Urine Retention (nocturia): Why am I producing so much urine at night?

Posted by terwifwoods @terwifwoods, Oct 30, 2021

Hello,

Per my doctor, I am an otherwise healthy 40 something year old male who was been diagnosed with urine retention and voiding dysfunction (approximately six weeks ago). I've had a cystoscopy, which confirmed I have a very tight external urethral sphincter muscle and a hypertrophic bladder. I was doing self-catherization for over a month and pelvic floor stretches. I opted to have a foley catheter for the next month to relax the sphincter and bladder. I am awaiting a urodynamic study for further details, but its over two months out.

I am drinking 100 ounces of water or more each day per my urologist. I drink over half of the total in the mornings, and taper off through the afternoon. I stop drinking fluids at 6pm.

However, I noticed I am producing more than half of my daily output of urine between 11PM – 5AM, even though I empty myself before bed. When I was self cathing, I would void 300-400 ml on my own and cath another 400-700ml at night! When I wake up with my foley cath, I consistently have over 1000ml in my nigh bag. I asked my urologist and doctor why my urine output is so high at night and they do not know.

WHY am I producing so much urine at night?

Prior to the urine retention problem, I would get up once at night to pee 2-4 times a week, and my prostate is fine. I occasionally snore and my wife has not noticed any issues with breathing during sleep. I was tested for sleep apnea three years ago and it was negative. I exercise at least five days a week and was in the best shape of my life prior to the retention issues.

Could this be hormonal or neurological? Does the fact I worked a swing shift for fourteen years (off at midnight-ish) influence this?

How can I get my urine production to increase during the day and decrease at night?

Please help! I'd like some type of guidance so I can get my life back on track…

Interested in more discussions like this? Go to the Kidney & Bladder group.

Good morning,

I have the same issue and it has been a long road. Have you tried these things yet:
1. Going on a schedule so say – 8 am, 11 am , 2pm, 5pm and 8pm and no liquid after 8pm – drinking water in between those times. I know it is not always easy to stick to a schedule.
2. Have you your hormones or other vitamins checked to make sure it is not some kind of imbalance?
3. Sounds like you are having issues with relaxation and you did say you were doing stretching exercises. This was my issue at least. Are you going to a pelvic floor therapist? I had to go to two different ones to find the one who was helping the most. My muscles are not too strong or weak – they don't relax.
4. Two months out for a urodynamics study sounds too long esp when you are having so many problems. Even with a foley or cath you have to be careful because that can give you other problems like infections.

I do have to cath a least once a day but things are better now. I have had this problem for awhile though so not sure this helpful but…I have always had to get up to go at night, had gotten worse over the last year. Now I am seeing improvement.

Thanks,
Heather

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@terwifwoods Having this issue must be causing you lost relaxation and sleep, right? I have the opposite problem, as I head closer and closer to kidney failure! I am limited on daily fluid intake to around 40 ounces, to help kidney stress be lessened.

As I read your post, I hoped you have also read what you wrote down. Several questions came to mind, chief among them is why you are intaking so much fluid per day? If this total is just water, remember there are liquid values in soup, fruits, sauces, etc., too, that would increase that fluid intake amount. What has your dr said about that high level of intake? Another thing you might consider, is if you finally have the opportunity to relax at night, letting your whole body relax and allowing the tightened urethra to also relax?

Here is an article from Mayo Clinic about benign prostatic hyperplasia that may answer a few concerns: https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
Ginger

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Don’t know if this will help, and have no idea what’s causing this, but it sounds like a situation that is disruptive to good sleep. Could you be retaining water in your lower extremities (gravity) during the day, and then, when you lie down, you are suddenly processing it? Maybe if you put your feet up at least as high as your heart for an hour or two before bed? Read/watch TV, etc in bed, before you go to sleep? Best wishes.

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A complex problem with no easy answers, but to add to your knowledge check out nocturnal polyuria. It tends to be related to a hormone called ADH. Synthetic forms of ADH are available if your physician thinks it is a worth a try. Good luck and let us know.

