Pee before ZZZ

July 20, 2019 7:02 PM

Why does my girlfriend feel the urge to pee multiple times before she can finally fall asleep?

My poor girlfriend has been suffering for several years from a feeling of needing to pee again and again before she can finally fall asleep.

She will pee, get back in bed, go pee again, go back to bed, go pee again, go back to bed, etc. This happens multiple times before she can finally fall asleep. The thing is, after the first time, there are only a few drops of pee.

After she finally falls asleep, she's good for the night...she doesn't wake up to pee again.

She's been to doctors about it and they didn't find anything physical that would seem to be a factor.

She and I assume this might be some type of psychological issue, but if that's the case, we don't know whether it's caused by some type of anxiety or something else.

The plan is to talk to a psychologist, but with the concern that it's something a random psychologist might not have a clue about. Therefore, I thought i would also put it out here to see if anyone has experienced something similar, and if so, whether a cause and/or resolution was found. Also to see if anyone has any suggestions about types of therapy that could potentially be helpful. She's really suffering and is willing to try different possible remedies.

Thank you.

posted by Dansaman to Health & Fitness (30 answers total)

When you say "doctors," does that include a gynecologist? Uterine fibroids can cause frequent urination.
posted by praemunire at 7:04 PM on July 20, 2019 [2 favorites]

I used to do this. It was OCD/anxiety related.
posted by MountainDaisy at 7:33 PM on July 20, 2019 [14 favorites]

Yes, this could be a growth or enlargement of some sort that is pressing on the bladder when your girlfriend lies down and relaxes. Something like a fibroid (per praemunire above) or an ovarian cyst etc. I'd see a gyno if I was her, or get a second opinion if she already has seen one.
posted by Thella at 7:50 PM on July 20, 2019 [1 favorite]

Is she finding she urinates more frequently in general, or just going to bed? Has she always been this way or is it something new that could indicate infection?

A (male) family member of mine saw a doctor about frequent urination and it seems to have to do with distress tolerance / sensitivity in his case, not that he actually *needs* to pee more often but that he's just more sensitive than most to the feeling. I think he generally indulges it, since it's a comfort issue.
posted by Lady Li at 8:00 PM on July 20, 2019 [3 favorites]

Yeah, I think we need to know what doctors she's been to. Endometriosis on the ureters did something like this to me, and I didn't even realize that's what was happening until it was eventually diagnosed (for other reasons) and removed.
posted by babelfish at 8:03 PM on July 20, 2019

It may be worthwhile to consult with a urologist, but any doctor can prescribe Uribel, for symptoms that include a frequent urge to urinate without producing much pee. Bonus: turns pee blue, but only temporarily.

Uribel contains both antispasmodic and analgesic agents, which may help with interstitial cystitis-type symptoms, i.e. the ones that "may resemble those of a chronic urinary tract infection, [but] there's usually no infection." According to the Mayo Clinic:

Your bladder is a hollow, muscular organ that stores urine. The bladder expands until it's full and then signals your brain that it's time to urinate, communicating through the pelvic nerves. This creates the urge to urinate for most people.

With interstitial cystitis, these signals get mixed up — you feel the need to urinate more often and with smaller volumes of urine than most people.

Interstitial cystitis most often affects women and can have a long-lasting impact on quality of life. Although there's no cure, medications and other therapies may offer relief.

Yoga and pelvic massage were also recommended when I was misdiagnosed with interstitial cystitis - my symptoms were different, because I had a superhuman ability to pee (documented after my nephrologist ordered a 24-hour urine catch), and it turned out to be related to an adverse effect from a blood pressure medication.
posted by Little Dawn at 8:04 PM on July 20, 2019 [1 favorite]

Wondering if it’s related to weakness in pelvic floor. I know it only happens at bedtime, but it may be that she is busy all day, and bedtime is the only time she is able to really notice and act on it. If she has access to (and coverage for) a physiotherapist that is trained in pelvic floor health, maybe worth a consultation.
posted by leslievictoria at 8:22 PM on July 20, 2019 [1 favorite]

Funny, I was just talking to my roommate about this yesterday. When I was going through a really anxious period, I felt like I needed to pee all the time. It made me anxious about leaving the house and not having a place to pee, which made the feeling worse. I saw a urologist who confirmed I had no physical issues. He said I could do pelvic floor therapy, but mostly what I needed to do was reset my bodily cues and try holding it a little longer. That said, I also try not to drink water an hour before bed.
posted by radioamy at 8:29 PM on July 20, 2019

