High levels of nocturia and getting up at night is a big problem that plagues the vast majority of older people. The number of times we normally urinate at night is between 0-1 times and increases in older people.

I have an uncle who was a special police officer when he was young, and he was very brave and physically fit, but now that he is older, he has to go to the toilet four or five times every night. Whenever his youthful bravery was mentioned at the dinner table, he would laugh at himself and say, "Now I'm an old man who has to get up and go to the toilet four or five times a night, I don't have much use for it anymore."

As you get older, no matter how healthy you were when you were younger, no matter what your profession, no matter how rich or famous you are, you can't seem to escape this fate, it's just that some people show up late and some show up early. Some are normal physiological phenomena, but some are diseases. I'll give you an overview.

First, let's take a look at how our bodies produce urine and store it, which will help us further understand why older adults urinate more at night.

After the blood reaches the kidneys, it first passes through the glomerular filtration to become primary urine. The glomerulus can prevent some large substances in the blood from entering the primary urine, such as blood red blood cells (when nephritis occurs, the glomerular filtration system has problems, which will lead to blood red blood cells entering the urine, and the urine will become hematuria). Then the tubules inside the kidneys will process the original urine and reabsorb 99% of the water and some substances in the original urine back into the body, and the original urine is concentrated to form urine. The urine is then transported through the ureters to the bladder, which is commonly known as the urinary bladder and is a cavity structure that serves to store urine. Our body produces urine every minute of every day, but we don't need to pee anywhere, anytime, and that's because we have a bladder. Our bladder has a muscle called the bladder sphincter, which is the equivalent of a faucet that is normally closed and opens when we need to urinate. The bladder can usually store a few hundred milliliters of urine. In addition, our bladder is also covered by the bladder forcing muscle, which squeezes out the urine when it is pushed. Men have one more prostate than women.

Okay, now let's talk about why nighttime urination increases in older people

First let's look at the physiologic causes of increased nocturia in older adults

1. Drinking a lot of water before going to bed, drinking a lot of tea or wine, or eating foods that contain more water, such as diluted rice or watermelon.

This doesn't need much explanation, normal people, regardless of age, who drink a lot of water before going to bed will have an increase in

2. Although there is no disease in the kidneys of the elderly, they are certainly not as good as when they were young. So the ability of the kidneys to reabsorb also decreases, which leads to more urine and more nocturia.

3. The bladder sphincter is not strong enough to hold so much urine. In addition, the bladder muscle will also atrophy, each time can not completely finish the urine, residual part of the bladder.

4. Elderly men basically can not escape the fate of the enlarged prostate, the prostate is large, poor urination, every time after urinating will remain part of the urine in the bladder, not long after, and have to go on.

Let's move on to the pathologic causes

1. Inflammation of the urinary system, there can be an increase in nocturia. In addition to this, patients will also have symptoms of urinary frequency, urgency and pain, and a small amount of urine each time.

2. Kidney disease, renal failure early on, the patient's urine volume is increased, and then is reduced. Patients also have swelling, back pain, nausea, anorexia and other symptoms. Especially patients who have been suffering from hypertension, diabetes, urinary stones should be careful, because these diseases can lead to complications of kidney damage and cause kidney failure, once the above symptoms occur, be careful whether it is kidney damage.

3. Diabetes can lead to increased nocturia. One of the characteristics of diabetes is excessive drinking and urination.

4. Occupying lesions inside the bladder, or bladder tuberculosis, which leads to a decrease in the capacity of the bladder and the inability to store urine. Patients with bladder cancer can have painless hematuria. Patients with bladder tuberculosis can have pus urine and fever.

5. lesions of the prostate, the principle of which has already been described. The patient has difficulty in urinating and is unable to urinate.

Older adults must pay attention to the following when getting up at night

1. After waking up, do not be in a hurry to sit up immediately, wake up first trip for a few seconds, and then slowly sit up to prevent a sudden stand up insufficient blood supply to the brain, fainting.

