Many older men complain, “I’m really getting old, when I was young I never got up at night, now I have to go to the bathroom several times a night and I can’t sleep well.” Indeed, many older men suffer from increased nocturnal urination. So what is increased nocturnal urination? Generally speaking, normal nocturnal urination is 0-1 times, and when the number of nocturnal urination is ≥2 times, it can be considered as an increase in nocturnal urination. What are the causes of increased nocturia? The increase in the number of nocturnal urination can be divided into two main categories of causes. One is an increase in total nocturnal urine volume; the other is a normal total nocturnal urine volume but an increase in the number of times, i.e., not much urine is passed each time. The increase in total urine volume at night can be physiological, such as drinking a lot of water, strong tea, coffee or taking diuretics before going to bed, or it can be caused by certain medical diseases, such as urolithiasis, diabetes, cardiac insufficiency, etc. There is also a more common situation caused by atherosclerosis in the elderly. Under normal circumstances, the kidneys have a stronger concentration function when a person is sleeping, which makes the kidneys produce less urine. However, glomerular arteriosclerosis causes the kidneys to lose their concentrating function, which leads to an increase in urine output. In addition, arteriosclerosis of the lower extremities increases vascular permeability, and many body fluids are deposited between the tissues of both lower extremities during the day, causing edema in both lower extremities. During sleep, as the lower extremities are elevated, the veins are reduced by gravity, so that the body fluids deposited between the tissues flow back into the bloodstream, promoting urine production, and the edema disappears by the time the person gets up in the morning. There are also many reasons for a normal total urine volume at night, but an increased number of times. The more common are: 1, mental factors, high tension or poor sleep, when the bladder is lightly filled (less than 300 ml) that is, the desire to urinate, so that the frequency of night urination increased, resulting in habitual nocturnal polyuria. 2, inflammatory stimulation, such as urinary tract infection, bladder stones, foreign bodies or tumors, etc. 3, prostate hyperplasia. The most common cause of prostate enlargement in older men. What should older men do when they have an increased number of nocturnal urination? The first thing to do is to distinguish what causes the increase in the number of nighttime urination. A very simple method is to keep a urinary diary, which means that you record the time and volume of urine each time you urinate, and then add up the daytime and nighttime urine volumes separately to calculate the daytime and nighttime urine volumes. The last urine volume before bedtime is counted as daytime, and the first urine volume in the morning is counted as nighttime, and the average of daytime and nighttime urine volumes is calculated for three consecutive days. Under normal circumstances, the daytime urine volume should be more than twice the nighttime urine volume. If the nocturnal urine volume is more than one-third of the total urine volume throughout the day, you can consider it as an increase in total nocturnal urine volume. In this case, the first thing to look for is the presence of a medical condition that is causing the increased urine volume, and if so, active treatment is required; if not, it may be caused by lifestyle habits or arteriosclerosis. You can reduce the amount of water you drink before bedtime, and not drink strong tea or coffee before bedtime. In addition, you can reduce urine production at night by elevating both lower extremities during naps and lounges to advance the return of body fluids deposited in the lower extremities. If the total amount of urine at night is normal, it is also important to look for further causes. Ultrasound can be performed to check the size of the prostate and the amount of residual urine in the bladder, as well as to detect the presence of bladder stones, foreign bodies or tumors, and routine urine examination for inflammation. If you have a urinary tract infection, you need anti-infection treatment; if you have a bladder stone, foreign body or tumor, you need surgery; if it is caused by mental factors, you can take sedative and tranquilizing drugs. If the increase in the number of nighttime urination is caused by prostate enlargement, oral 5-alpha reductase inhibitors (finasteride, such as “Paulownia”, “Capo”, etc.) can be taken to control and reduce the size of the prostate, and alpha-blockers (such as Harlequin, Cordova, Marsanyl, etc.) can improve the symptoms of difficult urination. If there are no obvious symptoms of difficult urination, you can also add M-blockers (such as Weixikang, Lovok, etc.) to reduce the number of nocturnal urination, but of course, these drugs must be taken under the guidance of a doctor. If the reduction in the number of nocturia is not obvious after taking the above-mentioned drugs, and there are obvious symptoms of dyspareunia at the same time, then surgery can be considered.