September 9, 2026, 3:51 pm | Read time: 5 minutes

The medical term nocturia refers to nighttime urination. According to the definition by the International Continence Society, nocturia is present if a person has to get up once or more at night to urinate.¹

However, this does not automatically mean that there is a disease or that treatment is necessary. In practice, closer attention is paid when individuals regularly have to get up at least twice a night and the nighttime urge to urinate affects sleep or quality of life.

If You Need to Go at Night, It’s Not Automatically a Problem

A nighttime trip to the bathroom can initially have completely natural reasons. For example, if someone drinks large amounts of liquid shortly before going to bed, they will need to go to the bathroom more frequently at night. Various lifestyle factors can also have an impact–for instance, certain foods and alcohol consumption can have a diuretic effect. Lastly, the bladder’s capacity varies from person to person.

As people age, nighttime trips to the bathroom become more frequent and are not necessarily a sign of illness. Therefore, the individual situation and changes over time are more important than a specific number. If, for example, you have been getting up once a night for years and are managing well, there is usually no reason for concern. It’s different if nighttime urination suddenly changes significantly. For instance, if one trip becomes two or three, or if the urge to urinate regularly interrupts sleep.

Possible Causes of Nocturia

It should be emphasized that nocturia is not a disease or an independent disorder. It is a symptom that can be attributed to various causes.

Increased Urine Production

The amount of urine the body produces mainly depends on how much fluid is consumed. However, there are cases where the body produces an excessive amount of urine. Medically, this is referred to as polyuria (FITBOOK provides more details in this article) when the daily urine volume is significantly increased, typically to more than three liters within 24 hours.

In nocturnal polyuria, the body produces an unusually large portion of the daily urine at night. This can be related to nocturia.

Bladder Problems

The cause can also lie in the bladder itself, such as when there is a bladder storage disorder.² In this case, the bladder’s storage capacity is reduced, or the bladder muscle is overactive. Even a relatively small amount of urine can trigger a strong urge to urinate. Typically, affected individuals need to go to the bathroom more frequently but only pass small amounts of urine. However, this does not change the fact that they wake up at night to urinate.

Additionally, diseases of the lower urinary tract can play a role in nocturia.

When the Prostate Affects the Bladder

A (benign) enlargement of the prostate is a largely normal process with age, which FITBOOK discusses in this article. For some men, however, it leads to discomfort over time. The prostate is located directly below the bladder and surrounds part of the urethra. As it enlarges, it can affect urine flow. Difficulties urinating or the feeling of not being able to empty the bladder properly despite a strong urge should be medically evaluated.

Nocturia According to Urologist “a Useful Sign”

An enlarged prostate can also lead to more frequent, especially nighttime, urges to urinate. Urologist Prof. Dr. med. Sigmund Pomer describes this in a conversation with FITBOOK as a “useful sign.” *

The frequency of nighttime bathroom trips can indicate how pronounced the prostate-related symptoms are. If a man needs to urinate more than four times a night, it could suggest a more pronounced prostate enlargement and help determine the urgency of treatment.

Depending on the severity of the symptoms, different treatment options may be considered. Initially, medications can be used to alleviate bladder irritation or improve urination symptoms. If these are not sufficient, a procedure to reduce or remove prostate tissue to improve urine flow may be considered in cases of significant prostate enlargement.

More on the topic

Many Women Affected When to Address an Overactive Bladder and What Can Help

Expert Reveals How to Keep Your Prostate Healthy: 8 Effective Tips

Many Other Possible Causes

There are various diseases and other factors that can be associated with nocturia. These include metabolic and cardiovascular diseases such as diabetes mellitus or heart failure. Kidney diseases, sleep apnea, and other sleep disorders are also possible causes. Additionally, fluid retention in the legs or certain medications, such as diuretics, can play a role.

Not infrequently, a lack of ADH or reduced ADH secretion is the cause. ADH stands for antidiuretic hormone, which ensures that the kidneys excrete less water at night. As people age, the body often secretes less ADH at night. However, in younger people, a changing sleep-wake rhythm can temporarily disrupt nighttime ADH secretion, leading to increased urine production during the night.³

The specific cause of the symptoms can only be determined individually by a doctor. This can be advisable even if the personal level of distress initially seems low.

Studies Show Increased Fall Risk with Nocturia

Even though nocturia itself is not a disease, it can become a safety risk in everyday life. Those who have to get up multiple times at night may move around tired and in the dark, increasing the risk of falls, especially among older people.

A systematic review from 2020 examined the connection between nocturia and falls or fractures.⁴ According to the observations, nocturia was associated with about a 20 percent higher relative risk of falls. For fractures, the risk estimate was about 32 percent, although the significance was lower for fractures than for falls. A more recent observational study in older people with hip fractures also found a connection between more pronounced nocturia and nighttime falls.⁵

Important: The data does not imply that nocturia directly causes falls or fractures.

* The consulting urologist is related to the article’s author.