What natural treatments are there for preventing nighttime urination?

Nocturia: definition and causes

What is nocturia?

As defined by the ICS (International Continence Society), nocturia is the term for when you wake one or more times to pass urine during your main sleep period. To qualify as nocturia, each urination episode must be preceded and followed by a period of sleep (1).

How often should you urinate at night?

When we sleep, our bodies secrete a hormone called vasopressin (also known as anti-diuretic hormone), which is supposed to concentrate urine and reduce the frequency with which we urinate (2). So in theory, this should prevent those nighttime trips to the loo.

But in reality, the mechanism doesn’t always work. It can be disrupted by various factors, not necessarily pathological. For example, we know that the need to urinate at night becomes more pressing as we get older: it’s estimated that 50% of American over-65s, for instance, get up at least once in the night to use the loo (3).

Some doctors define nocturia as anything above two urination episodes a night. But more than their frequency, it’s their impact on physical recovery and quality of life that really matters. When you’re getting up several times a night, your overall sleep period contracts, falling back asleep can be harder, sometimes leading to mood disorders, and there’s an increased risk of nighttime falls in the elderly (4).

The need to urinate at night: what are the causes?

Nocturia is often multifactorial. It may be the result of failure of one or more physiological mechanisms. Three main potential causes have been identified, which sometimes act in tandem (5):

• general polyuria – excessive urine production during the day as well as at night. It is often seen in diabetes or in cases of polydipsia (permanent, intense thirst) (6);
• nocturnal polyuria, characterised by excessive urine production but only at night : it may be associated with heart, circulatory, liver or kidney failure, neurological damage, sleep apnoea, taking diuretic drugs before bed, or simply physical changes related to age (7-9);
• bladder compression or dysfunction which reduces maximum urine volume and increases urination frequency: this is the cause in cases of benign prostatic hyperplasia or prostatitis in men, as well as in urinary infections, bladder stones, overeractive bladder and pregnancy (10-12).

I get up at night to urinate: advice for reducing the frequency of nighttime urination

When nocturnal urination becomes really debilitating, it’s advisable to consult a urologist to establish the cause. In addition to lab tests, starting a urination diary (where you note down the times you urinate and the volume of urine) will help produce an accurate diagnosis.

However, some simple changes in habits can provide some relief in the first instance:

• eat less salt. Consuming too much food high in salt during the day seems to increase the urge to urinate at night by maintaining water retention (13);
• restrict stimulants and spicy foods in your diet. Coffee and tea both have a diuretic effect (promoting urine production) and increase muscle contraction in the bladder (which becomes overactive) (14). Spicy ingredients such as chilli can irritate bladder walls, as can alcohol which also inhibits the action of vasopressin (15);
• drink less in the evening. Reduce your overall fluid intake in the evening whatever the source (water, herbal teas, broths ... ) (16);
• lose weight if necessary. Excess weight increases the risk of metabolic diseases associated with nocturia (hypertension, diabetes…) and induces additional intra-abdominal pressure (17);
• prevent constipation. The accumulation of stools in the intestinal tract can directly ‘weigh’ on the urinary organs, due to the proximity of the bladder to the bowel (18);
• relax. There is a likely two-way link between stress and the urge to urinate at night, especially in the case of an overactive bladder (19);
• consider seeing an osteopath. If you have an overactive bladder, osteopathy may provide an answer by eliminating certain joint or nerve blockages that can impair bladder function, or even by working on strengthening the pelvic floor (with Kegel exercises) which will help with associated urine leakage (20).

Which plants can help prevent nocturia?

Some natural treatments for preventing nighttime urination are more specific to men, while others are suitable for women too.

The ingredients in pumpkin seed, particularly its phytosterols and zinc, have been shown to have a positive effect on the bladder in both men and women. Pumpkin seed helps to maintain good bladder function and normal urine flow (21). It also supports the prostate, by inhibiting the enzyme 5-alpha reductase, responsible for converting testosterone into DHT (excess levels of which lead to an increase in prostate size) (22). If you are having to urinate too often at night, you may therefore want to consider supplementing with pumpkin seed oil (try, for example, the product Pumpkin Seed Oil).

Nocturia accompanied by burning, a feeling of heaviness in the lower abdomen, or difficulty urinating, are all symptomatic of urinary tract infections, which in some women, have a habit of coming back ... In this context, cranberry is often suggested as a natural way of making the environment inhospitable to foreign invaders. Current research suggests that its proanthocyanidins have an anti-adhesion effect on ‘visiting’ pathogens making it hard for them to stick to bladder walls (the cranberry extract supplement Cran-Max®, standardised to 7.2% type A proanthocyanidins, benefits from the patented technology Bio-Shield® for targeted delivery of its active ingredients) (23).

And for our male customers experiencing prostate issues, there are other plants that can help. One example is saw palmetto: used for centuries by Native Americans, it supports urinary function in cases of enlarged prostate, undoubtedly due to its high content of free fatty acids and sterols (24). Another is pygaeum africanum, rich in beta-sitosterols, which similarly helps prevent urinary discomfort in men (25). You can actually find these plant extracts combined synergistically in specific prostate formulations (such as ProstaNatural Formula, which also contains nettle root for additional prostate support, and zinc which helps maintain normal testosterone levels in the blood) (26-27).