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A toilet in an empty bathroom at night

Answer:

Needing to wake up more than once during the night to urinate, a condition known as nocturia, commonly occurs with age, affecting about 69% of men and 76% of women ages 40 and older (Weiss, Rev Urol 2012). Common causes of nocturia are urinary tract infections (UTIs), overactive bladder and benign prostate hyperplasia (BPH).

Depending on the cause of nocturia, certain supplements may be beneficial, while some others that are promoted for this use might not help, as explained below. Use the links for details such as dosage and ConsumerLab's Top Picks among marketed products.

It’s important to talk to your doctor if you’re experiencing excessive nighttime urination to ensure that the correct cause of the condition is identified. Other conditions that have been linked with nocturia include diabetes mellitus or diabetes insipidus, heart failure, kidney disease, chronic pain, low levels of albumin (which keeps fluid in your blood vessels), chronic venous insufficiency, obstructive sleep apnea, multiple sclerosis, Parkinson's disease, Alzheimer's disease, and depression. For some of these conditions, such sleep apnea, proper treatment can help reduce nighttime urination. Dietary habits (such as drinking too much fluid or consuming excess alcohol or caffeinated beverages) can also cause nocturia, as can certain medications, such diuretics used to treat high blood pressure. (Weiss, Rev Urol 2012; Kujubu, Geriatric Nephrology Curriculum 2009).

Cholesterol-lowering statin drugs have been reported to cause nocturia and other lower urinary tract symptoms (LUTS) in some people, although not all studies have found a connection and it’s not clear how statins might cause this effect. An analysis of data from the FDA Adverse Event Reporting System (FAERS) (which can detect patterns, but cannot prove cause and effect) between 2004 and 2011 found the number of reports of nocturia to be 57% higher than with statins compared to other drugs, and reports increased over the first 12 weeks of use, suggesting a potential link. Reports of increased daytime urination were similarly higher. The odds of a statin-user reporting nocturia appeared to be greatest among those taking lovastatin (Mevacor), followed by rosuvastatin (Crestor), simvastatin (Zocor), pravastatin (Pravachol), and lastly, atorvastatin (Lipitor). There did not appear to be an increased risk with fluvastatin (Lescol) or pitavastatin (Livalo) (Fujimoto, Int J Clin Pharmacol Ther 2014).

Supplements to treat nocturia in men

Possibly beneficial
Beta-sitosterol is a common ingredient in prostate supplements, and most (although not all) studies have found that beta-sitosterol can improve urologic symptoms in men with BPH.

Pygeum bark, an ingredient commonly found in prostate supplements, may help reduce the frequency of nighttime urination in men with BPH.

Taking the standardized pine bark extract Pycnogenol along with standard BPH management (i.e., regular hydration, exercise, frequent voiding, and avoidance of long periods of sitting and of drugs that restrict urine flow) seems to improve symptoms of BPH — including waking at night to urinate — better than standard management alone or some medications for BPH (dutasteride and/or finasteride).

Taking a whole-tomato food supplement containing lycopene may reduce prostate symptoms, including the need to urinate during the night, among HIV-positive men with BPH.

Cranberry powders and extracts may reduce lower urinary tract symptoms (LUTS) such as frequency, urgency and nighttime urination, in men with non-bacterial prostatitis or BPH, as well as in men undergoing treatment for prostate cancer.

May not help
Saw palmetto is commonly promoted for improving symptoms of BPH, including increased frequency of urination during the day and night, but the evidence of saw palmetto's benefit is conflicting and a number of studies have failed to show any benefit over placebo.

Supplements to treat nocturia in women

Possibly beneficial
Melatonin supplementation may modestly decrease nighttime urinary frequency by about one episode per night in postmenopausal women. However, the volume of urine voided does not appear to be affected.

A product called AZO Bladder Control with Go Less, which contains a "proprietary blend" of pumpkin seed extract and soy germ extract (Go Less®), may slightly decrease nighttime (and daytime) urinary urgency and frequency in women. A benefit in men has not been demonstrated.