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My husband finally got to a urologist. Dr found that his bladder was not totally emptying due to overgrowth of the prostate! A simple procedure called a Urolift was performed and things are good. His bladder, however, is aging badly since he went years without managing this. He is diabetic and age 73. Dr advised him to stop drinking water after 5 pm. The in office urolift went well, and he no longer needs the catheter.

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@stlsampsondev

Good morning,

I have the same issue and it has been a long road. Have you tried these things yet:
1. Going on a schedule so say – 8 am, 11 am , 2pm, 5pm and 8pm and no liquid after 8pm – drinking water in between those times. I know it is not always easy to stick to a schedule.
2. Have you your hormones or other vitamins checked to make sure it is not some kind of imbalance?
3. Sounds like you are having issues with relaxation and you did say you were doing stretching exercises. This was my issue at least. Are you going to a pelvic floor therapist? I had to go to two different ones to find the one who was helping the most. My muscles are not too strong or weak – they don't relax.
4. Two months out for a urodynamics study sounds too long esp when you are having so many problems. Even with a foley or cath you have to be careful because that can give you other problems like infections.

I do have to cath a least once a day but things are better now. I have had this problem for awhile though so not sure this helpful but…I have always had to get up to go at night, had gotten worse over the last year. Now I am seeing improvement.

Thanks,
Heather

Jump to this post

Thank you for the reply Heather. I do have a pelvic floor therapist. I am also non a schedule, and am not drinking anything after 6pm. I’m going to request testing for hormones.

You mentioned you had this problem for “awhile”. How long did it take until you saw improvements?

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@gingerw

@terwifwoods Having this issue must be causing you lost relaxation and sleep, right? I have the opposite problem, as I head closer and closer to kidney failure! I am limited on daily fluid intake to around 40 ounces, to help kidney stress be lessened.

As I read your post, I hoped you have also read what you wrote down. Several questions came to mind, chief among them is why you are intaking so much fluid per day? If this total is just water, remember there are liquid values in soup, fruits, sauces, etc., too, that would increase that fluid intake amount. What has your dr said about that high level of intake? Another thing you might consider, is if you finally have the opportunity to relax at night, letting your whole body relax and allowing the tightened urethra to also relax?

Here is an article from Mayo Clinic about benign prostatic hyperplasia that may answer a few concerns: https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
Ginger

Jump to this post

Thank you for the reply. My urologist directed me to drink 100 oz of water per day. The good news is my kidneys are prostate are ok. I also have a notebook of ongoing questions for my doctors. Hang in there!

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@bcs123456

A complex problem with no easy answers, but to add to your knowledge check out nocturnal polyuria. It tends to be related to a hormone called ADH. Synthetic forms of ADH are available if your physician thinks it is a worth a try. Good luck and let us know.

Jump to this post

Thank you! I am going to contact my doctor regarding ADH testing

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@frankandkaren

Don’t know if this will help, and have no idea what’s causing this, but it sounds like a situation that is disruptive to good sleep. Could you be retaining water in your lower extremities (gravity) during the day, and then, when you lie down, you are suddenly processing it? Maybe if you put your feet up at least as high as your heart for an hour or two before bed? Read/watch TV, etc in bed, before you go to sleep? Best wishes.

Jump to this post

Surprisingly I have no water retention in my legs. I do feel bloated at times, so I may be holding it in my abdomen. I’ll still try putting my legs up…thanks

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I am a 75-year-old male who is in good physical shape with some exceptions; I have Parkinsons (PD)
and must exercise (I'm involved in the Rock Steady boxing program for PD, I do weight training with light weight bar-bells, and lots of work with my treadmill (for balance, strength in the legs, breathing training, and more some weeks.

