You wake up in the middle of the night and the to pee or not to pee question comes up. You’re comfortable and you’re tired. But your bladder really isn’t going to let you stay. So you get up, deal with it. And the same thing happens again. Nearly everyone wakes up in the middle of the night to urinate at some point. But sometimes frequent urination can be a sign of health problems.

If you get up to pee at night occasionally—most people do—it’s no big deal. But frequent urination at night becomes a problem when you experience daytime fatigue as a result of interrupted sleep, says Matthew Rutman, M.D., associate professor of urology at Columbia University Medical Center.

Nocturia, or frequent nighttime urination, is generally defined as getting up at least once a night to pee. While getting up even once a night can be considered nocturia, it’s generally considered more bothersome to your quality of life when your nighttime bathroom breaks reach two or more times, according to Reviews in Urology.

Nocturia can result from one of three possible reasons: your bladder is having a hard time holding urine, you’re producing more urine than usual during the day, or you’re producing more urine during the night.

Sometimes, the latter is just a function of growing older, says Dr. Rutman. But if it’s happening consistently more than once a night or interfering with your ability to function the next day, the problem goes beyond normal aging.

While getting up to pee is annoying, it could also point toward a bunch of other underlying health problems. Here are a few potential issues behind the constant need to pee at night. Talk to your doctor if nighttime urination is disrupting your sleep to see if you might be dealing with any of them.

Cause of nocturia: high blood pressure

According to a new study, presented at the annual Scientific Meeting of the Japanese Circulation Society, people who woke up at least once per night to use the restroom were 40 percent more likely to have high blood pressure. And those who woke up multiple times each night had an even greater likelihood of it.

Of course, this doesn’t mean that your nightly bathroom visits are a sure-fire sign that you have high blood pressure. But if you have no idea whether your blood pressure is normal or not, you should get it checked. Especially if you’re at risk of hypertension. Many factors can put you at risk; a short list includes having diabetes, eating too much sodium and too little potassium, not being physically active, having extra weight, smoking, having a family history of hypertension, and overdrinking alcohol.

If you’re at risk of hypertension and you’re waking up several times a night to urinate, it’s worth discussing with a doctor.

Cause of nocturia: unrelated sleep problems

The more you wake up, the more opportunities you’ll have to notice you have to pee—and to empty your bladder. So, it may not actually be the urge to urinate that’s waking you up, says Dr. Rutman. You might just be waking up anyway.

One possible reason? Sleep apnea, a condition in which your breathing pauses while you sleep, can wake you up throughout the night. One recent study, for example, found that treating sleep apnea also treated nocturia. If you’re dealing with any other sleep issues, addressing them might help stop the peeing.

Cause of nocturia: bad drinking habits

Caffeine and alcohol are both diuretics, which increase your urine production, so drinking either late in the day could lead to excessive nighttime urination. Drinking too many fluids at night, regardless of what type, can also lead to nocturia.

Jason M. Phillips, M.D., a urologist with North Coast Urology, recommends cutting out all fluids two to four hours before bed and steering clear of caffeine and alcohol in the evening to prevent late-night bathroom trips if you’ve been bothered my nighttime peeing.

Cause of nocturia: certain medications

Some common medications, including Lasix and hydrochlorothiazide, which are used to treat edema (swelling) and high blood pressure, are also diuretics, says Dr. Phillips. If you’re on one of these, take it six hours or more before bed.

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It’s possible other meds can be the culprit too, so your doctor if nocturia is a side effect of any medications you’re on.

Cause of nocturia: untreated diabetes

When you have diabetes, the excess glucose, or blood sugar, rushes to your kidneys, leading water to enter as well, says Dr. Phillips. So you might find your bladder filling up more quickly than usual.

If your constant peeing happens throughout the day as well as at night, and large amounts of fluid come out each time, you might want to get a urinalysis test, which will reveal how much sugar is in your urine, says Dr. Phillips.

Cause of nocturia: an enlarged prostate

As men grow older, something called benign prostatic hyperplasia—or an enlargement of the walnut-shaped prostate gland responsible for urinary continence—can occur. This can be due to changing levels of hormones, including less testosterone production or an accumulation of dihydrotestosterone.

An enlarged prostate gland can cause pressure on your bladder, making you think it needs emptying more often than it does, says Dr. Phillips. A bigger-than-usual prostate can also cause other urinary symptoms, like issues starting or stopping your flow, a weak stream, or the feeling you didn’t complete empty your bladder after peeing.

An enlarged prostate can be treated with drugs like Flomax, Myrbetriq or anticholinergics that relax the bladder muscles, as well as the UroLift procedure.

Cause of nocturia: an irritated bladder or an infection

Similarly, irritants like spicy food, alcohol, and urinary tract infections can trick your bladder into thinking it’s full, says Dr. Phillips. Bladder problems will also likely show up as frequent urination throughout the day, not just at night.

You may thing that men don’t get bladder infections, but that’s a myth. Although less common, guys can get infections, particularly if they have an enlarged prostate, kidney stones, or their urethra narrows in size due to sexually transmitted infections, or injuries. Other signs of a bladder infection including burning or tingling, fever, and bloody or cloudy urine.

Bottom line on waking up to pee

How often you pee is affected by many factors, like fluid consumption, so there’s no need to automatically panic. According to the Cleveland Clinic, most people urinate about four to eight times a day. Urinating more than eight times a day could be a sign of a larger problem.

If you frequently hit up the bathroom, and there’s a lot of pee coming out each time, then drinking habits, medications, or diabetes may be the culprits, says Dr. Phillips. If there’s just a little, your bladder is more likely experiencing nerve overactivity due to pressure or irritation. And the good news is these problems are all treatable once you identify the cause.

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