Why do I pee so much at night? Nocturia causes, treatment, and pelvic exercises for relief
Waking at night to urinate? Discover what causes nocturia and get treatment tips, exercises, and advice from physical therapists.
Table of Contents
Fall asleep. Wake up to pee. Fall asleep. Wake up to pee. Repeat. If you routinely wake up more than once a night to urinate, you may have a condition called nocturia.
Nocturia is very common: about one in three adults over the age of 30 report that they visit the bathroom at least twice during the night. And about 70% of them are bothered by it. “People focus on the annoyance of having to get up to pee. They also may not realize how disruptive nighttime waking is to sleep in general, as well as to your overall quality of life,” says Karla Arevalo-Alas, PT, DPT, a physical therapist with Hinge Health.
If you’re affected by nocturia, know that you don’t have to just live with it. There’s a lot you can do to treat and prevent waking up at night to pee, especially when you know what factors are causing it, adds Dr. Arevalo-Alas.
Read on to learn more about nocturia — common causes, and how to treat it, along with effective pelvic floor exercises from Hinge Health physical therapists that can help with bladder issues like frequent urination.
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Bijal Toprani, PT, DPT
Karla Arevalo-Alas, PT, DPT
What is nocturia?
Nocturia means waking up during the night to urinate. It’s often considered significant if it happens two or more times a night. This tends to become more common with age — and affects about half of people 65 or older. “Waking up at night to urinate can leave you feeling very tired, since it interrupts your sleep,” explains Dr. Arevalo-Alas.
Some people pee a lot during the day, but not at night. That’s not nocturia, but a different condition called urinary frequency.
If you wake up for a different reason — for example, your dog barking, or your partner snoring — and go to the bathroom once you’re up, that’s technically not nocturia, either. “When you have nocturia, your bladder literally wakes you up,” explains Dr. Arevalo-Alas.
Causes of frequent urination at night
Why do you wake up so much at night to pee? There are many reasons why you might experience frequent urination at night, including drinking fluids or alcohol before bed, taking certain medications, having an overactive bladder, or managing health conditions like diabetes or high blood pressure. Sleep issues, pelvic floor problems, and pregnancy can also play a role. Here’s a closer look at what factors can cause frequent urination at night:
Drinking too much fluid at night. Whether it’s an after-dinner coffee, a glass of wine, or chugging water before bed to meet your daily hydration target, consuming any large amount of liquid in the hours before sleep can increase nighttime urination.
Medications. Certain classes of drugs, such as diuretics (often prescribed for high blood pressure or fluid retention), can contribute to more frequent urination at night. Diuretics work by helping your body get rid of excess fluid through increased urine production, though their effects can vary depending on the medication and when you take it.
Overactive bladder (OAB). If you find yourself often rushing to the bathroom during the day or night, you may have an overactive bladder. This happens when the signals between your brain and bladder don’t work as they should. This can cause your bladder muscles to contract before the bladder is actually full. Common symptoms include a sudden, strong urge to urinate, going more often than usual, waking up at night to pee, and sometimes urine leakage with urgency.
Other health issues. Conditions like diabetes, high blood pressure, heart or kidney disease, and an enlarged prostate can all play a role in nighttime urination. Diabetes may increase urine production and affect bladder nerves, while heart and kidney issues can cause daytime leg swelling that shifts into the bloodstream and is filtered into urine at night. An enlarged prostate can make it harder to fully empty the bladder, leading to more frequent urges overnight.
Sleep problems. Sleep apnea — a condition that causes pauses in breathing as you sleep — can cause you to urinate more at night. When oxygen levels drop as a result of sleep apnea, your body releases certain hormones that also increase urine production.
Pelvic floor problems. Tight pelvic floor muscles and pelvic organ prolapse (when pelvic organs move from their normal positions) put pressure on your bladder and can contribute to frequent nighttime urination.
Pregnancy. During pregnancy, your body retains more fluid, which can increase the need to urinate, even at night. Pregnancy hormones such as progesterone relax the bladder muscles, and the growing uterus puts additional pressure on the bladder, both of which can contribute to frequent nighttime urination.