I have had all kinds of prostate difficulties since I was 40 and onward – constantly dashing off to locate bathrooms because, as others have said, if you have BPH (and I have a large prostate) you continually fail to empty your bladder to near completness I have had prostatitis on many occasions, probably 4 biopsies of my prostate, numerous MRIs and other scans for tumors that consistently proved completely or relatively negative and have had examinations of the bladder and prostate every couple of years to ensure there was no cancer (the disease my father died of). I've also been, lately, taking terazosin to control the bladder during the night & prevent waking up at night 1-3 times, which, at first worked wonderfully for a few months and then (i.e., now) I'm back to waking up once or twice for nocturnal peeing and wearing men's diapers. A couple of years ago I had what was called a urolift wherein two tiny stainless steal balls were placed in or near the bladder to stop urgent trips to eh bathroom to urinate. This new technology helped to eliminate jaunts to the bathroom to empty my blafdder for a couple of weeks, then things improved no more and I was back where I was before the urolift.

But two to three weeks ago I had bloody – completely bloody – urine and got very nervous and saw my urologist right away. He gave me an internal bladder exam – can't recall the name of the exam but it entails a complete examination of the bladder through the use of a rubber tube that is inserted what felt like a yard into my penis and up to and inside the the bladder and this is "televised" if you want to watch the inner search, which I did. It turned out that I had a huge stone sitting in (on) my bladder that was so large – 4 cm X 1.5 cm X .5 cm – he couldn't take it out in his office and I had to have the stone broken up by a laser and crushed into small pieces. I heal pretty quickly and a couple of days later there was no trace of the stone. The point is anything in or around your bladder or urinary tract (canal) can cause simple or severe blockage and finally cause some kind of damage to the bladder – and could prevent you from urinating, could scrape the bladder and cause excessive bleeding, and/or could release too much urine throughout the day and night that you can't (easily) control. I'm seeing my urologist on Wednesday and have a feeling that things in my bladder will gradually change for the better having had this huge stone excised from my body; perhaps now it has already begun to take off enough pressure on my bladder on a given day, or longer time frame, that can make my daily life less miserable.

Incidently, before I saw the stone sitting on, or partly in, my bladder, I never had any pain or discomfort. DIdn't even know it was there. But about five months ago my urologist suggested to me during a meeting I had with him that I could have a bladder stone or stone fragments that might soon become troublesome and will need to be eliminated.

– Howard J. Scheiber, PhD

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Well if you want my full story it started in Jan 2020. I am now almost a year out and can leave the house with no accidents and not having to cath in a public bathroom which is good and no pessary – in the last month on and no waking up at night to pee which i was doing 6-8 times a night. Not sure your count but that was tiring…. It is so bad though because they took to long to catch my problem I have to get prolapse surgery which will fix bulge when I feel full and help to know when to pee. My urologist and urodynamics test (first time) – they told me was as simple as nerve issue and they could fix it with a nerve-stimulating device. Do not rush into that -please! And I tried meds – but they didn't work. I waited until august first PT therapist – I was told nerve surgery was only answer, but I keep asking questions. All we did with first PT was work on my weak leg muscles. Yes I have auto immune and lynch syndrome. Put that didn't explain my bladder problem. I am sure you trust your pt but unless they are relaxing your muscles and only those you won't see improvements. I spent four months in vain with the wrong therapist. Not their problem. Not many people have the weird issues I have. If PT is working keep going – if it is not try someone else. I know that is hard I was loyal for four months after 3 weeks I was off my cath for at least two days a week and only at night at home before bed because I worry too much – am I on week 3. I never did a foley and never will. I get it is tough decision but please try to reach out directly to urology at Mayo for help not internal med. See if they will take your case – they might. Or try urogyn. Keep trying and fighting. You will find your way. i fought and didn't give up and you will too. If you need anything else I am here. This was a long road. Get more blood tests and find better doctors – find a local urogyn if nothing else please. If you can. Good luck. Keep me posted. I am alive and kickin cause I am a pain in the ass. Two years ago docs told my I was a hypochondriac – well several surgeries later and a cancer survivor I am alive so never question yourself ever! And I also have this urinary thing too on top of all of it. I follow at Mayo in Rochester for cancer and urology – local docs brushed me off! MAYO is awesome! Keep fighting.

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I read not too long ago that medication will be available for this.

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