Last week I went on vacation with two of my closest friends. During our time together one friend casually mentioned that she doesn’t sleep well because she often wakes up at least 3 times per night to pee. “That’s not normal” I replied. “I can help you.” I am writing this blog to share with you the tips I shared with her that helped her reduce nighttime urinary frequency and get good restful sleep.
As a pelvic floor physical therapist, increased urinary frequency is a common condition we treat. It’s often caused by overactive pelvic floor muscles, medications, caffeine and alcohol intake, pregnancy, and/or infection. Waking up more than once per night to urinate is a sign of urinary frequency. Most people urinate 6-8 times per day and up to 10 times if they are drinking more liquid than usual. If you are urinating more than 10-12 times per day and waking up more than once per night to pee, you are showing signs of urinary frequency.
There are many simple strategies that we use to reduce urinary frequency. Before pelvic floor physical therapists begin treatment for urinary frequency, they must rule out any conditions that require immediate medical attention. This includes ruling out infection as a cause of urinary frequency. Signs of infection include burning with urination, urinary frequency and urgency, and/or cloudy or bloody urine. A urinary tract infection, commonly called UTI, is the most common cause for urinary frequency. If you suspect that you have a UTI, your physician can check for it by analyzing your urine for bacteria. If you don’t have signs of infection, aren’t pregnant, and are free of other red flags such as pelvic or lower extremity numbness, you can try the following strategies to decrease urinary frequency:
- Sit down while you pee and lean forward. Often times, when we use public restrooms we hover over the seat. When we squat like this, our pelvic floor muscles and our glutes kick in. We need these muscles to fully relax in order to properly let our bladders empty. When we lean forward while sitting on the toilet seat, our pelvic floor muscles are optimally lengthened, allowing for the best output of urine. If you are uncomfortable with the idea of sitting on a public toilet seat, I suggest that you wipe down the seat and ‘build a nest’ of toilet paper on the seat so you can fully relax.
- Diaphragmatic Breathing and Relaxation. Contracting your pelvic floor muscles is often something we do when we experience stress and anxiety. Diaphragmatic breathing is the easiest and best way to relax your entire body, including your pelvic floor. I love offering diaphragmatic breathing to my patients as the first line of treatment for urinary frequency because it’s highly effective and it can be done anywhere and at anytime. For those who wake often during the night with the need to pee, I recommend starting with 5-10 minutes of diaphragmatic breathing before bed, and after each time you urinate while still sitting on the toilet. To do diaphragmatic breathing, take a deep breath through your nose and try to fill your low belly up with air. You should feel your belly expand into your hands. Try to make each breath slow and deliberate. Exhale slowly through your mouth. Try to make each exhale longer and slower than each inhale. Before bed, lie on your back and put your hands on your low belly to perform these breathing exercises. The same strategy can be used while sitting on the toilet after you finish peeing for 3-4 rounds of breath. This will ensure that you are fully relaxed and have completely emptied your bladder.
- Limiting caffeine and alcohol intake. This includes soda, coffee, tea, and all alcoholic beverages. Caffeine and alcohol are diuretics, meaning that they cause the body to expel urine. If you are experiencing increased urinary frequency, limit your intake of caffeine and alcohol to no more than 1-2 servings per day.
- Set a liquid curfew. If you drink large amounts of liquid before bed, you will increase the likelihood of waking up at night to pee. Try to stay hydrated by drinking plenty of water throughout the day and set a cutoff time to stop hydrating. I usually recommend drinking half your body weight in ounces. So if you weigh 100 lbs, drink 50 ounces of water per day. I like to recommend that you set your curfew around dinner time, leaving about 3 hours liquid-free before sleep so that you can pee before bed and make that your last pee of the night.
- Listen to your body. We’ve all heard someone say that you should pee before a long car ride because you might not have a chance to go later. I’m here to urge you NOT to do that. The signals our body sends us to urinate are delicate and can be thrown off by forcing yourself to pee when you may not need to go. The opposite is also true – do not ignore the urge to urinate when you are busy. Excuse yourself when you need to. By peeing only when you need to, you can help retrain your body’s natural rhythms. When you need to pee, you’ll know, and all you’ll need to do is sit and relax 🙂
Hopefully these tips will help lead to reduced urinary frequency and more restful sleep. If your symptoms persist, talk to your primary physician, urologist, or pelvic floor physical therapist for more help.
Shah, A. P., By, Shah, A. P., & Last full review/revision June 2019 by Anuja P. Shah. (n.d.). Urinary Frequency – Genitourinary Disorders. Retrieved October 2, 2019, from https://www.merckmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/urinary-frequency.
Urinary tract infection (UTI). (2019, January 30). Retrieved October 2, 2019, from https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447.