The Girlfriend Doctor’s Checklist for Better Nighttime Bladder Control

March 12, 2025 Dr. Anna Cabeca

Do you have to get up multiple times at night to pee? Oh, so many of us do! It ruins our ability to get quality sleep, can disrupt our healthy circadian rhythm (important for hormone balance), and makes us just a bit cranky.

One in three adults over 30 make at least two trips to the bathroom every night and about 50% of adults over 65 get up at least once (with about 24% making two or more trips to the toilet). (1)

Much of this is completely unnecessary and we want and need a good night’s sleep.

I always suggest that women suffering from this issue (called nocturia) take a look at their evening habits. Oftentimes, just making a few behavioral changes can provide tremendous relief in the need to get up and go throughout the night.

So take a moment to look through my checklist and start making the simple changes that can help you. Pass it along to your girlfriends, too. If you don’t see fairly rapid improvements I recommend you also keep a bladder journal that you can then share with your doctor. Document what you are drinking, eating, and doing during the day and near bedtime on those evenings when you need to crawl out of bed more than once.

So which of these changes can you make today (for a more restful night)?

Hydrate often, but earlier: While it may seem contrary, it is important you hydrate adequately DURING THE DAY. My usual guideline is for most women to drink 60-70 ounces earlier in the day, at least 4-6 hours before bedtime. Read my article on the five hydrating tips for a healthier you for more helpful details. If your urine is dark yellow or has a strong smell it may mean you are dehydrated, this more concentrated urine can irritate the bladder. We want fairly clear pee and we should typically be emptying our bladders about 8 times a day. We also don’t want to become constipated (as this often means we are straining which can negatively affect our pelvic floor, worsening bladder control problems).

No fluids prior to bedtime: Stop drinking fluids at least 3 hours prior to bedtime. Use only a small amount of water if you need to take evening medication. You shouldn’t be drinking a lot of fluids during meals (it negatively affects digestion) anyway, so dinner can be an easy-to-remember “cut-off” for fluids at night.

Avoid foods known to be bladder irritants or diuretics (causing you to pee): While some people may be affected by certain foods others may not, it’s very individual. Consider removing suspected offenders (come on now, you know what your night-time snacking entails!) and see if things improve. Some common bladder irritants are:

Salty foods (can make your body retain fluid).
Chocolate – sorry but can be a bladder irritant for some people.
Sour cream, aged cheese, and non-probiotic yogurt (dairy can just be inflammatory).
Tomato-based foods (are acidic).
Many condiments can affect some people such as balsamic and flavored vinegars, soy sauce, salsa, ketchup, mayonnaise, onions, and some salad dressings.
Parsley (a natural treatment for UTIs) is a diuretic so best to avoid it later in the day. (2)
Sugar, honey, artificial sweeteners, and corn syrup.
Aged, cured, processed, canned, or smoked meats and fish.
Gluten (bread with rye, wheat, and barley) is inflammatory to many people.
Foods containing nitrates or nitrites such as corned beef, chicken livers, caviar, anchovies, and some meats.
Too much protein in the evening can be problematic. (3)
Spicy foods, hot peppers, hot sauces, etc. (4)

Avoid diuretic and caffeine drinks after lunch: Make sure the fluids you drink in the afternoon and early evening are not caffeinated and are not diuretics including alcohol, caffeinated coffee and tea, fruit juices (orange, lemon, and tomato juices are particularly acidic), and any drink containing artificial sweeteners; many can irritate the bladder. Energy drinks and even vitamin waters can contain artificial sweeteners and citric acid. Even cranberry juice (a natural “go to” for urinary tract infections) can cause some people bladder irritation as it is acidic. Alcohol may knock you out as a sleep aid but actually reduces the quality of your sleep and can be a bladder irritant. Carbonated drinks such as soda or even fizzy water may cause problems. Diuretic herbal teas such as green, fennel, nettle, dandelion, hibiscus tea, and dieters’ tea shouldn’t be consumed late in the day. Other herbal teas (without citrus, sweeteners, or preservatives) such as chamomile or peppermint are great as long as you don’t drink them too close to bedtime. Also, avoid any drink containing vitamin C.

Don’t smoke: Many vices are associated with worsening nighttime bladder control, including alcohol and caffeine, sugar, and smoking (yet another reason to quit). (5)

Evaluate your prescription medications and discuss with your doctor: Ask if any have potential side effects such as being a bladder irritant or diuretic, causing edema/fluid retention, or acting as a stimulant (affecting sleep). Your doctor may be able to have you take any offenders earlier in the day. Many medications, including blood pressure meds, beta-blockers, anticholinergics, lithium, water pills/diuretics, Lasix, muscle relaxants, steroids, some cold and allergy meds containing ephedrine or pseudoephedrine, as well as some sedatives and antidepressants can have side effects that may be causing you sleep disruption as well as the need to pee more often during the night. (6)

Avoid taking supplements at night that are associated with fluid retention such as vitamin C, Vitamin B6, and multivitamins containing them.