2. The path from the bedroom to the toilet should be kept clear to avoid tripping over it

3. Lighting is desirable

4. Keep warm when getting up at night to avoid catching a cold, especially in winter.

Also, don't hold your urine when you're young, and do more anal lifting exercises. If there is an infection in the urinary tract, treat it early.

When people get older and urinate at night, it's not necessarily because they use the faucet too much or are too old!

Here, Dr. Chan tells us why people urinate more at night in old age.

First of all, it doesn't necessarily mean that just because you're going to the bathroom more often at night that you're urinating more at night; sometimes it could be that you've been drinking too much water before bed lately.

Clinically, there is a specific definition for increased nocturia: going to the bathroom more than twice at night, the total amount of nocturia is more than 700ml, accounting for more than one-third of your 24-hour urine volume, but the total volume of urine in 24 hours is also not increased. So, if you urinate a lot throughout the day and night, whether the total amount is over during the day or at night, it can't be said that it's simply an increase in nocturia!

Secondly, increased nocturia, in our Western medicine, is usually said to be a sign of decreased kidney function!

Under normal circumstances, you don't buy an Apple cell phone, everyone will have two kidneys, and the evaluation of kidney function is often reflected by the millions of glomeruli, tubules and other renal units inside the kidneys. But as we grow older, especially after 40 years old, even if you don't have any other specific kidney disease, our kidney function will slowly go into decline, which is manifested by degenerative changes in the glomeruli and tubules, which decrease in number, and hardening of blood vessels passing through the kidneys, and shrinking of the kidney size.

Once you reach the age of 65, this degenerative change becomes more pronounced, especially as the renal tubules are not able to effectively reabsorb the water filtered out by the glomeruli into the bloodstream, which leads to disrupted urination patterns and increased nocturia in the elderly!

However, it is not that everyone after 65 years of age will increase nocturia, it also has to do with the individual's physical condition, such as some people also suffer from prostatitis, prostate hyperplasia and other diseases, then its increase in nocturia is more likely to occur! Of course, Dr. Chen has also seen people in their 70s with good kidney function, and even individuals who report that they still have a regular sex life!

Finally, let's analyze the topic that may be of most concern: is increased nocturia a disease?

This has to be analyzed on a case-by-case basis, as increased nocturia is not always caused by illness!

Like clinically, it is true that some elderly people suffering from prostate hyperplasia, chronic pyelonephritis, inflammation of the bladder and urethra, chronic interstitial nephritis, diabetes mellitus, and so on will lead to increased nocturia. So.We suggest that once the elderly feel that they are urinating more frequently at night, they should pay enough attention to it and go to the hospital for diagnosis first. If they really urinate more frequently at night, they must rule out the possibility of illnesses causing it.

If a definite disease is ruled out, a poor diet, high mental stress and a loose urethra can also cause increased nocturia in the elderly. Therefore, increased nocturia may not necessarily be a disease!

Increased nighttime urination that is not caused by a disease can be adjusted by trying a few things!

1. Drink less thin rice and porridge as well as fruits on yao;
   
2. Control salt intake appropriately;
   
3. Drink less water in the evening, especially preferably not coffee, strong tea, etc;
   
4. Watch less intense TV and movies before bedtime to avoid emotional over-excitement;
   
5. Take some potassium-rich foods such as mushrooms and cabbage;
   
6. Intentionally do more anal lifting exercises!

The prostate gland is a male-specific gonadal organ, which can be said to be the second lifeline of men, so why do men experience increased nocturia once they reach old age?

After urine is produced from the kidneys, it is stored in the bladder. When there is an action to urinate, urine will be transported from the bladder through the ureter to the prostate, and then through the urethra to be discharged out of the body. Normal prostate has good elasticity and nerve sensitivity, and can control spermatogenesis and urination well. If the elasticity decreases and the nerves are damaged, there will be a phenomenon of not being able to control urination and frequent urination.