Supplementing with cranberry powder does not appear to reduce the need to urinate at night among women with overactive bladder. However, drinking cranberry juice (or possibly taking cranberry pills) may help reduce the risk of recurrent UTIs, a common cause of nocturia, in women.

Like cranberry juice, supplementing with D-mannose may also reduce the risk of recurrent UTIs and corresponding nocturia among women.

May not help
While low levels of vitamin D have been linked with higher risk of overactive bladder, there is no convincing evidence that supplementing with vitamin D reduces nighttime urination among women with this condition.

There is currently not enough evidence to conclude that probiotics would be beneficial for preventing UTIs and associated nocturia.

Supplements to treat nocturia in men and women

Possibly beneficial
Taking glycine may reduce the frequency and urgency of nighttime urination among men and women with overactive bladder, chronic prostatitis, and/or bladder pain syndrome/interstitial cystitis. However, it doesn't seem to affect urinary frequency during the day.

Taking 840 mg (two capsules) of the supplement Urox (by Seipel Group) once daily for 8 weeks reduced nighttime urination by about 1 episode per night compared to placebo (color-matched cellulose) among 142 men and women with overactive bladder and urinary incontinence. Daytime urination decreased and symptoms of urgency improved. Reported side effects included diarrhea episodes (2), urinary tract infections (2), and flatulence (1), although two reports of diarrhea and one report of UTI occurred in the placebo group. This study was funded and conducted, in part, by the manufacturer of Urox (Schoendorfer, BMC Complement Altern Med 2018). Urox is a proprietary blend of unlisted amounts of concentrated extracts of Crataeva nurvala stem bark, horsetail stem, and Japanese evergreen spicebush root.

May not help
Valerian is commonly used as a sleep aid and some people take valerian in hopes of improving sleep and reducing the need to wake up to urinate. However, the evidence for valerian as a sleep aid is mixed, with most higher quality studies showing no benefit (although it might improve sleep in certain individuals), and there does not appear to be any research showing that valerian reduces nighttime urination.

Dietary habits that may affect nocturia

As noted above, drinking too much fluid or consuming excess alcohol or caffeine can cause nocturia. In addition, getting too much sodium from dietary salt (which is prevalent in processed foods) may increase thirst and subsequent fluid intake, which may increase the need to urinate at night. A study showed that even reducing daily salt intake from 10.7 grams (about 1.8 tsp providing 4,185 mg of sodium) to 8.0 grams (about 1.3 tsp providing 3,022 mg of sodium) reduced nocturia episodes by about 1 episode per night (Tomohiro, Eur Urol Suppl 2017). See our CL Answer about salt substitutes for information about replacing regular table salt with salt substitutes.

On the other hand, getting more of certain foods has been linked with reduced episodes of nighttime urination. For example, a 4-year study in China among men with LUTS and erectile dysfunction found that those who consumed high levels of dark and leafy vegetables (more than 50 grams per 1000 kcal/day — 50 grams is equivalent to about 1 ¾ cups of spinach, for instance) had decreased storage symptoms, including nocturia, by about 33% compared to consuming only a moderate amount (25 to 50 grams per 1000 kcal/day). On the other hand, there was no link between higher intake of soy foods, cruciferous vegetables (such as broccoli, kale, etc.) or citrus fruits and reduced storage symptoms (Liu, Medicine (Baltimore) 2016).

The Bottom Line on Supplements for Nocturia

There are many causes of nocturia, and some supplements may be helpful in certain situations. For example, beta-sitosterol, pygeum bark, pine bark extract (Pycnogenol), lycopene and cranberry seem to help reduce nighttime urination in men with BPH and other prostate conditions. On the other hand, although saw palmetto is commonly promoted for improving symptoms of BPH (including nocturia), many studies suggest it doesn't help. Among women, melatonin, cranberry, D-mannose and a specific product called AZO Bladder Control with Go Less, might improve nocturia caused by conditions such as overactive bladder or UTIs. Supplementing with vitamin D or probiotics is not known to help. In both men and women, glycine supplementation seems to be beneficial for nocturia associated with overactive bladder, prostate inflammation or other conditions. Valerian seems unlikely to help.

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