If your bladder acts as a middle-of-the-night alarm clock, you might be curious whether it’s a cause for concern.

Turns out you’re in good company if you’re wondering. “Is it normal to pee in the middle of the night?” is one of the most common questions that Marcelino Rivera, a urologist with Indiana University Health, said he gets asked in his practice.

In general, if you are waking up to pee once during the night, it’s likely that is normal for you, Rivera said. The kidneys’ main function is to filter out toxins from the bloodstream and concentrate those toxins into urine. According to Rivera, this is done continuously ― “during the day we are typically [going] every two to four hours depending on hydration status and fluid consumption” ― but at night, the body releases hormones to concentrate the urine more than during the daytime. Hence why we don’t typically wake up as much at night to urinate. 

But if you are peeing more than once during the night or running to the bathroom is disrupting your sleep, you might need to examine other areas of your waking life. 

Here are a few of the most common reasons you may be getting up to pee, whether they’re considered normal and expert advice on what to do about them.

You’re drinking too much water, especially close to bedtime.

This is pretty obvious: What goes in must come out. If you are drinking several glasses of fluid, you are properly hydrated and have properly functioning kidneys, you will likely wake up to go at night. 

“If your nighttime peeing is due to fluid consumption, stopping two to three hours prior to going to bed will reduce waking up at night,” Rivera said.

It could be your medication.

Some prescriptions may cause an increase in nightly bathroom visits, explained Rivera.These may include pills like high blood pressure drugs, some alpha blockers, muscle relaxers and sedatives.

You’ve had some alcohol or caffeine.

Alcohol and caffeinated beverages are diuretics, which means that drinking them causes your body to produce more urine. “Consuming alcohol or caffeinated beverages in excess can lead to nighttime waking and needing to urinate,” said Clare Morrison, a general practitioner and medical adviser at MedExpress.

You’re dealing with a sleep disorder.

If you’re peeing multiple times a night, you might have obstructive sleep apnea (OSA), a condition that causes you to involuntarily stop breathing while you are sleeping. In fact, 84% of patients with sleep apnea have reported frequent nighttime urination.

According to Emily Clionsky, a clinician and researcher with Clionsky Neuro Systems in Springfield, Massachusetts, this can occur in people of all ages and genders. She added that you also don’t have to be overweight or snore while sleeping to have OSA.

Additional symptoms include waking up with a sore or dry throat, restless sleep, loud snoring, morning headaches or mood changes. OSA can be treated through the use of nighttime breathing masks, upper airway stimulation therapy, surgical procedures and oral appliances.

You’re pregnant.

Pregnant women will often experience increased urination. This is due to the pregnancy hormone called human chorionic gonadotropin, or hCG, which can cause an increase of blood flow to the kidneys and your expanding uterus, which then puts pressure on your bladder.  

Ageing could be a factor.

As people age, bladder capacity tends to dwindle. So even if you are drinking the same amount of liquids as when you were younger, you may have to use the bathroom more often. This can be a normal cause of having to wake up in the night to pee.

Rita Starritt, an internal medicine doctor with Weight Loss MD San Diego, added that as we get older, we tend not to sleep as deeply, “so the urge to pee is more capable of awakening us.”

Starritt noted that “as women go through the menopausal and peri-menopausal period, there are changes in the urethral tissue … which makes the urge to pee more prominent in our brains.” In addition, there is more leakage as we age, so we may feel compelled to keep less in our bladder, she said.  

You have swollen legs.

If you have issues with lower leg swelling, that can contribute to nighttime bathroom trips, according to Rivera.

“When people lie down at night, all of that fluid in the legs starts to redistribute into the bloodstream and then gets filtered by the kidneys and made into urine,” he explained.

Raising or elevating your legs a few hours prior to bed will help, he said. But keep an eye on your leg swelling because lower leg edema may be a sign of cardiovascular disease.

“A weakened cardiovascular system may not be able to pump blood against gravity from the lower part of the body to the heart. Therefore, the legs get swollen and lots of fluid is retained in the body,” added S. Adam Ramin, a urologic surgeon and medical director of Urology Cancer Specialists in Los Angeles.

You have a UTI or prostate issue.

If the waking up to pee is also associated with urinary urgency or burning with urination, then it could be a symptom of an issue like a urinary tract infection or an enlarged prostate.

Ramin added that an enlarged prostate leads to thickening of the bladder wall, as the bladder wall muscle has to push against the obstruction of the prostate in order to empty. “Thickening of the bladder wall leads to reduced bladder capacity [and] reduced bladder elasticity, and therefore frequency of urination day and night,” he said.

You have another medical disorder.

On rare occasions, peeing in the middle of the night could indicate something more serious. Ramin said an increased urge and increased frequency of urination can exist in patients with disease processes that affect brain function. These may include dementia, Parkinson’s disease, brain tumours, history of brain stroke, radiation to the brain and brain surgery.

Rivera explained that other potential causes of nighttime peeing that are rarer include hormone-secreting tumours. Chirag Shah, co-founder of Push Health, an online health care services platform, added that recurring nighttime urination can also be an early indicator of diabetes. 

When to be concerned.

If you are concerned about your nighttime peeing habits, keep a diary of your drinking and urine output, Morrison suggested.

“If you’re urinating more than eight times in 24 hours, that’s too much,” she said, adding that it also depends on your age. “If you are between 65 and 70 and going up more than twice a night, you should make an appointment with your general practitioner.”

If your frequent urination is accompanied by things like an increased thirst, weight loss or increased appetite, you should most definitely see your doctor, said Eudene Harry, an emergency and integrative medicine doctor in Orlando, Florida.

Henry added that if you have made changes to your routine to combat some of the above and the problem does not improve or if it gets worse, this is also a cause for concern.

And finally, “if your urine contains blood, you have a fever, pain with urination or you urinate frequently but only in small amounts, these are all signs to give your doctor a call,” Henry said.