Why do you keep needing to get up to go to the loo during the night?

We all know how important it is to get a good night’s sleep, especially if you suffer from fatigue. But if you wake several times during the night needing to get up for a wee, having a full night's sleep is really difficult.

In this blog Helena from the MS Trust's information and engagement team explains what nocturia is and what you can do to to help with it.

Picture the scene. The light’s off and you’re tucked up in your warm, cosy bed after a long day. You close your eyes and start to drift off. Awww, bliss. But then, before you know it, you’re awake again and absolutely desperate for the loo. Half asleep, you walk like a zombie to the toilet, and then scramble back into bed. But just a few hours later it happens again. And then again. And again. Sound familiar? The need to wake up in the night to go to the toilet has a name; it’s called nocturia and is a common symptom of MS.

Getting up in the middle of the night once or twice is normal for most people, but with for some people with nocturia it can easily be as often as five or six visits to the toilet during nighttime. This can be both annoying and lead to some serious daytime tiredness.

The medical term for the excessive need to urinate at night is nocturia, but why does it happen? Here comes the science bit; when urine reaches a certain level in the bladder, nerve endings in the wall send signals to the part of the spinal cord that controls bladder emptying. This is known as the reflex centre in the spinal cord and it also sends messages to the brain, making you aware of the need to empty your bladder. These messages can usually be controlled by the brain until there is an opportunity to get to the toilet.

Needing the toilet a lot during the night can be down to lots of different reasons, but if you have MS and also need to go frequently during the day, it is most likely caused by the same problem. Here are some of the possible reasons for nocturia in MS..

• Nerve damage can make the bladder want to empty as soon as it starts filling up, meaning your bladder can have an issue with storing urine.
• If you feel like your bladder hasn't emptied, or it is difficult to start to pee, this can also be due to nerve damage. Here the signal that is sent to the brain telling you that it is time to go for a toilet break simply doesn’t happen, and so your bladder can end up being very full. Sometimes these messages between the brain and bladder can get so confused that it stops you halfway through a wee, because the valve which allows the urine out closes.
• Urinary tract infections are also very common in people with MS, especially if your bladder doesn't empty properly as there is a risk of the remaining urine being infected by bacteria. It is important to treat UTIs if you have multiple sclerosis as it can cause a lot of your other MS symptoms, such as spasticity or cognition issues, to worsen.

Nocturia is quite common in people with MS with as many as seven out of ten people saying they've been affected at some point.

Nocturia can also be caused by a number of other non-MS related things such as getting older, diabetes, sleep apnoea or even pregnancy so it's important to talk to a health professional to get to the root of the problem.

• Talk to a health professional, as mentioned above, nocturia can be caused by many things, so it's important to have it investigated properly. If you find talking about toilet habits embarrassing, please don’t! Your MS nurse and other health professionals know how common bladder issues are in MS and will have heard it all before!
• Reduce your caffeine and alcohol intake – they can cause poor sleep patterns. Caffeinated drinks in particular can also irritate the bladder.
• Try not to drink too much of anything before bedtime, not just alcohol or caffeinated drinks. Having your last drink no later than 8 pm can help, even if you are only drinking water.
• Check your medication, some might have side effects that can increase how much and how often you need to wee.
• Do your pelvic floor exercises, weaker muscles makes it harder to hold urine in.
• Think about whether there is anything else that is disturbing your sleep? I don’t mean a cover stealing partner or a screaming baby, although these things are rather disturbing too! Several MS symptoms can lead to bad sleep, such as spasms, pain or depression. If these wake you up you're generally more likely to feel the need to get up for a wee if you are already awake.
• Try to improve your overall sleeping habits, perhaps try to cut out watching TV and using your mobile phone in bed. Health professionals often advise stopping using “blue light electronics” an hour before bedtime, to improve your sleep.

There are a few different treatments available for bladder frequency which could help reduce your number of visits to the toilet in the night. Some of these medications work by reducing the amount of urine that the kidneys produce.

Your continence advisor or MS nurse can talk to you more about what is available.

If you think that you are suffering from nocturia talking to a health professional, your MS nurse or your GP are a good place to start. As mentioned there can be a lot of reasons for nocturia and it is important to understand what is really causing it so you can manage it better.