Daytime leaking has nearly stopped but I am still up three times a night

Fourteen weeks in and the daytime side is transformed. Coughing, sneezing, the school run, all of it is either gone or so much better that I have stopped thinking about it, which after two years is genuinely strange.

The nights have not moved at all. Three times, every night, sometimes four, and because everything else has improved I now notice it more rather than less. It is the thing wrecking my week now.

What I cannot work out is whether the night thing is even the same problem. It was never top of my list so it never really got discussed, and I did not think to raise it because I assumed it would come along with everything else. Is this something the exercises are supposed to fix and mine have not, or is it a separate thing I need to bring up as its own item?

Raise it as its own item. That would be my only contribution. Mine got treated as an afterthought to the main symptom for months and it turned out not to be related to the main symptom at all.

Worth checking what is actually waking you before you decide the bladder is doing it.

I spent a long time assuming I got up because I needed to go. When I actually wrote it down for three nights, twice out of three I was awake first and going to the toilet was just what I did next because I was awake anyway. That is a different problem and no amount of exercises was ever going to touch it.

The writing down was the whole thing. I could not have told you that from memory and I would have argued the opposite.

I cut everything after six in the evening for a month and got up just as often, only more thirsty and with a headache. Not recommending it, just reporting it.

Bring it as its own item, and bring a diary with volumes on it, because the answer to your question genuinely cannot be worked out without one.

The word for waking during your main sleep period to pass urine, with sleep either side of it, is nocturia, and it is a defined term rather than a description. The definition is standardised internationally, which is why it excludes a trip before you have got into bed and a trip when you were awake anyway. That precision is doing real work here, because it is the first thing that separates the mechanisms.

Broadly there are three, and they wear the same clothes. Either there is more urine produced overnight than the bladder can comfortably hold, or the bladder is signalling at a smaller volume than it should, or something else is waking you and the toilet is what you do once awake. Gerry has just described the third one and it is the most commonly missed of the three, precisely because the person can honestly report that they woke up needing to go.

This is why volumes matter more than counts. A record that says three trips tells me how often. A record with times and volumes on it tells me whether those are three small voids or one large one and two small ones, and those point in opposite directions. Three nights is enough, and it is the piece of work you can do before your review rather than during it.

On whether the training should have fixed it: pelvic floor muscle training is not a stress incontinence treatment only. The same Cochrane review that reported cure in 56% of women with stress urinary incontinence against 6% of controls also reported cure in 35% against 6% across all types of urinary incontinence, from 3 trials and 290 women, at moderate certainty. So it reaches more than one mechanism. What no source I would cite says is that it reliably fixes night time waking, and I am not going to tell you it should have, because that would make your fourteen weeks sound like a failure when what you have is an improvement in the symptom that was treated and a second question that has not been assessed.

Nadia, on the fluid experiment, that is a very common one and it is not a neutral thing to try. Reducing fluids concentrates urine and can make urgency worse rather than better, and NG210 covers bladder emptying disorders in the same guideline as incontinence, so going less often is not automatically going better. The other problem with it is that a change made without a baseline cannot be interpreted afterwards, which is why you ended up with a month of data that answers nothing except that you were thirsty.

What I am deliberately not giving anyone here is a number of night trips that counts as too many. I do not have a figure for that I would put my name to, and the thresholds that circulate are conventions rather than findings. The two questions that are worth more than a count are whether the pattern has changed and whether it is wrecking the following day. Yours is wrecking the following day, so it is a treatment question regardless of what anybody's threshold says. Getting up at night to wee has the mechanisms and what a diary shows.

Whether yours is bladder driven, sleep driven or something else is not something I can say from here, and there are causes of a changed night time pattern that need a doctor rather than a physiotherapist. Take the three nights to your review and ask for it to be assessed as a separate symptom.

Did the three nights with a jug, which was as undignified as it sounds.

Two of the three nights the volumes were tiny, which I was not expecting at all, and the first waking was always around the same time regardless of what I had drunk. Handed it over at my review last Tuesday and it has gone off as a separate thing rather than being folded into the leaking.

No answers yet. But it is being looked at as its own problem now instead of being the bit at the end of the appointment when the time has run out, and Gerry, you were right, I could not have told you any of that from memory.