Modern society, the incidence of prostate disease is very high, such as long-term masturbation, late at night, sedentary, holding urine, drinking alcohol, etc. are common triggers, if there have been these bad habits, to the older age, the physical condition is also followed by the decline of the natural will also appear a series of prostate problems.

As we grow older, the prostate gland will naturally age, and at this time will grow more to make up for the missing function. Then after the age of 45, every year of growth, will grow 1mm more to make up for the missing function, this situation is generally within the normal range, there will not be any problem, but if excessive hyperplasia, then it will affect the urination, urinary frequency and nocturia symptoms.

It is recommended that if older men experience excessive nocturia, go for a prostate ultrasound and urinalysis, and then consider further treatment.

Why do older people often urinate more at night?

Chinese medicine often talk about the elderly kidney qi deficiency, qi insufficiency and increased nocturia, this time we analyze from the perspective of modern medicine:

As people age, they experience some of the following physiological changes:

1. Decline in kidney function

We know that the water we drink ends up being excreted through the kidneys. There are glomeruli and tubules in the kidneys. The glomeruli filter out most of the water in the blood that flows through the kidneys, and the tubules reabsorb the useful components and water in the filtered water back into the bloodstream, leaving a small amount of unwanted components and water, which flows into the bladder through the ureter to form urine. When a person reaches the age of 30 or 40, the kidneys begin to age, the glomeruli and tubules undergo degenerative changes one after another, their number begins to decrease, the blood vessels that pass through the kidneys begin to harden, and the function of the kidneys begins to diminish.The deterioration of the renal tubules is particularly obvious for people over 65 years of age. At this time, the renal tubules cannot effectively reabsorb the water filtered out by the glomeruli into the bloodstream, which means that the concentration function of urine decreases, resulting in the symptom of polyuriathat causes increased nocturia in older adults.

2、Disordered secretion of antidiuretic hormone

Antidiuretic hormone (also known clinically as vasopressin), as the name suggests, has the effect of reducing the formation and elimination of urine. In healthy adults, antidiuretic hormone secretion has a circadian rhythm, less during daytime activity and more at night when sleeping. In old age, the rhythm of antidiuretic hormone secretion gradually changes from twice as much at night as during the day in young adults to basically the same at night and during the day. The decrease in antidiuretic hormone secretion at night in the elderly leads to an increase in urine formation at night.

3. Reduction in bladder reserve capacity

The bladder is a "reservoir" for storing urine. When you are young, the bladder's tension is soft, the sphincter muscle is strong, and the function of reserving urine is strong;In old age, the bladder wall becomes rigid, contractile function decreases, and the volume of urine stored in the bladder gradually decreases.When the urine reaches half, it produces the urge to urinate and immediately passes the signal to the brain. Due to the shallow sleep of the elderly, the brain is easily awakened and can only go to the bathroom to empty the urine after waking up.

In addition to some of the physical changes that occur with age, theThere are also many diseases that can cause nocturia, common such as diabetes, renal system diseases, etc., and we are closely related to the male is the elderly prostate hyperplasia and caused by increased nocturia.Due to the enlargement of the prostate, the urethra becomes thinner, the resistance to urination increases, and the residual urine after the bladder is emptied increases on top of the original bladder capacity that has been shrunken, while the bladder produces the urge to urinate. In addition, the elderly due to low immunity, living hygiene is not careful, often lead to urinary tract infections can also cause increased nocturia.

Text: Prof. Wang Chuanhang, Wang Haohao Master's Student, Department of Men's Medicine, China-Japan Friendship Hospital

For >65 years, in older adults, nocturnal polyuria is defined as nocturnal voiding of >33% of total 24h urine output. The following causes are generally considered:1. Low bladder capacity e.g. reduced bladder capacity or impaired bladder function: bladder outlet obstruction due to overactivity of bladder forcing muscles and prostatic hyperplasia with age.2. Increased nocturnal voiding: e.g. decreased secretion of arginine pressin leading to increased urination.3. Sleep disorders: e.g. as seen in those with obstructive sleep apnea.4.Increased nocturnal polyuria: e.g. in those with obstructive sleep apnea.5.Increased nocturnal polydipsia: e.g. in those with obstructive sleep apnea.

