Q: I am 46 years old. Before going to bed, I usually have about two cups of water because I feel thirsty.

I need to wake up to go to the toilet about three to six times. Sometimes I even wet the bed.

A doctor I consulted advised me not to drink at night. However, I have to drink as I feel very thirsty. This is causing me much fear and stress at night. What can I do about it?

A: You have the problems of nocturia, a need to wake up one or more times to pass urine; and nocturnal enuresis or bedwetting.

Some people mistake insomnia for nocturia. Insomnia commonly causes frequent urination at night, but once asleep, the person does not have to wake up to pass urine.

Nocturia is very common and its occurence increases with age. It is stressful and it has a negative impact on one's quality of life, from sleep to work. Some people may have additional urinary symptoms, such as frequent urination even in the day, difficulty in passing urine and urinary incontinence.

The causes of nocturia are varied and may be divided into several categories - increased overall urine production, increased night-time urine production, decreased bladder capacity or a mix of these causes.

You should seek medical advice for your condition. Your doctor will take a detailed history regarding your urinary complaints. A physical examination and specific investigations will be performed to determine the cause.

Depending on the cause, treatment options include behavioural therapy, medication and/or surgery.

Fluid management is one of the simplest therapeutic options for nocturia. Restricting fluids one to two hours before bed, omitting fluids after awaking to pass urine during the night and avoiding diuretics like coffee, tea and alcohol in the evenings and nights are all effective in reducing the severity of nocturia. -Dr Siow Woei Yun