Need to pee more than TWICE during the night? It could be a sign of these serious health conditions…

How many times do you get up in the night to pee? If it’s just once and you’re under 70, then you’re the norm.

For older people, twice is acceptable, according to NHS guidance.

However, more frequent nocturia – the term for needing a wee in the middle of the night – may be a sign of a serious condition, which is why experts say not to ignore it.

Indeed, it could indicate a urinary tract infection, diabetes, heart disease or bladder cancer. So here’s what to do if your sleep is plagued by endless toilet trips…

I’ve been going to the loo at night for as long as I can remember. Is there something wrong with me?

Answer: Probably not. The number of nightly bathroom visits tends to increase with age – with over-70s waking up twice, on average, while those in their 90s often need to go four times.

According to Doncaster-based GP Dr Dean Eggitt, going in the night is normally linked to how much fluid you drank in the evening, and how much caffeine – a so-called diuretic that helps reduce fluid build-up in the body – you consumed throughout the day.

But if there is a change to what’s usual, it may be time to seek medical advice.

‘If you’re suddenly noticing that you’re up and down to go to the loo at night more often than normal, or you’re having to rush to the loo all the time for fear of getting caught short, you should definitely mention it to your doctor,’ says Dr Eggitt.

I recently noticed I’ve started making multiple trips to the loo each evening – is this cause for alarm?

Answer: While you should get the problem checked out, there’s usually no reason for serious concern, says Dr Eggitt.

The most common reason for going more is old age. As we age, the body naturally stops producing a hormone that usually stops us from needed to wee during the night.

ADH – antidiuretic hormone – regulates the amount of water in the body, with levels increasing during sleep so we produce less urine.

Newborns have very little ADH, which, alongside a tiny bladder, means they wee constantly. As toddlers, their ADH levels rise, allowing them to sleep at night without a nappy. ADH production decreases again after 60, as the pituitary gland in the brain becomes smaller.

For men, prostate enlargement – a common condition affecting over three million in the UK – can cause more nightly weeing as the gland begins to push into the bladder. As a result, says Dr Eggitt, you’re already ‘pre-loaded’ with urine when you go to bed, meaning the bladder fills up.

Women often wee more after childbirth, as the pelvic muscles stretch, making it harder to control the flow of urine.

When should I be worried?

Answer: If you have other symptoms along with a change in normal habits, there could be more serious causes, says Dr Nicholas Faure Walker, consultant urologist at The Princess Grace Hospital in London.

Diabetes can cause nocturia, as high blood sugar increases thirst and bladder irritation, leading to more loo trips.

If the need to wee is accompanied by chest pains, swollen ankles and sweating, it could signal a heart condition. Poor circulation caused by heart disease makes the ankles swell with fluid. When you lie down in bed, this fluid is reabsorbed into the blood and passes through the kidneys, creating the urge to wee.

If the need to urinate comes on very suddenly and is accompanied by pain, you could have a urinary tract infection.

Can it ever be something life threatening?

In rare cases, nocturia can be a sign of cancer.

Blood in your urine, as well as weeing through the night, can indicate bladder cancer. But pelvic and even bowel cancer can both also cause tumours that press on the bladder, making you need to wee more than usual.

In these scenarios, the nocturia will often be accompanied by bloating or bulges of the stomach, which Dr Walker says will need to be checked out.

It’s not any of these things but it’s still bothering me – what can I do?

While there’s no cure-all for nocturia, there are some treatments available.

If it is due to muscle weakness – as experienced by women after birth – exercises can tone the

pelvic floor and bladder. Kegel balls inserted into the vagina help to contract and release pelvis muscles. For men with enlarged prostates, there are medications to reduce swelling, as well as surgical options.

You can also try what’s known as double voiding, says Dr Eggitt.

He adds: ‘Rather than having to go back to the loo in half an hour, try waiting 30 seconds after you do a wee, and then try to push out more liquid. That little dribble can expel the extra urine that may have been stuck in the bladder – and that bit of squeezing is like gym for the bladder, making it easier to hold in wee in the future.’

Otherwise experts say to limit liquid intake during the day.

‘Try to restrict your fluids within four hours of going to bed,’ says Dr Walker. ‘Even if you don’t mind the disruption of needing the loo throughout the evening, your partner will thank you!’

Are bladder problems keeping you up at night? Write to us at health@mailonsunday.co.uk