Response by poster: It's only happening at night after she gets in bed and before she falls asleep. Once she falls asleep, she's fine. It does not happen during the daytime. She might go slightly more frequently during the day than the average person, but nothing extremely out of the ordinary range. And she definitely doesn't go repeatedly during the day like she does before falling asleep. The reason we think it might be psychological is because it doesn't happen during the day and it doesn't happen after she falls asleep. As I mentioned in the posting, she's had this condition for a few years.
posted by Dansaman at 9:14 PM on July 20, 2019

I had this pretty severely for awhile! It was primarily happening right before sleep, but for a time it also started happening during other times of day, though not as severely.

I saw a urogynecologist and nothing major was physically wrong, but they found I was not emptying my bladder fully - it wasn’t a huge volume of urine left but it they were able to detect it. The doctor hypothesized that it was a combo of stress and minor pelvic floor dysfunction and I was given the option of medication or seeing a pelvic floor physical therapist.

I haven’t followed through on the therapist referral yet but I am considering it, in the mean time the source of stress (roommate situation) went away and the problem got significantly better. Also I stopped drinking alcohol in the late evening, because that seemed to cause irritation and increase my need to urinate.
posted by mai at 9:22 PM on July 20, 2019 [1 favorite]

One question they asked me at the doctor: if she stays on the toilet a few more minutes, does any additional urine come out? This is called having a “shy bladder” and it means you are having trouble fully relaxing the pelvic floor muscles.
posted by mai at 9:24 PM on July 20, 2019 [1 favorite]

Definitely look into the possibility of a pelvic floor issue. Is she a runner? Have anxiety? Nervous about her weight and sucks in her stomach? If she's walking around with a tightened core every day, her pelvic floor might just be tired and the end of day relaxation is giving her the sensation of needing to pee. Is sex painful for her, or does it hurt to use a tampon? If so, it could definitely be pelvic floor.

I've had this problem before and I'm usually a double peer when I'm out somewhere, especially when it's somewhere new. It's not a universal problem, so I had also associated it with just a psychological quirk. But then, surprise, I also had a really tight pelvic floor. So it was sort of psychological: being somewhere new makes me nervous makes me tense up and creates the sensation of needing to pee, even if I didn't.
posted by lilac girl at 9:28 PM on July 20, 2019 [2 favorites]

I do this, not several times but a couple. If I think "Do I have to pee?" then that thought will keep me awake until I just go pee. Probably anxiety. Doesn't totally impact my life too much. I also get more abdominal pressure from sleeping on my stomach and endometriosis and IBS (and since my hysto a few months ago I get other weird bladder pressure sometimes). I also have trouble sleeping so I may be up for a little while just trying to sleep and I have a small ish bladder so I'd rather pee RIGHT before I go to sleep so I don't end up waking up in the middle of the night.

I would talk to a therapist about this, but of course make sure there isn't anything medial. For me it's mostly "Dang it! Why did I ask myself if I should pee?!"
posted by Crystalinne at 9:35 PM on July 20, 2019 [9 favorites]

Best answer: 1) I encourage being really aggressive talking with the doctors and absolutely running down all possible physical causes or co-factors.

2) This was me, and it was 100% anxiety related and had a couple of really clear personal life triggers. And it sounds like my symptoms were the same. I would pee, get in bed, lay there for a few minutes, then feel like I needed to pee again. I could sit on the toilet for minutes at a time, and only a few drops would come out, and it would feel like a huge relief... but if I didn't fall asleep within a few minutes of getting back into bed, the cycle would repeat. Was totally fine when I fell asleep, and had no abnormal urination urges through the day. For a time, the only relief I had was taking sleeping pills -- they would knock me out fast enough that I could get through the initial getting-to-sleep period. Not really a good strategy, though! Therapy helped a great deal, as did completely cutting out caffeine for awhile.

