Waking up in the middle of the night to pee

Could It Be What I’m Drinking?

You may just be drinking too much or too close to bedtime. Drink less several hours before you go to sleep. Don’t have alcohol or caffeine late in the day. And be sure to use the bathroom before you go to bed.

Could It Be an Infection?

A urinary tract infection (UTI) triggers a need to pee more during the day and at night. It may hurt when you pee, your stomach may ache, and you might have a fever. Your doctor can diagnose and treat a UTI.

Could My Age Make a Difference?

The older you are, the more likely you are to need to pee at night.

As you age, your body produces less of a hormone that helps concentrate urine so that you can hold it until the morning.

When you're older you're also more likely to have other health problems that make you need to pee overnight. Your gender can play a role, too:

• Men: An enlarged prostate is common when you're an older guy. It usually isn’t serious, but it can keep you from emptying your bladder.

• Women: After menopause, you make less estrogen. That can cause changes in the urinary tract that make you have to go more often. If you’ve had children, the muscles in your pelvis may be weaker, too.

Could It Be My Medicine?

Some medicines pull fluid out of your system and make you pee more. Ask your doctor if any of your meds do this. You might solve the problem by taking them earlier in the day, or the doctor may be able to change your medication.

Could It Be a Sleep Problem?

Sometimes it’s not the urge to pee that wakes you -- but once you’re up, you need to go. That can happen if you have restless legs syndrome, hot flashes, ongoing (chronic) pain, or depression. There’s also a connection between sleep apnea and having to go at night.

Treating the sleep disorder usually solves the nighttime peeing problem, too.

Could It Have Anything to Do With My Heart?

When your ticker doesn’t pump the way it should, fluid builds up. You’ll notice this especially in your ankles.

When you lie down, your body flushes out the extra fluid. That fills your bladder and wakes you up.

You might help control the swelling by resting with your feet up during the day, or by wearing compression socks.

Could It Be Something Else?

See a doctor if you've tried to control the problem but it's not getting better. Other medical issues can cause your bladder to hold less than it should. These include:

• Bladder tumor
• Prostate tumor
• Overactive bladder
• Interstitial cystitis
• Pregnancy
• Obesity

Conditions that can cause your body to make too much urine include:

• Diabetes
• Diabetes insipidus
• Liver failure
• Neurologic diseases like multiple sclerosis, Alzheimer’s and Parkinson’s

If you have an underlying health issue and you get it treated, that may stop the nighttime peeing problem. But you may need medication to help with that, too.

Do I Need to See a Doctor?

Getting up in the night to pee can give you problems during the day, like lack of concentration or other health problems. When you're older, nocturia also raises your chances of falling and breaking a hip.

The first question a doctor will ask you if you complain about having to pee in the middle of the night is, "Did the need to urinate wake you up, or did you wake up and notice you had to urinate?"

"How you answer makes a difference," says Randy Wexler, MD, an associate professor of family medicine and vice chair of clinical affairs at the Ohio State University Medical Center.

Wexler explains that, when you sleep, increased blood flow to your kidneys can accelerate urine production. So if you wake up because of a snoring bedmate or insomnia or some other reason that has nothing to do with your bladder, you'll still have no problem producing urine if you decide to head to the bathroom.

But if having to pee is the reason you're waking up, that's not something to ignore, he says. (Even the color of your pee can give you insight to your health.)

Here, he and other experts explain some of the most common causes of having to pee at night—and what to do about them. (Learn the 5 best foods for your brain and pick up tips to naturally protect yourself from dementia and stroke in Prevention's Ageless Brain.)

You're drinking too much water before bed.

Yes, this is super obvious. But Wexler says some people don't realize just how much H2O they're swallowing in the hours before bed—and how that fluid can disrupt their sleep. "I tell patients to stop drinking water two hours before bed," he says. Also, hit the bathroom before you hop in the sack. If you follow these instructions and you're still waking up to pee, it's time to see a doctor. (Along with bedtime, here are 5 times you shouldn't drink water.)

Prevention Premium: 20 Doctor-Recommended Natural Remedies For Everyday Ailments

You're drinking alcohol or caffeine too close to bedtime.

