Incontinence: Ask the Expert

This started a couple of years ago.  I never have had any leakage, but I feel like I have to go to the bathroom when I go to bed at night.  When I go, only a little comes out.  I go back to bed and about two minutes later, I feel like I have to go again.  When I go, a little more comes out.  I always try to make sure that my bladder is empty, but a few minutes later, I have to go again.  I wake up a couple times through the night to go to the bathroom, but I never go very much.  During the day, I sometimes have the same problem, but usually, I don't. 

I thought it was related to anxiety, but I started taking zoloft, and it hasn't seemed to help.  Birth control pills seem to make this problem much worse.  I wasn't on the pill last year, and I don't remember having this problem as much.  I started taking the pill a month ago, and its gotten much more pronounced.

What is going on with me?  What can I do to fix it?

Nocturia, or frequency at night, is common.  It is a diagnosis that fits under the umbrella of overactive bladder and most commonly occurs either because women drink too many fluids before they go to bed at night, which results in “large volume” voids throughout the night, or because the bladder has picked up some bad habits and sends signals that it is full when it isn’t, which usually results in multiple low volume voids like you describe here, or because there is some other reason why you are up at night, such as anxiety, or other health problems and women void because they are awake for the other reason.  

Frequent low volume voids at night are typically because the bladder has become too sensitive to even small amounts of urine being present.  Most people do not completely empty their bladders when they void; it is common for there to be “just a little” left.  This is normal.  What is not normal is to feel as though you have to void this tiny amount.  Some strategies to deal with this include doing pelvic floor exercises when you experience the urge to void and you know that you bladder is empty.  When you contract your pelvic floor there is a reflex arc that causes you bladder to relax and may help the urge to pass without going to the bathroom so that you can sleep.  There are also medications that can help to calm the bladder, and also make you sleepy, which is a bonus at night when you are trying to fall asleep!