Andrologist, Urologist


  • Nocturia is waking up more than once in night for urinating after going to sleep.
  • Waking up more than once at night for urinating leads to sleeplessness, fatigue, poor concentration daytime, anxiety etc.
  • Nocturia can be due to increased urinary frequency at night-time or increased urine production at night (Global or Nocturnal polyuria).

Global Polyuria – Patient passes more urine during day time as well. Causes include uncontrolled blood sugars, diabetes insipidus (lack of vasopressin hormone).

Nocturnal polyuria – patient passes more urine only during night-time. Various reasons for increased urine output at night include congestive cardiac failure, varicose veins, sleep apnea, swelling lower limbs, drinking lot of fluid before sleep, taking certain medications that increase urine production etc.

Nocturnal frequency – Some patients may not be producing more urine at night but may wake up more often from sleep for urination due to urinary tract infection, OAB (overactive bladder), Prostate enlargement (Read BPH (Enlarged prostate) Symptoms) , small bladder capacity, stroke, interstitial cystitis etc.

Diagnosis is made by doctor after recording detailed history from patient. Patients are usually given a chart to record his drinking and urination habits over whole 24 hour, called bladder diary. Increased urine production need thorough workup to rule out heart condition, diabetes, snoring habits, lower limb edema etc. Certain conditions such as prostate enlargement need ultrasonography tests to look for prostate size. Urine infection is ruled out by taking urine sample for testing.

Treatment of nocturia is as per the underlying cause identified. Restricting fluid intake after evening and Passing urine immediately before sleep is advised. Changing the schedule of diuretic drug, wearing compression stockings during daytime, control of diabetes etc are helpful. Nocturia secondary due to cardiac dysfunction, snoring needs respective consult from cardiologist and ENT specialist. Symptoms due to prostate enlargement may need medicine or surgery for prostate. Patients experiencing increased frequency due to infection are treated with antibiotics. Certain medications such as anticholinergics and beta agonist are helpful in controlling increased frequency. Increased urine output at night is treated with desmopressin medication.


Prostate enlargement diagnosis

Prostate enlargement diagnosis starts with the history and examination of the patient. Symptoms are scored to assess the severity of disease. (Read symptoms of prostate enlargement at BPH (Enlarged prostate) Symptoms). Per rectal examination in office room gives the initial clue to the enlargement of prostate. Since the urinary symptoms are not exclusive for prostate enlargement in men, few basic investigations are often required to reach final diagnosis before initiating treatment.

  1. Urine examination – patient provides a sample of freshly passed urine in a sterile container. This test tells about presence of any infection in urine.
  2. Uroflowmetry – In this test, patient need to hold urine till he gets urge to pass urine. Patient is asked to pass urine in a machine, which then generates a report about the flow of urine. After patient finished passing urine, the presence of any residual urine in bladder is checked by ultrasound.
  3. Ultrasound abdomen – ultrasound is done to see the kidneys, bladder and size of prostate. Kidneys are part of urinary system and prostate enlargement can affect kidney function.
  4. Serum creatinine – creatinine is marker of kidney function. Long term disease can lead to kidney damage and hence need for checking creatinine.
  5.  Blood PSA – PSA is test done to screen patients aged 55-70 years to rule out presence of prostate cancer. Patient with prostate cancer have raised blood PSA levels. However PSA can be raised in other conditions also such as urine infection, prostate infection, urine retention, large prostate etc. Read more about serum PSA at Prostate cancer and PSA testing
  6. TRUS – Trans rectal ultrasound (ultrasound probe passed through rectum) is conducted in office setting under local anaesthesia as it provides the more accurate size of prostate enlargement compared to abdominal ultrasound.
  7. Endoscopy – Flexible endoscopy through urethra may be ordered by physician as per the symptoms of patients and ultrasound findings.  Patients having severe symptoms with normal prostate size on ultrasound may need this test. Flexible endoscopy is done under local anesthesia in office setting which gives visualised information about intraurethral prostate protrusion, and whether it is causing any mechanical obstruction. Sometimes physician advices about prostate operation based on endoscopy report even if size of prostate is normal on ultrasound.
  8. Urodynamics – This test is selectively performed for patients who are suspected of having poor bladder contractility as the cause of his symptoms. These patients include those having symptoms of bed wetting, spontaneous urine leakage, neurological disorders, having previous prostate surgery etc.

After these tests the decision is taken by the doctor for treating the patient with either medicines or with surgery. Read treatment of enlarged prostate at Treatment of Benign Prostatic Enlargement


BPH (Enlarged prostate) Symptoms

The prostate is a small gland present in men just below the urinary bladder. Urethra make its way through it. The prostate does not grow until about 40 years when usually it starts enlarging.  Prostate enlargement occurs in every male though the rate of increase in size may vary with race, familial factors, etc. Although an increase in the size of the prostate is associated with the chances of having urinary symptoms, it may not always be true. Enlarged prostate may cause none to little symptoms and minimal enlarged prostate may cause severe bothersome urinary symptoms. The enlarged prostate ( or BPH) may affect by irritative or obstructive voiding symptoms.

Irritative symptoms of enlarged prostate

  • Frequency – passing urine too frequently
  • Urgency – Inability to hold and postpone passing urine and need to rush for passing urine at first thought
  • Nocturia – getting up at night for more than once for passing urine
  • Dysuria – burning sensation while passing urine

Obstructing symptoms of enlarged prostate

  • Poor flow – having weak urinary stream
  • Intermittency – urine flow interrupts many times while voiding
  • Incomplete evacuation – a feeling of residual urine in bladder and persistent urge to pass urine even after finished voiding 
  • Straining – passing urine with the push or need to strain for passing urine
  • Hesitancy – taking a long time to initiate the urinary flow
  • Post void dribbling – the continuous passage of urine in drops at end phase of passing urine

The presence of the these symptoms points towards something wrong in the urinary system and most commonly due to prostate once age crosses 50-60 years. The symptoms are then graded in each person to place each patient in certain risk groups by the physician and subsequent treatment of enlarged prostate are initiated for each risk group. Not all patients require surgery for enlarged prostate and medicine is appropriate for patients with minimal symptoms. Passing blood in urine is the ominous sign after 60 years and may point towards something more serious happening inside and need to be evaluated promptly.

(Click below to watch and know in detail about all diseases affecting prostate gland at