Overactive Bladder at Night
Overactive bladder, or OAB, is exactly what it sounds like — a bladder that has a sudden need to urinate. This urge may be difficult to near impossible to stop and it can lead to incontinence.
Typically, OAB is characterized by that "need to go" feeling, urinating eight or more times in a 24-hour period, and urge incontinence — an involuntary loss of bladder control that occurs following that "need to go" feeling.
As uncomfortable as OAB is, it can be even worse when it is experienced at night as it can lead to a loss of sleep.
Nocturia vs Overactive Bladder at Night
Nocturia is when you must get up at least once to urinate overnight. Typically, it becomes bothersome when it occurs repeatedly.
Nocturia and OAB are NOT the same thing. Nocturia can coincide with OAB; those with OAB at night experience nocturia, as they are urinating several times during the night. However, not everyone with nocturia has OAB, because other conditions can cause nocturia.
Other common conditions that may cause nocturia include:
- Bladder obstructions
- Urinary tract infections
- Excess fluids
- Untreated or poorly controlled diabetes
- Congestive heart failure
- Benign prostatic hyperplasia
- Diabetes insipidus
In addition, certain medications can cause nocturia; examples of these medications include:
- Diuretics such as furosemide (Lasix) and torsemide (Demadex)
- Excess vitamin D
- Phenytoin (Dilantin)
Signs and Symptoms of Overactive Bladder at Night
As we discussed, OAB and nocturia may differ, though they can coincide. Those with nocturia may experience symptoms only at night, while having no issues with urination during the day. However, those with OAB have an increased likelihood of also experiencing nocturia.
It is important to discuss your symptoms with your healthcare provider. Are you experiencing OAB? Or is it nocturia related to a different medical condition or medication? Ruling out the cause can help you receive the proper treatment.
Common signs and symptoms of OAB at night include:
- Rising throughout the night to urinate, especially if it occurs more than once or the rate is increasing
- Urinating so frequently at night that it is disrupting quality of sleep
- Fatigue due to sleep disruptions
Prevention and Treatment Options
Prevention of nighttime urination is typically recommended by healthcare providers. Common lifestyle modifications include the following:
- Restriction of fluids before bed, while ensuring that adequate fluids are taken in throughout the day
- Avoiding beverages with caffeine
- Avoiding alcohol
- Maintaining a healthy weight; excess weight can place pressure on the bladder
- Taking afternoon naps
- Taking diuretics at a time when they will not disrupt sleep
Your healthcare provider may also request that you keep a voiding diary. A voiding diary will help you and your provider pinpoint what is causing symptoms of OAB. Common items to record on a voiding diary include:
- How much fluids are consumed
- What kind of fluids are consumed
- Times of urination
- Whether there was an urge for urination
- Whether incontinence was experienced
If lifestyle modifications are not enough, medications may be prescribed:
- Anticholinergics treat bladder spasms, which reduces the urge to urinate.
- Diuretics, though it may sound counterproductive, if timed appropriately can be very effective. A diuretic taken in the morning can assist with regular urine production, which helps to rid the body of excess fluids earlier in the day.
- Tamsulosin (Flomax), finasteride (Proscar), and dutasteride (Avodart) all treat benign prostatic hyperplasia, which reduces pressure on the bladder.
- Desmopressin (DDAVP) helps the kidneys produce less urine; this medication is helpful when the cause of OAB is diabetes insipidus.
In more extreme cases of OAB at night, nerve stimulators may be placed. These nerve stimulators assist with helping the bladder make regular contractions.
The Bottom Line…
OAB at night is troublesome because it disrupts your quality of sleep, which has a trickledown effect. Without quality sleep, we’re fatigued and less able to function at an optimal level throughout the day.
Having a frank discussion with your healthcare provider about OAB – daytime and nighttime – is in your best interest; it can improve your quality of life.