Nighttime Urination – Nuisance or a Bigger Concern?

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Nighttime Urination – Nuisance or a Bigger Concern?
You’ve done all the things that you know for managing nighttime urination. You reduce fluid intake in the evening. You avoid coffee, alcohol, and caffeinated beverages. If you are on prescription diuretics, you take them earlier in the day. To deal with swelling in the legs, you elevate the legs or even wear compression stockings. Perhaps you have even tried some of the prescription drugs for overactive bladder.

Despite all this self-care, you find that you have to get up two, three or more times per night to use the bathroom. Getting up frequently during the night to urinate is at the least disruptive to a good night’s sleep. Once considered a benign nuisance, nighttime urination is fast becoming recognized as a warning sign related with illness and increased mortality. Fortunately, there are many nutritional options that help manage this disruptive nighttime symptom.

[Jump to: Nutritional Options]

Nighttime Urination


Nighttime urination, also known as nocturia, affects up to 40 percent of the population. Often dismissed as a normal part of aging, epidemiologists or those who study disease statistics find otherwise. Nocturia affects both men and women. Statistical analysis in a European investigation across five countries found that 48.6 percent of men and 54.5 percent of women have to get up at least one time per night to urinate.

Quality of life because of sleep disruption is a significant problem, but the nocturia is a symptom. Besides aging, it has historically been attributed to a bladder or prostate concern like benign prostate hypertrophy, overactive bladder, or bladder obstruction. Medications for these conditions often fail to provide the needed relief for the nocturia. These bladder concerns do create nocturia symptoms, but research shows that is more than a bladder or prostate problem or a nuisance symptom related to aging.

Type 2 Diabetes and Low Testosterone


Several studies have indicated that those who have to get up at night because of nocturia have an increased risk of mortality. Getting up twice per night was considered a moderate problem, whereas three or more times of needing to urinate at night is considered a severe problem. One study in particular found that men with three or more times of nighttime urination and type 2 diabetes were found to have difficulties with erectile dysfunction, stroke, hypertension, low testosterone, and higher levels of serum creatinine. Those who had the lowest testosterone levels had the greatest difficulty with nighttime urination than any of the other factors combined. After a 3 ½ year follow up, it was found that the men with type 2 diabetes who had severe problems with nighttime urination had a threefold higher mortality rate than the others.

Heart Disease and Other Disorders


A February 2016 study published in the Journal of Clinical Sleep Medicine evaluated 1,478 men, average age 73.8 years. The men were followed for nearly 10 years. After controlling for numerous variables including the effects of insomnia and sleep disruption, men who got up three or more times to urinate at night had a higher risk of death and it was related to heart disease and/or type 2 diabetes.

Nocturia can be an early warning sign of other diseases or disorders unrelated to the prostate or dietary intake. The nighttime urination may be due to endocrine problems like diabetes, cardiovascular disease, autonomic nervous problems, chronic kidney disease, fluid build-up or edema lymphatic problems, or obstructive sleep apnea. Clearly, a severe nocturia problem is more than a symptom; it reflects the stress state that the body is under and needs to be investigated. Here are some other major findings.

Overweight and Underweight


Body weight is related to nighttime urination and increased risk of mortality. Individuals who have a higher BMI (body mass index) over 25 and those who are underweight have a higher risk too. Research published last year found that Japanese men who were underweight or had a BMI of less than 18.50 had a significantly higher mortality rate and had significant disruptions with nighttime urination. The authors advised that further research is warranted to explore this finding. Nocturia and overweight status may relate to the inflammatory status of the body and changes in fluid dynamics. Individuals who are underweight and have nighttime urination may reflect significant exhaustion of the adrenal glands and may benefit from taking adaptogenic herbs for the adrenal glands.

Erectile Dysfunction


Erectile dysfunction (ED) has been linked with nighttime urination. Often the erectile dysfunction and nocturia are related to type 2 diabetes. Research published earlier this year found that nearly 80 percent of men with moderate to severe ED correlated with moderate to severe nocturia and had type 2 diabetes.

Nighttime Urination, Disrupted Body Clocks, and Disrupted Hormones


Nighttime urination research has expanded beyond prostate dysfunction, heart disease, and diabetes, etc. and into the study of circadian rhythm gene clocks 2 and a disruption in chronobiology. The focus is trying to shift towards the actual problem of voiding during sleep, i.e. looking at the problem as a sleep disorder and a circadian rhythm disorder. This is a completely new arena of study.

We do know that in other areas of health that when the circadian rhythm is disrupted several other concerns like obesity, diabetes, and heart disease are more prevalent. Hormones levels become more challenged, including leptin and its influence on the other hormones like insulin and the sex steroid hormones. Scientists will wrestle with the question of what came first; the sleep disorder, the changed 24-hour circadian rhythm, disrupted gene clocks, or the nocturia. Regardless, getting the circadian rhythm back on track is vital to restorative sleep, healthy body clock rhythms, and reducing nighttime urination.

Children


Children who have to get up at night to urinate may be struggling with sleep apnea. Sleep apnea may be due to underlying inflammation from food allergies and enlarged adenoids. Inflammation from the food allergies contributes to immune waste and affects fluid management within the body. Adults can suffer from this same problem.

