Waking up at night with the need to pee isn’t just a nuisance—if it’s happening frequently, it could also be a sign that something is wrong. In a new video, YouTuber and urologist Dr. Rena Malik explains that waking up two or more times at night to urinate is medically known as nocturia, and breaks down the most likely reasons that you might be experiencing it.
One possible explanation is overactivity of the bladder, where it spasms and gives you the urge to urinate before it is full. There are all kinds of reasons this might occur, such as an obstruction like an enlarged prostate which is blocking urinary flow. “It could also be because of a neurological condition, or because of age, or other factors that may be causing your bladder to be overactive,” Malik says.
Another cause is a change in the compliance of the bladder. Usually, the bladder is able to expand like a balloon without much of an increase in pressure. However, certain factors like neurologic injury and radiation can make it more stiff, less compliant, and therefore less able to hold large amounts of urine.
Another potential reason for nocturia is an increase in urine volume. “As you age, after about 65 years of age, you will make one third of your urine volume at night,” Malik explains. “So naturally most people after 65 will wake up one time, and that’s within normal limits.” However, if you are making a lot of urine at night and you’re not in this age group, it could be a sign of a medical condition like diabetes insipidus, or primary polydipsia, which affects thirst.
Malik also points out that many people who wake up in the night might not necessarily have any urological health issues, but rather other sleep problems. If you’re waking up and then going to the bathroom once you’re already awake, as opposed to being woken by the urge to urinate, then Malik recommends looking at your sleeping habits.
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