Is There a Cure for Nocturia? Every Treatment, Ranked

There is no single cure for nocturia, because nocturia is a symptom with several causes rather than a disease. There are, however, treatments that work well for the cause they target, and the effect sizes are known. This page lists them with the numbers from the trials, so you can see what each one is realistically worth before you try it.

One unit makes the comparison possible: change in the number of times people got up per night. Where a trial had a placebo group, the number that matters is the difference between treatment and placebo, because placebo alone often reduces nocturia by a third of a trip or more.

First, what a good result looks like

Going from three trips to zero is rare with any treatment. Going from three to two, and pushing the first trip later so the first block of sleep is longer, is a realistic and meaningful outcome. That first stretch of sleep is the deepest, and several trials found people valued the delay in the first void as much as the reduction in count.

Before any of the treatments below, keep a three-day bladder diary. It tells you whether you are making too much urine at night or holding too little, and most of the treatments below only work on one of those.

Treating the underlying cause

These are first because when they apply, they outperform anything aimed at the bladder.

CPAP for sleep apnoea

In a 2015 meta-analysis of five studies and 307 patients with sleep apnoea and nocturia, CPAP significantly reduced both the number of night-time voids and the volume of night urine. Most of the studies compared people with themselves before and after treatment rather than against a control group, so the exact size of the effect is uncertain. The direction is consistent, and CPAP has the advantage of treating something that matters well beyond sleep.

Applies if: you snore loudly, stop breathing in your sleep, or wake unrefreshed and sleepy in the day.

Lifestyle measures

In a Japanese study of 56 people with nocturia, four instructions for four weeks reduced night-time voids from 3.6 to 2.7 on average, and about half improved by more than one trip a night. The four: restrict fluid intake, especially in the evening; do not spend excess hours in bed; take moderate daily exercise; keep warm in bed. People who produced more urine over 24 hours responded best.

There was no control group, so some of that improvement is the placebo effect that every nocturia trial shows, and the number cannot be set directly against the drug trials below. Even so, it is free and it carries no risk.

Applies if: anyone. Start here.

Raising the legs, or compression stockings

In a small study of 31 people who wore compression stockings during the day for four weeks, night-time voids fell by 0.5 and uninterrupted sleep increased by 0.8 hours. There was no control group. The idea is to stop fluid pooling in the legs during the day so it is cleared before bed rather than after.

Applies if: your ankles swell by evening. Stop if the stockings hurt, and do not use them if you have poor circulation in the legs without asking a doctor first.

An afternoon diuretic, timed deliberately

This sounds backwards and works. In a double-blind trial in men over 50 with nocturnal polyuria, 40 mg of furosemide taken six hours before bed reduced night-time voids by 0.5 against no change on placebo, and cut the proportion of urine made at night by 18 percent. The diuretic makes you pass the extra fluid in the early evening instead of overnight.

Applies if: your diary shows nocturnal polyuria. This is a prescription decision, not something to try with a spare tablet, because diuretics affect blood pressure and salts.

Desmopressin

The only drug designed specifically for nocturia. It is a synthetic form of the hormone that reduces urine production overnight. In three-month trials, the low-dose tablet reduced night-time voids by 0.37 more than placebo in 385 men and by 0.22 in 261 women, and it delayed the first trip to the bathroom by about 40 minutes in men and 49 minutes in women.

The main risk is low blood sodium, which is more likely with age. That is why the low-dose under-the-tongue form exists, and why people over 65 starting it need their sodium checked. It is not suitable for people with heart failure or existing low sodium.

Applies if: your diary shows nocturnal polyuria and the causes above have been dealt with.

Prostate drugs

In the Medical Therapy of Prostatic Symptoms trial, 3,047 men with prostate symptoms were randomised to placebo, doxazosin, finasteride or both. After one year, night-time voids fell by 0.35 on placebo, 0.40 on finasteride, 0.54 on doxazosin and 0.58 on the combination. The researchers concluded that the net benefit was modest, less than 0.2 fewer trips a night than placebo.

In a Japanese cohort of men starting tamsulosin, nocturia improved in 17.9 percent, the lowest improvement rate of the seven prostate symptoms measured.

Applies if: you have the daytime signs of an enlarged prostate, a weak or hesitant stream and a feeling of not emptying. Worth taking for those. Not worth expecting to fix nocturia on its own.

Overactive bladder drugs

Antimuscarinics and mirabegron reduce urgency and increase the volume the bladder can hold. They help nocturia when an overactive bladder is the cause, which shows in the diary as small voids with urgency, and do little when the problem is urine volume. Antimuscarinics can cause dry mouth and constipation and are increasingly avoided in older people because of effects on memory. Mirabegron does not carry that concern.

Prostate surgery

Surgery relieves obstruction more completely than any drug, and it does reduce nocturia. In one study of 49 men, TURP took them from 3.0 to 1.9 trips a night on average at six months. In another, 42 percent of 102 men still got up two or more times after the operation, and the risk was higher in smokers and men with metabolic syndrome. In the Japanese cohort, nocturia improved in 32.2 percent of men after TURP, again the least improved of all symptoms.

The lesson is the same as for the drugs. Removing obstruction helps nocturia that comes from obstruction. It does nothing for night-time urine production, which is why so many men are disappointed by it.

Melatonin

In a small crossover trial of 20 men with prostate obstruction and nocturia, 2 mg of slow-release melatonin at night reduced night-time voids by 0.32 against 0.05 on placebo. The difference did not reach statistical significance, though the share of men who responded and the bother score both improved significantly. The authors themselves were unsure whether the change was clinically meaningful.

Applies if: sleep is poor and the diary does not show high night-time volume. It is cheap and well tolerated, but the evidence is one small study.

Supplements

Two prostate supplements have a nocturia-specific result. In pooled trials of rye grass pollen extract, men were about twice as likely to report less nocturia than on placebo. Across 18 trials of pygeum, nocturia fell by 19 percent. Both bodies of evidence are small, short and old, and both studied men with enlarged prostates. Neither reduces the amount of urine made at night.

Saw palmetto, the most heavily marketed, has the weakest evidence: its largest modern trials did not beat placebo. If you try a supplement, give it 12 weeks with a diary before and after, and stop if nothing has changed.

Putting it together

Start with the diary and the lifestyle measures, because they are free, carry no risk, and about half the people in the one study that tested them improved by more than a trip a night. If you snore, get a sleep study. If your ankles swell, raise your legs in the late afternoon. If the diary shows high night-time output despite all that, ask about a timed afternoon diuretic or desmopressin. If it shows small voids with a weak stream, the prostate is part of the picture, and prostate treatment is reasonable as long as you expect it to help the stream more than the nights.

Most people who get a lasting improvement do it by stacking two or three of these, each aimed at a different part of the problem.