The main thing to keep in mind is that if you are experiencing repetitive trips to the restroom at night, don’t ignore it. If you have taken the usual steps to reduce fluid intake in the evening and other commonsense hygiene habits, but your physician tells you its just part of normal aging, don’t settle for that answer. The sleep disruption alone makes it much harder to get through the day, but what about trying to find out about the underlying cause? Research in the last five years tells a very different story. Nighttime urination is a symptom of something more threatening than previously understood.

Nutritional Tools to Help Reduce the Nightly Bathroom Battles


If your spouse tells you that you stop breathing and snore like a freight train, get evaluated for sleep apnea. Sleep apnea is nothing to dismiss and relates to other disorders like heart disease, cancer, obesity, and stroke risks. Improving sleep apnea can create a significant improvement in nightly bathroom trips overtime as fluid regulation and sleep rhythms improve. Improving leptin, lymph congestion, and removing food allergies and intolerances is at the core. Nutritional choices that help lymph congestion, allergies, and circulation include arabinogalactan, grape seed extract, quercetin, and horse chestnut.

If your legs are swollen and varicose veins are preventing normal fluid movement, this will impair normal fluid dynamics. When you lie down at night or for extended periods of time, then gravity is no longer working against which helps fluid management and leg swelling. Horse chestnut, resveratrol, proteolytic enzymes, curcumin, and arabinogalactan help support healthy lymph and vascular flow. Extra magnesium and potassium may be helpful for some. Cranberry and mangosteen extract acts like a natural diuretic that may assist with fluid retention in the body.

If the prostate is enlarged from BPH or cancer, then work on reducing inflammation and consider support for xenoestrogen detoxification. Zinc, selenium and lycopene together with saw palmetto have been found to control urinary tract symptoms related to BPH. Researchers found that those with prostate cancer and urinary tract infections causing nighttime urination benefited significantly from cranberry extract.

Individuals who have cardiac problems like heart failure may benefit from taking coenzyme Q10. Nighttime urination was significantly improved in patients who had end stage congestive heart failure in just three months when 60 mg of coenzyme Q10 was added to their treatment program. This study used a very small dose of coenzyme Q10. Dosage for heart support often ranges from 200-600 mg per day, depending on the amount of fatigue and if statin medications are being used. Statin medications rob the body of coenzyme Q10 which compromises health and heart.

Cordyceps has been found valuable in helping aging bodies and nighttime urination and even helps support and protect DNA.

Low testosterone levels and erectile dysfunction in men was found to worsen the nocturia. Testosterone production requires zinc and may be taken with other nutrients to help normalize testosterone levels and erectile dysfunction such as the nutrients like muira puama, tribulus terristrus, panex ginseng, acetyl-l-carnitine, and saw palmetto.

Women who have nocturia may have the opposite problem with testosterone. One study reported that women who had PCOS (polycystic ovary syndrome) and had higher levels of testosterone had greater likelihood of bladder symptoms and nocturia. In both men and women, the imbalance with testosterone was found linked with blood sugar problems, i.e. type 2 diabetes. Addressing the blood sugar problems is integral to addressing the nocturia. Nutrients to consider may include chromium, cinnamon, lipoic acid, vanadium, and the B vitamins.

Bladder irritation from interstitial cystitis, infections, overactive bladder requires a different approach. Information about this may be found in the article Natural Support for Bladder Problems.

The normal rhythms of the body depend on several things. This can be simply improving meal timing as discussed in The Leptin Diet. High fat and high sugar diets worsen the body clock rhythms. Melatonin, phosphatidylserine, and resveratrol help support the natural circadian rhythms. Healthy methylation also drives the circadian clock. Methylation requires several B vitamins, magnesium, zinc, choline, and MSM sulfur.

If your physician fails to pursue the discussion about how many times per night you are getting up to urinate, they are missing a big problem. If you are getting up more than once per night on a regular basis, the problem needs to be addressed. Don’t dismiss it. Look further into these issues discussed and then take action. Besides stubbing your toe against the bed frame in the dark and sleep disruption for all because of the noise and lights, it may just save your life.

Nutritional Options


Zinc – Zinc is a mineral vital for numerous processes, but is especially important for prostate, testosterone, adrenal, and thyroid health.

Saw Palmetto – Saw palmetto is the go-to nutrient for benign prostate enlargement. It may also be helpful for balancing testosterone function in the body.

Panax Ginseng – This special form of ginseng helps physical endurance and stamina. It is also essential to testosterone production and may help erectile dysfunction.

Selenium – Selenium is a trace mineral needed for blood sugar and hormone function. Studies show that it is essential for detoxification and also helpful for benign prostate enlargement.

Chromium – Modern agricultural practices render the food supply nearly void of this vital blood sugar and insulin management mineral. High carb or sugar intake increases the need for chromium.

Cordyceps – Cordyceps is a traditional Chinese medicinal herb that has been used historically for kidney health. Because of the natural antioxidant and anti-inflammatory properties, it is often used to help weakened and aging states that may cause increased problems with nighttime urination.

Cranberry – Well-known for its antioxidant support for bladder and urinary tract health, cranberry provides additional support for nighttime urination. It has accepted use for prostate and bladder outlet obstruction.

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