Have you ever awakened at 1 a.m., needing to use the bathroom, only to have it happen again two hours later? Perhaps you figured your exhaustion the next day was just age catching up with you. However, those nighttime trips are actually your heart sending an SOS—one that could appear years before you feel any chest pain.

The Nocturia and Heart Disease Link

A 2023 study tracked a sample of adults for about 27 years and found that urinating two or more times nightly increased the risk of death from any cause, and increased the risk specifically for heart disease by at least 50 percent.

Nocturia has been identified as a marker of increased coronary heart disease risk in men under 60.

Most remarkably, around 75 percent of coronary heart disease patients developed nocturia approximately five years before any heart-related symptoms, such as chest pain or shortness of breath, appeared. The earlier nocturia began, the earlier heart symptoms tended to show up.

How does nighttime urination link with heart and overall health?

The Heart-Bladder Connection

Several key mechanisms link nighttime urination to cardiovascular health.

One way is through its effect on sleep. Waking frequently disrupts deep sleep and the body’s natural circadian rhythm.

Sleep fragmentation can trigger inflammation through neuro-immune pathways, contributing to the buildup of plaque and raising the risk of cardiovascular disease.

On the other hand, people with cardiovascular disease often have atherosclerosis (a buildup of plaque in the arteries), which can affect multiple parts of the body. When plaque builds up in the pelvic blood vessels, blood flow to the bladder may be reduced.

Atherosclerotic disease can reduce blood flow to the bladder, leading to oxidative stress and decreased bladder capacity, which can contribute to an overactive bladder, Dr. Lori Lerner, a urologist, told The Epoch Times.

For people with congestive heart failure, fluid that pools in the legs during the day moves back into circulation when lying down at night, increasing urine production, Lerner said.

For people with heart disease, sleep apnea can cause both oxidative stress and nighttime urine production.

Another possible link is diabetes.

“The connection between nocturia and cardiovascular health makes sense, as increased urine volume (diuresis) is a hallmark of diabetes, and diabetes is a risk factor for cardiovascular and kidney disease,” Natalya Zinkevich, assistant professor of biology at the University of Illinois, told The Epoch Times.

People with diabetes often struggle to regulate blood pressure through fluid balance. Increased thirst and the high osmolarity of urine (from glucose loss) further contribute to frequent nighttime urination, Lerner said.

What You Can Do

If nocturia is related to heart disease, managing the underlying cardiac condition would be the first step. Additionally, implementing specific lifestyle adjustments to prevent fluid retention could be helpful.

Cutting back on fluids in the evening, two to four hours before going to bed, and following basic sleep habits is a good place to start.

According to Lerner, the most effective lifestyle changes are exercise, cutting back on sugar, and limiting alcohol before bed.

Avoiding coffee and other stimulants in the afternoon or evening can also help, Stacey Roberts, a registered nurse and pelvic health physiotherapist, told The Epoch Times.

Pelvic floor physical therapy can also be useful, she said.

“This may include downregulation exercises of the pelvic floor by initiating diaphragmatic breathing and happy baby pose if the pelvic floor is upregulated. If they are weak, Kegels may be necessary,” she said.

Pelvic floor therapy could also include hip-stabilizing, core, and flexibility exercises, she added. “Each program should not be cookie-cutter, but instead be reflective of how the patient is presenting,” Roberts said.

She explained that people with nocturia often have either weak pelvic floor muscles or muscles that are overly tight. Overly tight muscles stay partly contracted and can feel stiff or uncomfortable, which can also affect blood flow.

Once either the weakness or the tightness is treated, the pelvic floor, urethra, and even the bladder can start working more normally, she said.

Low-intensity shockwave therapy—a type of pelvic floor therapy—helps repair tissue and improve blood flow. “I’ve seen men with nocturia improve within just a few sessions, especially when we combine it with pelvic floor therapy,” Roberts said.

Because nocturia is a symptom rather than a disease, identifying the root cause, which may also be medications or other medical conditions, is essential. Finding the cause may require a thorough medical evaluation, including cardiovascular assessment, sleep studies, or urologic examination.

“Patients don’t have to suffer from this, even though it is common,” Lerner said.