Below, Dr. Ormond and Karyn Eilber, MD, a board-certified urologist and an associate professor of urology and OB/GYN at Cedars-Sinai Hospital, break down the relationship between nocturia and falling, why it's dangerous, and what you can do to prevent both occurrences.
What causes nocturia?
The bladder's functionality often changes with age, according to the National Institute on Aging (NIA). Your bladder can weaken or lose elasticity and the ability to hold as much urine. All of these changes can cause you to pee more frequently or have incontinence, impacting incidences of nighttime bathroom behavior. However, aside from internal physiological concerns, Dr. Eilber says that nocturia is concerning for people over the age of 65 and anyone with mobility-related disabilities because stumbling to the bathroom at night can increase your risk of falling.
What makes falling dangerous?
Falling is dangerous for anyone, but "falls are dangerous, especially for people over 65, because they can result in hip and other fractures that require hospitalization and usually surgery," says Dr. Eilber.
"An overactive bladder—which is frequency, urgency, and incontinence associated with a strong urge to urinate—is, unfortunately, a common cause of hip fractures," she says. This secondary relationship between having to use the restroom and more serious injuries might not be immediately apparent. However, if you think about what can happen when you're racing or stumbling for the bathroom in the dark, the risk can make a lot of sense.
According to the Centers for Disease Control and Prevention (CDC), more than 3 million ER visits in 2019 were due to falls in those who were 65 years or older. "Falls may lead to head and organ damage apart from bone fractures. For those over 65, broken bones and fractures can be risky due to the slower healing process," says Dr. Ormond. "Mechanical trauma from falls may also cause pinched nerves and other nervous system problems." He adds that pinched nerves can lead to back pain, hip pain, wrist pain, or torn and stretched tendons.
Falls can happen to anyone: abled or disabled, younger or older. Everyone risks a more serious injury, but for people over 65, there are more concerns and risks involved with treatment and recovery. Hospitals pose a risk for bacterial infections or COVID 19 exposure, especially if a person is immuno-compromised. Surgeries are generally riskier the older a patient is because you simply heal slower, says Dr. Ormond. If there are things you can do to prevent fall risk, it’s worth doing them.
How to reduce the risks of waking up to pee at night
"The simplest thing to do is to avoid fluids after dinner and avoid bladder irritants in the evening, including caffeine, carbonated beverages, and alcohol," says Dr. Eilber. "People who are very light sleepers (and potentially wake up for other reasons) but just decide to go pee since they are awake should consult with their physician about ways to sleep better."
Managing your environment is also a good idea, says Judy Wright, MD, a family physician, medical director, and podcast host of Queens on Call. She recommends that you remove stray cords and folds in hallway rugs. She also suggests getting rid of slippery rugs or shoes, eliminating clutter, and keeping a pair of slippers with good traction on the bottom near your bed. Additionally, she recommends adding night lights on your path to the bathroom and incorporating strength, balance, and mobility exercises into your day.
Dr. Wright adds that bladder conditions are important to treat, manage, and that informing your friends and family about them is a good idea. Even though there is a stigma associated with bladder conditions, there's nothing to be ashamed about. Using adult diapers is also a recommended solution if nighttime incontinence is a concern.
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