Symptoms of nocturia
The main symptom of nocturia is waking up at least twice during the night to urinate. Waking up multiple times during the night can disrupt your sleep cycle and lead to other effects, such as waking up feeling tired and daytime sleepiness.
Exercises to help ease nighttime urination
Want expert care? Check if you're covered for our free program →- Ankle pumps
- Ankle circles
- Clamshells
- Diaphragmatic breathing
- Reverse kegels
- Bridges
These exercises work together to support healthy bladder habits, especially at night. Ankle pumps and ankle circles help keep fluid from pooling in your legs by promoting blood and fluid flow back into your circulatory system during the day. This may reduce the amount of fluid that shifts to your bladder at night and contributes to nocturia. Clamshells and bridges strengthen the pelvic floor and glute muscles, offering better support to the bladder and reducing urgency or leakage. Diaphragmatic breathing promotes relaxation of both the nervous system and pelvic floor, making it easier to empty your bladder and helping to ease feelings of nighttime urgency. Reverse kegels focus on releasing pelvic floor tension, which can assist in emptying your bladder completely and maintaining a steady urine stream. Practicing these movements regularly can help restore a sense of control over nighttime bathroom trips, contributing to better sleep and overall comfort.
Dr. Arevalo-Alas recommends that you do these exercises daily about an hour before you go to bed. “You can do them while you watch TV, or listen to relaxing music,” she says. After you do them, spend about 20-30 minutes lying down with your feet elevated on some pillows. “The combination of the two will help to get rid of extra fluid and relax pelvic and bladder muscles,” Dr. Arevalo-Alas explains.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Pelvic floor physical therapy is more than just kegel exercises. Various exercises tailored to your symptoms and needs are key to getting relief. Pelvic floor PT can relieve many different pelvic issues, such as pelvic pain, painful sex, and urinary incontinence.
Members of the Hinge Health pelvic health program experience an average 67% reduction in pelvic pain and 54% reduction in urinary incontinence within the first 12 weeks. Learn more*.
Treatments for nocturia
If you’re dealing with frequent nighttime urination, doing targeted exercises, staying active, avoiding caffeine, alcohol, and other fluids in the evening, adjusting the timing of certain medications, managing underlying medical conditions, trying bladder retraining, and, when needed, taking prescription medication can all help ease symptoms. Here’s how to treat and prevent frequent urination at night:
Try physical therapy and targeted exercises. Targeted exercises (like the ones above) can help address nighttime urination by strengthening your pelvic floor, supporting better bladder control, and reducing urinary urgency. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
Stay active. Regular physical activity supports pelvic floor strength, which can help with bladder control and reduce nighttime urination. Additionally, being active during the day contributes to better overall sleep quality, making it less likely that you’ll wake up frequently during the night. You may want to avoid vigorous exercise within two hours of bedtime; for some people, this may stimulate your body and interfere with falling asleep. Opt for more relaxing activities, such as stretching or gentle walking, if you want to move in the evening.
Be mindful of evening fluids. Aim to hydrate earlier in the day and try to limit how much you drink in the evening — especially in the two hours before you go to sleep. Consuming large amounts of fluid before bed can contribute to nocturia (frequent nighttime urination). If you enjoy beverages like coffee or alcohol, having them earlier may help reduce both nighttime bathroom trips and disruptions to your sleep.
Adjust when you take medications. If you take a diuretic or other medication that might affect your sleep, ask your healthcare provider whether adjusting the timing of your doses could help manage nighttime symptoms. For example, you might discuss whether taking your medication in the morning or moving your afternoon dose earlier in the day is appropriate for you. Always check with your provider before making any changes to your medication schedule.
Manage underlying health conditions. If you have a medical condition that may cause you to urinate more (like diabetes, high blood pressure, sleep apnea, or an enlarged prostate) work with your doctor to help get it under better control.
Try bladder retraining. Bladder retraining is a structured approach that helps you gradually increase the amount of time between bathroom visits, giving your bladder time to adjust and improve its capacity. Over time, bladder retraining may make it easier to manage nighttime urges and reduce the number of times you wake up to urinate. Here’s how to get started:
Keep a bladder diary. Record how often you urinate, the amount each time, your daily fluid intake, and your typical interval between trips to the bathroom.