Please feel free to memail me if I can be any more help! This was so awful to go through, but it's solvable!
posted by curious nu at 9:41 PM on July 20, 2019 [2 favorites]

This happened to me in college and went away as randomly as it arrived. Thinking back now, one difference is that I was drinking chamomile tea, which I believe is a diuretic.
posted by salvia at 10:45 PM on July 20, 2019

Best answer: if she follows the suggestions above and it is clearly nothing physical, then she might want to consider teaching her brain to uncouple the minor sensations that making her feel like she just has to be get up and pee when actually she doesn't. I do this around leaving the house. If I can convince myself to ignore it, the pressure of needing to go will go away. I think for her, trying to "just ignore it" might be really, really hard at first so this might help - first go out and buy some depends (so she can relax that even if she is wrong and she does need to go, nothing bad will happen) and try using the toilet as completely as possible, putting on the depends and then make it a firm rule not to use the bathroom again until after she has fallen asleep and woken up again. It will be uncomfortable, The idea is practice being mindful - shifting from "i have to go pee now" to "oh, notice this feeling in my body. it is a sensation that I am having but I don't have to do anything about it - it is OK to ignore it." and then let herself try to ignore it. I might also have some distractions like a podcast, music or a book, because it will probably be hard to fall asleep the first few nights. Assume no accidents (which should happen since she doesn't really need to pee), after a few trials, her brain will figure out that it is safe to ignore those sensations and she will have broken out of the cycle.
posted by metahawk at 10:45 PM on July 20, 2019 [1 favorite]

this sounds really obvious (in fact, too obvious, i'm 100% sure you've considered this already) but i realized i was drinking most of my daily water intake at night after work, and when I didn't this no longer happened.
posted by colorblock sock at 10:58 PM on July 20, 2019 [1 favorite]

I hope this is helpful, but for me at bedtime, sometimes physical symptoms come up that didn't happen during the day because I kinda just got trained to ignore my whole body always. So when finally it was time to come together, body and brain, and sleep, everything that was bothering me during the day finally expressed its physical symptoms via itchiness or achiness or sweatiness or whatever. It does sound like anxiety, which is totally okay and can be dealt with without doubling down on guilt/shame/anxiety about anxiety. I agree with everyone who says ruling out physical stuff is important, which also can be hard given the lack of medical science about women in general.
posted by lauranesson at 11:56 PM on July 20, 2019 [1 favorite]

I had had two severe bladder infections within six months of each other, the third was initially diagnosed as a pelvic infection, then overactive bladder, and now am back on long term antibiotics which seem to be clearing things up...Just throwing this out there in case she's had a UTI. Caveat the my symptoms were constant (day and night) and painful.

Definitely get things checked out physically; but regardless it's worth seeing a therapist because anxiety can make it worse regardless of the cause.

Also I don't drink tea anymore. At all.

Fwiw, I believe transdermal ditropan (oxybutynin) patches (maybe oral tablets too?) are available over the counter in the US. Usually around where the UTI/Azo/cranberry stuff is. It's basically a bladder relaxant so the muscle stops freaking out about those two drops of pee. Not instead of anything of course. But you know, if she needs to get through the next few weeks while she sets up appointments and stuff. It can become quite the anxiety spiral. I was on it for years, it does take the edge off.

I saw a GP, gynocologist, urogynecologist, pelvic floor physical therapist, and therapist.

I hope she works it out and gets relief soon. It's annoying af.
posted by jrobin276 at 4:01 AM on July 21, 2019

Sometimes the various lumpy bits inside the body move into different positions when you lie down. These lumpy bits moving can put pressure on the bladder and either make it difficult to pee, or difficult to empty the bladder fully, or squish the bladder so that it feels like you gotta pee desperately because whatever it is is leaning on the bladder hard enough that anything more than a teaspoon wants to come out.

If your girlfriend is a younger woman, especially a skinny younger woman probably the only mobile lumpy bits inside her is the contents of her colon. If she is older or large or has had a couple of kids it could be anything nudging her bladder to get elbow room. She can do a personal internal exam inside the vagina to detect if there is anything lumpy that changes from one day to the next on the back wall of the vagina. That lumpy stuff is fecal matter. If there is stuff in there it means she is not emptying her colon completely and has some tendency towards constipation. Exercise, more fluid and lots of prunes, raisins, stir fry veggies etc. could make a difference. Or she could put a solid pillow under her butt when she goes to bed and see if that reduces the desire to pee at all.

It's very likely something else, but this is an easy to rule out possibility.

