To pee or not to pee…that middle of the night question!

I’d love to be able to count the number of hours in our lives that are spent in the darkness contemplating whether we need to get up to go to the toilet or whether we can make it to morning! Probably too many. Whenever my patients report that they are getting up to go to the toilet either regularly (most nights) or frequently (more than once), my eyebrows do an internal raise (not actually possible, but you know what I mean). I always make a mental note to investigate why, even if this isn’t the main reason they have come to see me. Why? Because it can be a symptom of something else, so lets explore that here.

The very first thing I do when I hear this symptom is get a simple blood test done for the patient. It’s called “Glycated Hemaglobin” (HbA1C) for short. It’s an indicator of blood glucose management, as nocturnal urination can be an early symptom of diabetes. I also ask the following questions:

• how much fluid are you drinking each day, and what (and roughly when?) - e.g. coffee is a diuretic, and can have stronger effects as we age due to poorer liver and kidney function

• how is your hormone balance (and questions around this)

• do you get fluid retention in your legs or abdomen?

• do you have any pain in your lower abdomen?

• Are you susceptible to urinary tract infections?

• Are you taking any medications (and I’ll check for this as a possible side effect)

• Do you have any blood in your urine, or is it an odd colour?

If the above list is making you go “hm, yes” to some of the questions, I’d love to talk with you. If you’re waking up needing to pee, your brain won’t do that for no good reason, so my advice is, get up and go, and lets figure out the cause so you can get a peaceful nights sleep.