What is considered normal
Most adults urinate 4–8 times a day. At night, a healthy person usually does not wake up or gets up only once, especially in old age. Doctors distinguish several variants of disorders. Pollakiuria is a frequent urge with the usual daily volume of urine. Polyuria is the excretion of a large amount of urine, more than 3 liters per day in an adult. Nocturia can be associated both with a decrease in bladder capacity and with the fact that the kidneys produce a lot of urine at night.
- Pollakiuria - often, but in small portions
- Polyuria - a lot of urine per day
- Nocturia - waking up at night to urinate
- Urgency is a sudden strong urge that is difficult to control.
Possible reasons
If a lot of urine is produced, you should first rule out diabetes mellitus, as well as the habit of drinking a lot, taking diuretics, and diabetes insipidus. If the portions are small, the cause is often in the bladder or prostate: infection, overactive bladder, stones, compression of the bladder by an enlarged uterus or prostate. Nocturnal urges in older adults are often associated with heart failure, leg swelling, sleep apnea, and evening fluid intake.
- Urinary tract infection
- Overactive Bladder
- Prostate adenoma in men
- Diabetes mellitus and diabetes insipidus
- Pregnancy, uterine fibroids, pelvic organ prolapse
- Diuretics, caffeine, alcohol, sleep apnea
Associated symptoms
Associated complaints suggest the direction of the search. Burning and cloudy urine indicate infection, a weak stream and straining in men indicate obstructed outflow, sudden strong urge with leakage indicate an overactive bladder. Thirst, dry mouth and weight loss are common symptoms of diabetes. When you have urges at night, it is important to pay attention to snoring and breathing pauses during sleep, swelling of the legs and shortness of breath.
- Pain or burning when urinating
- Weak stream, feeling of incomplete emptying
- Sudden urge, urine leakage
- Thirst and dry mouth
- Snoring and daytime sleepiness
- Swelling of the legs in the evening
What examinations are needed
The most useful first step is to keep a urinary diary for 2-3 days: the time of each urination, the volume of urine, the amount of drinking, and episodes of leakage. It shows how much urine is being produced and when. A general urine test detects infection, blood and glucose, while a blood glucose test detects diabetes. Ultrasound of the kidneys and bladder with determination of residual urine evaluates emptying. Men additionally undergo uroflowmetry, ultrasound of the prostate, and PSA is determined by age.
- Urination diary 2–3 days
- General urine test
- Blood glucose, glycated hemoglobin if necessary
- Ultrasound of the kidneys and bladder with residual urine
- Uroflowmetry
- PSA in men according to indications
What to do and treatment
Treatment depends on the cause. For infection, antibiotics are prescribed, for diabetes, treatment by an endocrinologist. For an overactive bladder, they begin with behavioral measures: bladder training with gradually increasing intervals, exercises for the pelvic floor muscles, limiting caffeine and alcohol. If this is not enough, the urologist will prescribe medications to relax the bladder. For prostate adenoma, drugs are used to facilitate the outflow, and in case of severe symptoms, surgery is used. With nocturia, limiting fluids 2–3 hours before bedtime helps, but the total volume of drinking cannot be sharply reduced.
- Don't drink a lot of fluids in the evening
- Limit coffee, strong tea, alcohol
- Bladder training
- Exercises for the pelvic floor muscles
- Medicines and surgeries - as prescribed by the urologist
- Treatment of diabetes, heart failure, sleep apnea