Getting up at night to use the bathroom is often thought of as a problem mainly for older men. Not so—two in three women over age 40 wake up at least once each night because of a full bladder. And nearly half of them make two or more nighttime trips to the bathroom. Factors that increased the likelihood that a woman woke at night to urinate included older age, having had a hysterectomy, having hot flashes, and using vaginal estrogen. Many of the women had no other urinary problems, such as an overactive bladder or leaking urine when coughing, and many weren’t especially bothered by having to get up at night to urinate. Getting up once or more each night to urinate may not be “bothersome,” but it can still cause problems. It can interfere with sleep. It can also lead to falls and injury.
New guidelines from the American College of Physicians offer drug-free ways women can use to reduce or stop urinary incontinence, a potentially embarrassing condition that affects millions of women. The guidelines recommend that women first try Kegel exercises, bladder training, exercise, and weight loss if needed. These approaches can work for both of the leading types of urinary incontinence: stress incontinence (leakage with laughter, sneezing, or other things that put pressure on the bladder) and urge incontinence, also known as overactive bladder, which is caused by unpredictable contractions of muscles in the bladder wall. Other lifestyle changes, like watch fluid intake and minimizing bladder irritants like caffeine, alcohol, carbonated drinks, and other may also help. If these approaches aren’t effective, the next step might be treatment with medication, surgery, or even an injection of botulinum toxin to relax overactive bladder muscles.