Kegels to strengthen her pelvic floor could make a difference, but if she wants to strengthen her pelvic floor the exercise to do is squats - and to do those without being bored she needs to find some activity she can do on the floor, like petting the cat, or cleaning up where the tea pot spout dribbled, or shooting marbles.
posted by Jane the Brown at 5:04 AM on July 21, 2019

She should see a urologist.
posted by bile and syntax at 6:56 AM on July 21, 2019

Nthing pelvic floor. I had this for a few years, with no other symptoms that I really noticed, and also assumed it was psychological so didn't think much of it other than to find it mildly annoying. Then all of a sudden (with some precipitating factors) it started happening all the time. Doctors and specialists were fairly useless other than to rule stuff out, and it turned out my pelvic floor muscles were super tight and causing the urinary symptoms plus a bunch of pelvic pain. I've been doing physio for about 2 months and the symptoms have improved a lot, including having to pee several times before sleep. I have noticed that my pf muscles are definitely worse by the end of the day unless I do all of my stretches/exercises, which is probably why the urinary symptoms were only an issue at bedtime for years. So, nthing the suggestion to get an assessment by a pelvic floor physiotherapist.
posted by DTMFA at 8:30 AM on July 21, 2019

Also, fyi if it is hypertonic pelvic floor muscles, kegels will make them far worse (the issue is that they are tight and short and have too much tone).
posted by DTMFA at 8:36 AM on July 21, 2019 [1 favorite]

This can be caused by yeast. Try using some Gyne Lotrimin/motrin, etc. cream rubbed in the area for a few days and see if there's any relief.
posted by Sunnyshe at 9:21 AM on July 21, 2019

Unless you are 100% sure of what medical issue your girlfriend is facing, please do not try remedies that are just put out there by strangers on the internet. Go to a urologist as mentioned upthread. While anecdotally remedies may have helped other people with their own medical problems, it seems like there are a ton of perspectives here on what could possibly be happening with your gf and not a lot of clear indication in one way or another. At best, taking uneccessary medications or putting unnecessary creams on will do nothing and just prolong the issue. At worst your gf could end up with side effects that she did not have before that could further muddle the ability to reach an accurate diagnosis.
posted by donut_princess at 10:07 AM on July 21, 2019 [4 favorites]

Things that are generally helpful with no down side:
Sex can introduce bacteria that irritate the urethra, peeing after sex helps.
Some dyes may irritate the bladder, causing the need to pee feeling. Avoid food with dyes for a week.
More fluids, esp. cranberry juice. Drinking more, therefore peeing more, is generally good for the urinary tract. Cranberry juice may help. Alcohol is an irritant. Try a week of really drinking lots, and add cran, maybe with sparky water.

As a general rule, if your urine is no darker than apple juice, you are probably getting enough fluids.
posted by theora55 at 12:18 PM on July 21, 2019

I developed this habit while I was pregnant - I was up multiple times a night to pee because of the extra bladder pressure and so I would try to do a final pee so I could sleep for longer. Several years on I find limiting my water intake to prior to 7 p.m. and limiting refined sugars helps a lot but I still go a few times before bed, for me it's a sensitivity to the "need to go" sensations that is most apparent when I'm not distracted by anything else and trying to fall asleep. Maybe she could try stretching out the times between subsequent pees to reduce the sensitivity she feels to the "need to go" sensations?
posted by lafemma at 2:31 PM on July 21, 2019

Nthing pelvic floor, but not in a "kegels will fix this" way, because kegels are not the only aspect of pelvic floor health. Instead, I'd recommend working on developing a little more core strength, like with yoga or Pilates. It certainly will not harm anything, and may significantly help. Speaking from experience.

I personally prefer taking live classes, but I live in a major metropolitan area with so many studios that we're tripping over them. There is absolutely nothing wrong with using free videos from the internets, and many people prefer that. Once you get the hang of identifying the everyday movements where you SHOULD be using more core, it's easy to start putting a little more oomph back into the way you walk and sit and stand that helps to reinforce those muscles.
posted by desuetude at 7:40 AM on July 22, 2019

When I was dealing with post-pregnancy pee issues, it helped my anxiety about it to just wear a normal menstrual pad sometimes. I knew that I didn't have much in there, but knowing that I had that extra layer of protection helped me relax about it.
posted by oryelle at 8:04 AM on July 22, 2019

For me, it was anxiety that came about having a couple of UTIs. I was so afraid of getting another that when I knew I'd be in bed (without peeing) 6-8 hours, I felt the NEED to pee if it seemed like there was any chance that I might be able to.
posted by metasarah at 8:23 AM on July 22, 2019