High blood pressure frequent urination at night

Normally, the amount of urine your body produces decreases at night. This allows most people to sleep 6 to 8 hours without having to urinate.

Some people wake up from sleep more often to urinate during the night. This can disrupt sleep cycles.

Drinking too much fluid during the evening can cause you to urinate more often during the night. Caffeine and alcohol after dinner can also lead to this problem.

Other common causes of urination at night include:

• Infection of the bladder or urinary tract
• Drinking a lot of alcohol, caffeine, or other fluids before bedtime
• Enlarged prostate gland (benign prostatic hyperplasia, BPH)
• Pregnancy

Other conditions that can lead to the problem include:

• Chronic kidney failure
• Diabetes
• Drinking excessive amount of water
• Heart failure
• High blood calcium level
• Certain medicines, including water pills (diuretics)
• Diabetes insipidus
• Swelling of the legs

Waking often during the night to urinate can also be linked to obstructive sleep apnea and other sleeping disorders. Nocturia may go away when the sleeping problem is under control. Stress and restlessness can also cause you to wake up at night.

To monitor the problem:

• Keep a diary of how much fluid you drink, how often you urinate, and how much you urinate.
• Record your body weight at the same times and on the same scale daily.

Contact your health care provider if:

• Waking to urinate more often continues over several days.
• You are bothered by the number of times you must urinate during the night.
• You have a burning sensation when urinating.

Your provider will perform a physical exam and ask questions such as:

• When did the problem start and has it changed over time?
• How often do you urinate each night and how much urine do you release each time?
• Do you ever have "accidents" or bedwetting?
• What makes the problem worse or better?
• How much fluid do you drink before bedtime? Have you tried limiting fluids before bedtime?
• What other symptoms do you have? Do you have increased thirst, pain or burning on urination, fever, abdominal pain, or back pain?
• What medicines are you taking? Have you changed your diet?
• Do you drink caffeine and alcohol? If so, how much do you consume each day and when during the day?
• Have you had any bladder infections in the past?
• Do you have a family history of diabetes?
• Does nighttime urination interfere with your sleep?

Tests that may be performed include:

• Blood sugar (glucose)
• Blood urea nitrogen
• Fluid deprivation
• Osmolality, blood
• Serum creatinine or creatinine clearance
• Serum electrolytes
• Urinalysis
• Urine concentration
• Urine culture
• You may be asked to keep track of how much liquid you take in and how much you void at a time (voiding diary)

Treatment depends on the cause. If excessive nighttime urination is due to diuretic medicines, you may be told to take your medicine earlier in the day.

Carter C. Urinary tract disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 40.

Elsamra SE. Evaluation of the urologic patient: history and physical examination. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 1.

Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 106.

Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline Amendment 2019. J Urol. 2019;202(3):558-563. PMID: 31039103 pubmed.ncbi.nlm.nih.gov/31039103/.

Samarinas M, Gravas S. The relationship between inflammation and LUTS/BPH. In: Morgia G, ed. Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia. Cambridge, MA: Elsevier Academic Press; 2018:chap 3.

Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Maybe you’ve noticed that you’re rushing to the restroom lately. Or you’re waking up in the middle of the night to go. Perhaps you're needing to take way more breaks at work to pee.

There are many potential causes of frequent urination. They include, but are not limited to, an increase in water intake, a urinary tract infection, or onset of a new disease such as diabetes, as the Mayo Clinic notes.

It’s worth asking yourself: “Have I started a new medication lately?”

That gotta-go impulse is a relatively common side effect of various drugs available over-the-counter and by prescription. “Many medications can lead to urinary retention and something we call ‘overflow incontinence,’ which is when the bladder is not able to contract and expel urine effectively, leaving urine in the bladder,” says Brooke D. Hudspeth, PharmD, an associate professor and the chief practice officer at the University of Kentucky College of Pharmacy in Lexington. Other meds may interfere with the function of the urethra and lead to leakage or cause the bladder to quickly fill up with urine and make you pee more frequently.

Whether you’re on diuretics ("water pills”) to reduce your blood pressure, a decongestant to clear your sinuses, or a mood-stabilizing medication for bipolar disorder, here are some common medications that may be causing you to urinate more.

1. Diuretics

The point of a diuretic is to increase urination. “All diuretics work to increase the excretion of water and sodium from the body through the kidneys,” explains Dr. Hudspeth. This is helpful in treating conditions such as high blood pressure, swelling, heart failure, and liver or kidney disorders, she says. But peeing more can disturb your sleep if you’re waking up multiple times to go to the bathroom. Hudspeth recommends asking your doctor if you can take diuretics earlier in the day to avoid cutting into your sleep.

RELATED: 8 Common Medications That May Cause Dehydration

2. Tricyclic Antidepressants

Peeing is normally a well-orchestrated process. When your bladder fills up (and is holding that urine) the urethra — the tube connected to the bladder that empties urine — needs to stay shut to keep it all in until you decide you’re ready to go to the bathroom, says Hudspeth. What’s more, your bladder has to be able to contract to expel the urine into the urethra. Tricyclic antidepressants may interfere with both processes, and lead to leakage, also called urinary incontinence.