A number of diseases and risk factors predispose to increased nocturia: obesity, high blood pressure, diuretic use, benign prostatic hyperplasia, prostate cancer, snoring, diabetes. Kidney disease, congestive heart failure, restless leg syndrome, etc. And any habits such as drinking alcohol or coffee.

Increased nocturia can be a sign of disease in the organism, or it can be a sign of functional deterioration with age such as overactivity of our bladder's forced urinary muscles, and a decrease in the secretion of hormones such as arginine pressin.

There is a reminder of the elderly men, night urination attention to safety, try to squat toilet, do not stand for too long, or may occur after urination upright hypotension caused by fainting and other occurrences.

I'm 68 years old, have prostate enlargement, get up two or three times at night, it affects my sleep, visited many hospitals, the treatment is not satisfactory, I recently have time to do abdominal lifting exercises to improve the function of the prostate, a month, the swelling feeling has been relieved, the number of times of urination has been reduced, and then adhere to a period of time, to see what the effect is?

As a urologist specializing in urinary control at a tertiary care hospital, I can attempt to answer this question.

Many older people think it's normal to urinate more at night as they get older. Of course, there are certain factors, because it has a certain relationship with the aging of the human organism, with the increasing age and accompanied by different degrees of comorbidities, the bladder function and nerve function will be damaged to a certain extent. Here we first exclude the normal situation of drinking water, alcohol and some stimulating beverages and foods at night.

First of all what is nocturnal polyuria?

The definition from the International Urological Control Society is ≥1 nocturnal sleep onset urination, while the Chinese expert consensus defines this number as ≥2. Therefore, when the number of nocturnal urination increases more than twice in older adults, it is defined as increased nocturia!

For older men

Prostate enlargement is one of the more common causes of urinary problems in older men. The incidence of urinary problems caused by prostate enlargement increases with age, exceeding 50% after age 50 and 83% after age 80!

For older women

Unlike men, women do not have an organ like the prostate. This is why increased nocturia in many older women is overlooked by many patients and doctors. In fact, not a few women experience increased nocturia as they age, especially those who may have stress incontinence and uterine prolapse!

Problems common to men and women

In addition to male and female-specific organs that may cause increased nocturia, there are many other conditions that may cause increased nocturia in older adults. Some of the more common diseases include the following:

Neurological disorders: For the elderly, strokes and cerebral hemorrhages can lead to an increase in nocturia, as well as Parkinson's, multiple system atrophy, cerebellar atrophy, and so on. Although these neurological disorders are not directly related to the bladder or urinary system, they can affect the nerves involved in urination and can cause increased nocturia. And because of their age, many patients do not consider the two together, and sometimes when they undergo surgery or many treatment modalities, they are often ineffective!

To summarize, increased nocturia is very common in the elderly, and in addition to ruling out normal triggers, one needs to be alert to the possibility of disease if there is an increase in the number of frequent night risings!

I am Shao Yunpeng, a doctor who focuses on urology popularization, if the answer is useful to you or people around you, thank you for liking the attention forwarding, thank you!

Although the elderly drink less water before going to bed, but the night urine is still more, I think the reason is: First, from the perspective of traditional Chinese medicine, the kidney, spleen two deficiency, yang qi deficiency. Poor sleep quality, night urination naturally increases. Secondly, from the Western medical analysis, the bladder sphincter relaxation, urinary drainage will often have a sense of urination. Some older men may have a desire to urinate due to prostate enlargement or enlargement, which presses against the bladder.

The above is my opinion, please correct me if I am wrong.