase in inflammation and autonomic dysfunction in the body, as well as an increased risk of cardiovascular disease.^(22,23)

   So while the link between nocturia and cardiovascular disease is not yet completely understood, there definitely appears to be a correlation between the two. If you are experiencing nocturia or other symptoms of cardiovascular disease, it is important to speak with a healthcare professional for proper diagnosis and treatment.

5. Causes of Nocturia in Women

   The causes of nocturia can sometimes also be gender specific. Some additional causes why women may feel the sensation to pee while lying down can depend on the following:

   1. Enlarged Ovaries Or Uterus: There are many medical conditions that can cause an enlarged uterus or ovaries in women, including pregnancy, uterine fibroids or abnormal growths, endometriosis, ovarian cysts, cancer, or adenomyosis. Such conditions may indirectly be responsible for causing nocturia. These conditions can cause discomfort or pressure in the pelvic region, which can irritate the bladder and cause more frequent urination, including at night. At the same time, lying down in a position that puts extra pressure on the bladder can make this urge to pee worse at night, and this is why many women only notice these symptoms of nocturia at night while lying down.⁽²⁴⁾ Additionally, some medications used to treat these conditions, such as diuretics, may also increase urine output and contribute to nocturia.⁽²⁵⁾
   2. Vaginal Birth: Pregnancy and giving vaginal birth can be a cause of dysfunction of the pelvic floor muscles. This can lead to symptoms like urinary incontinence or frequent urination like nocturia. The pelvic floor muscles help support the bladder and urethra, which are the structures involved in urination. Dysfunction of these muscles can lead to weakened support, causing the bladder to sag and increasing the risk of urine leakage or incontinence. This can lead to a frequent need to urinate, especially during the night. In addition to incontinence, dysfunction of the pelvic floor muscles can also lead to other bladder problems, such as overactive bladder, urinary urgency, and incomplete emptying of the bladder, all of which can contribute to nocturia. Treatment for dysfunction of the pelvic floor muscles to reduce the occurrence of nocturia and other issues may include pelvic floor exercises (Kegels), biofeedback therapy, or electrical stimulation of the muscles. In some cases, surgery may be necessary to repair weakened or damaged muscles.^(26,27)

6. Causes of Nocturia in Men

   Just like there are gender-specific causes of nocturia in women, the same is applicable to men as well. In men, there are two such health conditions that may cause the sensation of an increased need to pee when lying down. These include:

1. Enlarged Prostate: Also known as benign prostate hyperplasia, an enlarged prostate is quite common in men over the age of 50 years, and it is usually not very serious.⁽²⁸⁾ Enlarged prostate occurs when the prostate gland grows in size and compresses the urethra, making it difficult to empty the bladder fully. This can lead to several urinary symptoms, including feeling a pressing need to pee when lying down. Nocturia is, in fact, a common symptom of an enlarged prostate gland since the increased size of the prostate gland can cause obstruction of the urethra and reduce the bladder’s ability to hold urine, resulting in frequent urination, especially at night. In addition to nocturia, other symptoms of benign prostate hyperplasia may include weak urine flow, dribbling after urination, a feeling of incomplete bladder emptying, and an urgency or a sudden need to urinate. Treatment for an enlarged prostate may include lifestyle modifications, such as cutting down on your fluid intake before bedtime and avoiding caffeine and alcohol, as well as medications to relax the muscles in the prostate gland and improve urine flow. In some serious cases, surgery may be needed to remove the excess prostate tissue.^(29,30)
2. Prostatitis: Prostatitis, or inflammation of the prostate gland, can contribute to nocturia, which is a condition in which an individual wakes up during the night to urinate. Prostatitis is most commonly observed in men between the ages of 30 to 50 years, and the onset can either be sudden or it can be a chronic condition.⁽³¹⁾ Prostatitis can cause urinary symptoms such as frequent urination, urgency, and incomplete bladder emptying. These symptoms can be especially troublesome at night and contribute to the development of nocturia. Other symptoms of prostatitis may also include pain or discomfort in the pelvic region, painful ejaculation, and flu-like symptoms such as fever, chills, and body aches. Treatment for prostatitis may depend on the exact type and cause of the condition, but usually includes antibiotics if the prostatitis is caused by a bacterial infection, alpha-blockers to relax the muscles in the prostate gland, and anti-inflammatory medications to reduce inflammation and alleviate pain. In some cases, lifestyle modifications such as reducing caffeine and alcohol intake and avoiding spicy foods may also be useful.^(32,33)

If you find yourself urinating more often than usual or experiencing pain during urination, it is a good idea to make an appointment with your doctor. Painful or frequent urination can be one of the first symptoms of many health conditions like diabetes, heart disease, or even thyroid disorders. This is why it is never a good idea to ignore this symptom of having to pee more frequently at night.

There are many potential treatments for addressing the underlying health condition that is causing you to feel the sensation of having to pee when lying down. Some of the commonly prescribed treatments for treating nocturia include:

• Nocturia Caused By Urinary Tract Infection: Treatment involves antibiotics and increasing your fluid intake.^(34,35)
• Nocturia Caused By Swelling In The Leg Or Leg Edema: The treatment focuses on identifying and treating the underlying cause, using prescription diuretics, wearing compression stockings, and reducing your salt consumption.⁽³⁶⁾
• Nocturia Caused By Diabetes: Identifying which type of diabetes you have, taking insulin if you have type 1 diabetes, and medications for type 2 diabetes and other symptoms associated with the condition.
• Nocturia Caused By Cardiovascular Disease: Medications, lifestyle modifications, and surgery is prescribed in cases of serious cases of cardiovascular disease.
• Nocturia Caused By Enlarged Ovaries: The treatment focuses on dealing with the underlying cause, and surgery in rather serious cases.
• Nocturia Caused By Pelvic Floor Dysfunction: Practicing Kegel exercises, medications, and surgery are some of the treatment options for treating nocturia caused by pelvic floor dysfunction.⁽³⁷⁾
• Nocturia Caused By Enlarged Prostate Or Benign Prostate Hyperplasia: Medications and surgery (in serious cases) are the prescribed treatment in such conditions.
• Nocturia Caused By Prostatitis: Antibiotics and alpha-blockers are the prescribed treatment for dealing with nocturia caused by prostatitis.⁽³⁸⁾

Nocturia is a common condition that affects many individuals, especially as they age. The term refers to the need or sensation of having to wake up during the night to urinate, and it can be caused by a variety of factors. These may include lifestyle choices, medical conditions, and even certain types of medications. Nocturia can significantly affect a person’s quality of life, leading to sleep disturbances, fatigue, as well as other types of health problems. Therefore, it is important to seek medical assistance and consult a doctor if you are experiencing symptoms of nocturia, as proper diagnosis and treatment can help give you relief from these symptoms and improve your overall well-being. By working with a doctor, you can identify the underlying cause of your nocturia and develop an effective treatment plan that best meets your individual needs.

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Also Read:

• Nocturia: Causes & Treatments of Overactive Bladder During Night