Getting up at night to urinate: age or an enlarged prostate

Emil Aldyrakov — GP, urologist-andrologist

Men put getting up at night down to age and live with it for years. Yet it is the most common first symptom of a condition that responds well to treatment at an early stage and poorly at a late one.

What counts as normal

One trip a night in older adults falls within normal. Two or more, happening regularly and disturbing sleep, is nocturia and deserves assessment. Importantly, nocturia is a symptom rather than a diagnosis, and it has several possible causes.

It is not always the prostate

Besides benign prostatic enlargement, night-time urination is caused by:

• large fluid or alcohol intake in the evening, and caffeine;
• diuretics taken in the second half of the day;
• diabetes mellitus and diabetes insipidus;
• heart failure — fluid accumulated in the legs during the day returns to the circulation when lying down;
• sleep apnoea — an underrated and frequent cause;
• overactive bladder;
• urinary tract infection.

Which is why the consultation begins not with the prostate but with your daily routine and other conditions.

Other symptoms worth noting

A weak stream, needing to strain, an interrupted flow, a sense of incomplete emptying, frequent daytime urination, and urgency that is hard to hold. These are scored together on a standard questionnaire — which makes the complaint measurable and lets you see the effect of treatment later.

The bladder diary

The cheapest and one of the most informative tools: over 2–3 days you record the time and volume of what you drink and what you pass. The diary immediately separates nocturnal polyuria — producing a lot of urine overnight — from a problem with emptying. It costs nothing and frequently changes the plan.

What is assessed

Examination, urinalysis, and ultrasound of the prostate and bladder including post-void residual volume — a key measure of whether the bladder is emptying. By age and indication PSA is discussed: it is ordered not to diagnose enlargement but for the separate question of early prostate cancer detection, and under American Urological Association guidance that is a shared decision with the patient.

Why not to wait

Long-standing obstruction gradually changes the bladder wall, and its function does not fully recover even after the cause is removed. Early on, medication and routine adjustment are usually enough.

Coming in

In our clinic a urologist consultation is AED 600; transabdominal prostate ultrasound AED 1,000, transrectal AED 1,100, bladder ultrasound AED 800, free PSA AED 150 and urinalysis AED 50. All in a single visit.

Sources

• AUA. Management of Benign Prostatic Hyperplasia / LUTS
• EAU. Management of Non-Neurogenic Male LUTS

FAQ

Does getting up at night always mean a prostate problem?

No. Evening fluids, alcohol and caffeine, afternoon diuretics, diabetes, heart failure, sleep apnoea, overactive bladder and urinary infection can all cause it. That is why the consultation starts with your daily routine and other conditions.

Why keep a bladder diary?

Over 2–3 days you record the time and volume of what you drink and pass. It separates nocturnal polyuria, producing a lot of urine overnight, from a problem with emptying, and frequently changes the plan.

What is checked at the appointment?

Examination, urinalysis and ultrasound of the prostate and bladder including post-void residual volume. PSA is discussed by age and indication for early prostate cancer detection, as a shared decision with the patient.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

Book an appointment