Frequent Urination at Night and Slow Urine Stream at Night in Men: Symptoms of Enlarged Prostate 

by Alex Shteynshlyuger MD

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What are the Causes of Waking Up to Pee at Night in Men?

There are 5 major causes of nocturia or waking up at night to urinate in men.   Nighttime urination is very common in men over age 50 and causes significant inconvenience due to lack of restful sleep.

  1. An enlarged prostate is the most common reason that men have an urge to pee at night sometimes once or twice a night, but when severe, they may need to wake up to pee as many as 8-10 times a night.
  2. Nocturnal polyuria is more common in elderly men. This is caused by the increased production of urine at night but the kidneys.  Nocturnal polyuria can be caused by decreased availability of hormone called ADH or vasopressin (antidiuretic hormone).  Nocturnal polyuria can also occur in patients with CHF (congestive heart failure) due to increased urine production at night.
  3. Overactive bladder combined with small bladder capacity is another common cause of frequent urination at night in men. Most often overactive bladder and small bladder capacity as a result of an enlarged prostate but can be caused by many other less common causes.  This problem can occur in younger men as well as older men
  4. Drinking a lot of fluids before going to sleep, also known as polydipsia. Some men in the habit of drinking tea, water or alcoholic beverages including beer before going to sleep.  This, of course, stimulates urine production especially considering that alcoholic drinks such as beer diuretics, increase the production of urine, it is not surprising that men have to wake up at night to urinate
  5. Sleep apnea is another increasingly common cause of the need to wake up at night to urinate. Sleep apnea is more common in men who snore, especially overweight men.  It appears that men with sleep apnea have decreased vasopressin levels which leads to overproduction of urine at night.

Is it Normal to Wake up One, Two or Three Times a Night to Urinate?

 Normally, men do not need to wake up at night to urinate.  Most men may occasionally need to wake up at night to urinate if they drink a lot of fluids before going to sleep or have alcoholic beverages.

When the need to wake up at night to urinate he is more consistent, for example, if you waking up a few times a week to urinate once or twice a night, or every night, this is typically a sign of an underlying problem, most likely enlarged prostate. 

Symptoms of enlarged prostate typically occur around age 50 but may occur in some men as early as age 35-40 depending on genetics and other factors.  Typically waking up to pee at night is 1 of the first symptoms of an enlarged prostate.  Other symptoms may include slow urine stream, intermittent flow, urge to urinate and frequent urination during the day.

Most men are not bothered if they have to wake up occasionally to urinate. When the need to pee at night becomes more consistent, the problem becomes more bothersome even though some men may be oblivious to it. 

Waking up at night causes interrupted and inadequate sleep.  Disturbed sleep can lead to low energy levels and feelings of tiredness, irritability during the day, poor mood, difficulty concentrating and decreased sexual interest.  Poor sleep due to frequent urination can also affect job performance.

Treatment Options for Men with Urge to Urinate at Night?

At New York Urology Specialists, our experienced urologists perform a thorough evaluation of each man who has frequent urination as well as the urgency to urinate at night.  Once we establish the cause of frequent urination at night, appropriate treatment is recommended.  Our board-certified urologists are very successful in helping men with bladder control problems at night.

Behavioral changes such as not drinking fluids for 2 hours before going to sleep and urinating before going to sleep is often helpful but does not always solve the problem of waking up at night to urinate.  Behavioral changes also may not help men during the day if have frequent urge to urinate, especially when they are in a social situation or driving a car.

In some men, the need to urinate at night is caused by one problem. In other men, multiple causes interact which causes men to wake up at night to urinate.

For men at risk for sleep apnea, a sleep study is recommended. If a man is found to have sleep apnea, CPAP often improves urinary symptoms.  Simultaneously, if men have enlarged prostate, treatment for enlarged prostate is initiated.

In men with nocturnal polyuria, the replacement of vasopressin often improved symptoms.  Commonly, nocturnal polyuria coexists with an enlarged prostate. Men may need to be treated for symptoms of the enlarged prostate at the same time to achieve maximum benefit.  

What are the Risks of Urgency to Pee at Night in Men?

Urge to urinate at night and in the evening may interfere with sexual activity. 

Interruption of deep REM sleep may lead to tiredness and irritability during the day.  There are some studies that suggest that interrupted sleep may also be associated with low testosterone levels.

Studies show that men will have to wake up at night to urinate are at increased risk for multiple problems.  In particular, for older men with osteoporosis who are frail, the urge to urinate at night may lead them to rush to the bathroom and put him at an increased risk of falling.  Falls in the elderly with osteoporosis often lead to hip fractures.

Urinary Incontinence at Night in Men with Enlarged Prostate

Urinary urge incontinence caused by an inability to get to the bathroom in time to urinate is a common problem in men with an enlarged prostate.  Typically, men who experience problems with leaking urine at night do not empty their bladder completely and have very significant enlargement of the prostate.  Treatment of enlarged prostate usually leads to complete resolution of urinary urgency, frequency, and nighttime incontinence.

Why Choose New York Urology Specialists for Treatment of Urinary Retention Caused by Enlarged Prostate?

  • All treatment is performed by a Board-certified urologist experienced in treating men with symptoms of BPH using medical therapy, minimally invasive therapies, lasers and open surgery.
  • We are one of the few practices in the region to offer a full range of options for treatment of BPH.
  • We offer BPH treatment options under local anesthesia which avoids the risks, costs, and recovery from general anesthesia. Most men are able to return to office work and other normal activities the next day.
  • Extensive Experience: Hundreds of men treated successfully using medical therapy, Urolift, lasers for BPH (Holmium, Thulium, Evolve, Greenlight lasers), Bipolar TURP, traditional TURP, open suprapubic prostatectomy, robotic suprapubic prostatectomy for BPH.
  • We treat men with BPH who have heart problems (hypertension, CAD, CHF), renal failure (ESRD) on hemodialysis, men on blood thinners such as aspirin, Lovenox, Coumadin (Warfarin), apixaban, rivaroxaban (Xarelto).

Excellence-Urology_Care VasectomyWhen it comes to experience and innovation – New York Urology Specialists are a step ahead.  Better Science Means Better Care.  We specialize in minimally invasive highly effective treatment for symptoms of enlarged prostate and BPH. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4044

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Schedule an Appointment with Dr. Shteynshlyuger:

Call today: 646-663-4044 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of urinary problems in men.  He uses modern effective and proven treatment methods including prostate enucleation and Urolift for BPH.  He is highly recommended by top primary care physicians in the New York area.

He has successfully performed hundreds of prostate procedures in adults. Urolift procedures are performed in the office under local anesthesia, in a surgical center and affiliated hospitals under anesthesia.

If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to Contact Us with any questions.


If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: (646) 663-4044

We offer affordable, highest-quality urology care with or without insurance.   Find out our office hours or directions to our office. We offer weekday, weekend, and evening office hours.