11. Frequent Urination at Night (Nocturia)
Frequent urination at night, known as nocturia, is a common but often overlooked symptom of heart failure. During the day, fluid tends to collect in the legs and ankles due to gravity. When a person lies down at night, this fluid shifts back into the bloodstream, increasing blood flow to the kidneys. The kidneys then produce more urine, leading to multiple trips to the bathroom at night.
At first, patients may dismiss nocturia as a “normal part of aging” or blame it on drinking too much water in the evening. But in heart failure, it is a sign of fluid overload and poor circulation. This constant disruption also worsens fatigue and poor sleep, which already trouble heart failure patients.
Take the example of Mr. Joseph, a 66-year-old retired bank manager. He began waking up three to four times a night to urinate. He thought it was prostate-related, but tests showed his prostate was normal. Further evaluation revealed heart failure with fluid buildup. After adjusting his medications and reducing evening salt and fluid intake, his nighttime urination decreased, and his sleep improved.
For families, it is important to notice if a loved one is waking up frequently to use the toilet at night, especially if other symptoms like swelling and breathlessness are present. Doctors often use this as a clue to monitor how well treatment is working.