3. Antihistamines

For some people, sneezes can cause a little urine to leak. But this may also be due to an antihistamine that you’re taking to control allergy symptoms. The most common offenders are Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine), says Jason Varin, PharmD, an assistant professor at the University of Minnesota College of Pharmacy in Minneapolis. “The bladder is a smooth muscle that fills up with urine. When it reaches a certain level and is full, it sends signals to the brain that it’s time to urinate,” he explains. Trouble is, certain antihistamines can relax the bladder, blunting its ability to push out urine. In the end, there is still some urine left in your bladder, which means it will fill up again faster and send that “gotta pee” signal to your brain sooner.

RELATED: 10 Common Food and Medication Interactions to Avoid

4. Decongestants

The good thing about decongestants such as Sudafed (pseudoephedrine) and Suphedrine PE (phenylephrine) is that they temporarily quell nasal congestion by constricting blood vessels, ultimately lessening swelling. But that effect happens to other muscles, too, including the bladder’s sphincter, says Dr. Varin. “This is the on-off valve of the bladder, and these medications may make the bladder constrict so that it’s more difficult for urine to pass from the bladder,” he says. In people with male genitalia, “decongestants can also constrict the prostate, which surrounds the urethra, also making it more difficult to pass urine,” Varin adds.

5. Calcium Channel Blockers

Among older adults who went to the doctor because of incontinence, 60 percent were taking medications that had urinary symptoms as a side effect, per a previous study. Among the most common medications they were taking? Calcium channel blockers. This class of medication, used to treat hypertension, may cause the bladder to relax and affect its ability to empty properly, says Hudspeth.

RELATED: What Does Burning or Painful Urination (Dysuria) Mean?

6. Mood Stabilizers

Lithobid (lithium) is a mood-stabilizing medication used to treat bipolar disorder, notes the National Alliance on Mental Illness (NAMI). “For some individuals, lithium is the best treatment, considered a lifesaver for some, even though it has a host of likely side effects,” says Varin. One of those potential side effects is excessive urination and thirst, which may affect up to 70 percent of individuals who take lithium long term, per a paper published December 2016 in the International Journal of Bipolar Disorders. While this side effect may be annoying, it can also be dangerous if the dose you’re taking is too high. “Lithium doses that are too high for an individual can lead to changes in the kidney and to a form of diabetes that impacts the function of the kidneys,” explains Varin. That condition is called diabetes insipidus, which is not the same as type 1 or 2 diabetes. “Diabetes insipidus has to do with the kidney’s ability to regulate fluids and reabsorb water properly, resulting in an increased urination of mostly fluids. In turn, that creates what some describe as an endless thirst,” he says. It can cause electrolyte and fluid imbalances, so talk to your doctor if you have these side effects.

7. Antipsychotics

Versacloz, FazaClo, and Clozaril (clozapine) are antipsychotic medications that treat schizophrenia, and can be a particularly important medication for patients who have suicidal thoughts, according to the U.S. National Library of Medicine. Frequent urination is one possible side effect because it can cause diabetes insipidus, says Hudspeth. One of the main complications of diabetes insipidus is dehydration, which has symptoms including thirst, dry skin, fatigue, dizziness, confusion, and nausea, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Talk to your doctor if you’re on this medication and experience increased urination.

RELATED: 10 Ways to Keep Your Bladder Healthy and Happy

8. Some Medications for Type 2 Diabetes

The newer medications for type 2 diabetes, a class called sodium-glucose cotransporter-2 (SGLT2) inhibitors work by “increasing the amount of glucose or blood sugar your kidneys excrete and pass through urine, which takes fluid with it,” says Varin. Some good news: There was a concern that SGLT2 inhibitors would also increase the risk of urinary tract infection (one symptom of UTI is a persistent urge to urinate, per the Mayo Clinic), but newer research has failed to find that connection, suggests the February 2020 issue of Clinical Kidney Journal.

9. Alpha Blockers

Alpha blockers, such as Cardura (doxazosin), Minipress (prazosin), and Hytrin (terazosin), are another class of medications used to treat high blood pressure. They work by relaxing blood vessels to allow for adequate blood flow — but they may also relax the muscles of the urethra and cause urinary incontinence, says Hudspeth. According to the Mayo Clinic, these drugs are often used in combination with other blood pressure lowering drugs, such as diuretics, so there’s a chance that increased urination issues could be caused by one or both these medications.

RELATED: The Possible Benefits of Metformin for Type 2 Diabetes and Other Health Conditions

10. Opioids

Opioids are drugs that can be prescribed by doctors to treat pain, such as OxyContin (oxycodone) or Vicodin (hydrocodone), morphine, and methadone, according to the Centers for Disease Control and Prevention (CDC). These are highly addictive, and one in four people who are treated long-term with these drugs experience opioid addiction, says the CDC. Clearly, that is the chief concern. But a lesser side effect is urinary problems, according to an article published in January 2017 in the International Journal of Molecular Sciences. Opioids can impair your bladder’s ability to empty by interfering with proper bladder contraction. Your doctor may be able to prescribe other pain control medications if you’re experiencing side effects.

If you have any concerns about your medication or new onset of urinary changes, speak to a primary care provider for an evaluation and medical guidance.

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