Both alcohol and caffeine can increase your urine output, Wexler says. If you're the type who enjoys a cup of joe after dinner, or if you drink booze before bedtime, you're asking for trouble. Wexler recommends cutting off all caffeine—that includes tea—at 6 PM. He also suggests you stop drinking alcohol at least three hours before bed. Again, if you try these changes and your problem persists, see your doc.

Check out your body on alcohol:

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You're low on this hormone.

"With aging comes a natural loss of antidiuretic hormone," says Tobias Köhler, MD, chair of urology at Illinois's Memorial Hospital. This hormone helps your kidneys control their fluid levels. The less of the hormone you have, the more you pee. Köhler says this natural hormone loss usually starts around age 40, but often becomes noticeable much later—during your 60s or 70s. "There are some drug therapies, but a lot of people just deal with it," he says. (Think your hormones are wacky? Here are 11 signs you have a hormone imbalance.)

You have an infection.

If you're a woman and you've eliminated the "self-inflicted" pee triggers mentioned above, the most-likely culprit is a urinary tract infection, Wexler says. "If it's a urinary tract infection, urination may be accompanied by burning or dribbling or discomfort," he explains. Also, these sensations are going to persist during the day. (Watch for these other UTI symptoms all women should know.)

While far less common in men, a urinary tract infection can also cause guys to feel like they have to pee all the time, including at night, Wexler adds. Again, a burning sensation while peeing is something to watch for.  

Your legs are swollen.

If you have swollen feet or legs—a condition known as edema—that fluid retention in your lower body can cause you to pee a lot when you lie down. "All that fluid in your legs has to go somewhere, and that increases your urine production," Köhler explains. The solution: Elevate your legs a couple hours before bed. That will help the fluid in your lower half flow upward, and so will allow you to get your peeing done before climbing in bed, he says.

MORE: 10 Things Podiatrists Wish Everyone Knew About Their Feet

You’re dealing with diabetes or prediabetes.

If you're suffering from diabetes or prediabetes, your body may ramp up your urine production in order to clear away excess blood sugar. That could explain why you're waking up to pee at night, Wexler says. As with a UTI, frequent peeing caused by diabetes or prediabetes will persist during the day. Especially if you tend to feel thirsty all the time—even when you drink a lot of water—that's a sign blood-sugar issues are to blame, he adds.

You have an STD.

"Some sexually transmitted diseases can cause frequent urination, such as gonorrhea and chlamydia," Wexler says. A burning sensation while you pee is also a sign your problem could be an STD—though for middle-aged or older adults, a UTI is a lot more likely, he adds.

Your uterus or ovaries are enlarged.

A wide range of conditions—including uterine polyps, ovarian cysts, or uterine and ovarian cancers—can cause an enlargement of these organs. If they're oversized, they can press on your bladder and make you feel like you have to pee all the time, Wexler says. "There's really no way to know if one of these is the cause unless you see a doctor," he adds.

MORE: Sneaky Signs Of Ovarian Cancer That Every Woman Should Know

Your bladder is slipping.

The muscle, ligaments, and connective tissue that help make up a woman's pelvic floor also support her bladder and other organs. As a result of age or, more commonly, vaginal child birth, that pelvic floor can weaken and a woman's bladder can slide or "prolapse" into a position that puts pressure on it, Wexler says. If that happens, you may feel like you need to pee all the time. "Women can do Kegel exercises for bladder prolapse, but they'd need to be diagnosed first," he says. (These Luna Femme Training Beads from the Prevention Shop give your pelvic floor muscles a workout—and feel pretty fantastic, too.) 

You have prostate problems.

A man's prostate doesn't stop growing until the day he dies. "If you live long enough, you will have prostate issues," Wexler says. An enlarged prostate can pinch a man's urethra closed, making it difficult for him to fully empty his bladder. That can make him feel like he has to urinate all the time, Wexler says. The good news: Prostate-related peeing problems usually have nothing to do with prostate cancer, he says. There are also drug or surgery treatments available if your enlarged prostate is causing urinary issues that are too annoying to ignore.

Markham Heid is an experienced health reporter and writer, has contributed to outlets like TIME, Men’s Health, and Everyday Health, and has received reporting awards from the Society of Professional Journalists and the Maryland, Delaware, and D.C. Press Association.

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