Start a schedule. Begin by urinating first thing in the morning when you wake up. Then, use the baseline interval you observed in your diary to set regular bathroom breaks. For example, if you usually urinate every hour, try to schedule and stretch out your bathroom visits to every hour and 15 minutes.
Practice urge suppression. When you feel the urge to urinate before your scheduled time, try a distraction technique such as Kegel exercises or deep breathing. If you are able to wait until the scheduled time, continue; if not, aim to wait five minutes before going to the bathroom. Walk calmly to the restroom instead of rushing. This helps retrain your brain and bladder to reduce urgency.
Make gradual adjustments. Every week or so, extend your interval slightly, with the goal of reaching three to four hours between bathroom visits.
You can try bladder training alone, or under the guidance of a pelvic floor physical therapist, says Dr. Arevalo-Alas. A physical therapist can also prescribe specific exercises to improve your pelvic floor muscle function while doing bladder retraining.
Consider medications to reduce nocturia. If lifestyle changes and exercises are not enough to ease nighttime urination, talk to your healthcare provider about medication options. Certain prescription medications, such as anticholinergics, may help relax your bladder and reduce urgency. Alpha-blockers (a type of blood pressure medication) are sometimes used to address urinary symptoms related to an enlarged prostate. Topical estrogen therapy may be recommended after menopause to support the tissues around the bladder and urethra. Your provider can help determine which approach may be most appropriate based on your individual needs and health history.
Pelvic floor physical therapy for nocturia
Physical therapy is an effective treatment for nighttime urination that’s related to pelvic floor muscle issues. It focuses on safe movement, targeted exercises, and stretches to support healthy pelvic floor muscle function and control. Physical therapy can help strengthen pelvic floor and core muscles, improve muscle coordination, and enhance relaxation, all of which can make it easier to fully empty your bladder and reduce both urgency and frequency at night.
A physical therapist (PT) can assess your movement patterns and pelvic floor function to design a personalized exercise program for you. They can also recommend ways to adjust your daily habits — such as adjusting fluid intake, exercise timing, and evening routines — to minimize symptoms. In addition, PTs can teach techniques for urge suppression, relaxation, and bladder retraining, providing you with practical tools and guidance for managing nocturia.
Pelvic health physical therapists can be seen in person or, for those who qualify, through a program like Hinge Health with access to a physical therapist via telehealth/video visit. (See examples of pelvic floor exercises above.)
When to see a doctor
Nocturia often improves with simple management or at-home treatments. But if your nocturia is getting worse, or causing difficulty with daily activities, see a healthcare provider to rule out other medical conditions, like sleep apnea or diabetes. It’s always a good idea to see a doctor if you find that you’re routinely waking up to pee more than once a night, advises Dr. Arevalo-Alas. It’s also a good idea to get care if you notice any of the following:
A sudden increase in nighttime bathroom visits
A pain or burning sensation when you pee
Other symptoms like swelling, fatigue or weight changes
PT tip: Drink up during the day
“If you pee a lot at night, you might be tempted to cut back on fluid during the day, but that’s a mistake,” says Dr. Arevalo-Alas. Dehydration makes your body retain more fluid and can actually irritate your bladder, she explains. Aim to drink about half your body weight in ounces daily (e.g., 75 ounces of water for a 150-pound person).
How Hinge Health can help you
If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
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References
Leslie, S. W., D’Andrea, V., Sajjad, H., & Singh, S. (2024). Nocturia. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK518987/
What Is Overactive Bladder (OAB)? (n.d.). National Association for Continence. https://nafc.org/overactive-bladder/
Khosla, L., Huang, A. J., Kasarla, N., Monaghan, T. F., Weiss, J. P., & Kabarriti, A. E. (2022). Association between pregnancy and nocturia: A National Health and Nutrition Examination Survey analysis. Neurourology and urodynamics, 41(6), 1505–1510. https://doi.org/10.1002/nau.24998
Leslie, S. W., D’Andrea, V., Sajjad, H., & Singh, S. (2024b). Nocturia. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK518987/
Urology Care Foundation. (2023). Nocturia: Symptoms, Diagnosis & Treatment - Urology Care Foundation. Www.urologyhealth.org. https://www.urologyhealth.org/urology-a-z/n/nocturia