Reduce fluid retention (if you have swollen feet or legs) by elevating legs in the evening (redistributes fluids from the legs back into the bloodstream) and wearing compression socks early in the day (so fluid doesn’t collect in the legs). If you retain fluids the issue is when you go to bed at night those fluids flow directly to the kidney and then the bladder, making you have to get up. (7)

Empty your bladder—twice—right before bedtime: Empty your bladder right before bedtime. Take a few deep breaths while pausing for a minute. See if you can empty out anything more.

And one BIG recommendation: Retrain your bladder!

We can retrain our bladder but we have to stop making it think it is small!

One way many of us may be negatively training our bladder is when we do that “final pee” prior to walking out the door, even when we don’t have to go. I know many of you likely do this. But it is something we should really try to avoid as it actually trains our bladder to hold less urine.

Another way we can retrain our bladder is to WAIT a moment before running to the toilet at night. On those sleepless nights sometimes we are waking up for other reasons (versus the need to pee). Sometimes we’re stressed, having a hot flash, or maybe uncomfortable for another non-bladder-related reason. Or, we may be having a little bladder spasm, but it will quickly pass and we don’t really need to get up and go. Try to resist getting up!

We can also retrain our bladder during the day. When you feel the urge to pee try holding off, even for a few minutes. If you routinely practice this you will teach your bladder it isn’t small! As a doctor performing surgeries, I often had to just hold my pee for hours on end. I think most doctors have large bladder capacity because of that training!

Along with following the checklist and making those changes there are many decisions we make each day that can impact our evening bladder control.

Lifestyle Interventions Can Also Help

The great news is that the listed lifestyle interventions not only help with nighttime bladder control but also help with a wide variety of health concerns like insulin control, weight management, sexual health, and so much more.

1| Get to a healthier weight, get back your insulin control, and have a healthy gut!

Obesity increases the incidence of nocturia by 2 to 3 fold. (8) A Keto-Green lifestyle and diet will help you get to your healthiest weight and will improve your insulin sensitivity and gut health. And if you’re looking for extra hormone-balancing support, consider adding Mighty Maca Plus to your routine. This powerful blend of 30+ superfoods and adaptogens is designed to support hormone balance, reduce inflammation, and promote optimal wellness—all essential factors in bladder health, metabolism, and energy levels. Obesity is a risk factor for developing insulin resistance and Type 2 diabetes, and both of these conditions are proven risk factors for bladder control problems.

2| Address disruptive sleep issues such as sleep apnea.

Studies have found that 80% of the time people with sleep-related disorders (apnea, severe snoring, insomnia, restless leg syndrome) wake up due to their sleep disorder, not the need to pee, but they identify waking up as the need to pee (thus training their bladder to think it’s small). I’ve had a lot of issues with sleep throughout my own life; sleep disruption certainly isn’t just a menopause issue. Check out this earlier article on how to improve your sleep. There is a lot you can do to improve things. Sleep apnea, by the way, is a prime suspect in nocturia. It alters the production of antidiuretic hormone, causing more frequent urination. (9) One study revealed that 90% of patients having nocturia had sleep apnea, and that CPAP treatment reduced nocturia symptoms significantly. (10)

3| Manage your diabetes and hypertension:

Both can result in fluid retention and are associated with increased risk for nocturia. (11)

4| Get moving!

Here are some suggestions for incorporating more exercise into every stage of your life.

5| Strengthen your pelvic floor with Kegel exercises.

Pelvic floor muscle training has been proven effective in treating nocturia and other types of bladder leaking. (12) Our pelvic floor muscles are weakened over time from sedentary lifestyles, childbirth, hormonal changes, etc. Learn much more at the link! I also have numerous podcasts on this important topic on my website including this one with Michelle Kenway, a pelvic floor physiotherapist, who talks to us about having fun while strengthening our pelvic floor.

6| Give your lady bits some love…

Vaginal dryness, irritation, and other lady bit issues happen to all of us as we age but there is a lot we can do about it! These issues keep us up at night and are also associated with nocturia. I recommend Julva® my beautiful vulva cream containing DHEA. So many women have benefitted from it relating to bladder control. You can read the story behind why I created Julva here .

To control accidental leaking many women in my community use Julva

7| Snack on pumpkin seeds, pears, and bananas!

Taking in antioxidant-rich fiber can help. (13)

So Let’s All Get Up Less At Night!

We owe it to ourselves to improve things that impact our quality of life.

Getting up more than once in the middle of the night is not healthy, and can impact our mood as well as the relationship with our partner or spouse. I know it makes me cranky. And it’s easy to adjust. Keep my checklist taped to the fridge and keep faithful to it for a week. I know it will help.

You can also listen to this earlier podcast I did with an expert on the subject of all things bladder control. We had this talk a number of years ago but it is a really informative discussion and you will learn a lot.