How does Bedwetting in Adults Occur? How to stop it?

Bedwetting Basics

Inability to hold urine is called urinary incontinence or enuresis. Wetting the bed during the night is called nocturnal enuresis. Adults who have never achieved bladder control at night have primary nocturnal enuresis. Adults who recently started wetting the bed after years of staying dry at night have secondary nocturnal enuresis. Bedwetting during adulthood is most often due to underlying health problems or side effects of medications.

Causes & Risk Factors

Obstructive sleep apnea is common during adulthood with loud snoring, fatigue, and daytime sleepiness. Sleep apnea causes increased urine production during the night and can cause nocturnal enuresis. Constipation can cause bedwetting due to pressure on the bladder from enlarged bowel. Excessive urine production during the night from kidney disease or diabetes can also lead to nocturnal enuresis.

Urinary tract infections and overactive bladder are common causes of bedwetting in adults. Symptoms of overactive bladder include urinating more frequently than usual, rushing to the bathroom, and daytime incontinence.  

Excess fluid that accumulates in the legs and ankles during the day may shift to the kidneys during the night when lying flat in bed. This increases urine production during sleep and may cause enuresis. Women may experience incontinence due to weak pelvic floor muscles after childbirth. Men with enlarged prostate glands may develop enuresis along with increased frequency of nighttime urination. Medications may also contribute to bedwetting. Diuretics increase urine output and may cause incontinence if taken in the evening. Sedatives make adults less able to awaken from sleep in response to a full bladder. Alcohol consumption increases urine output and irritates the bladder, increasing the risk of enuresis. 

Talking with the Doctor

Adult bedwetting is usually managed by the primary care physician. A urologist may be consulted if the incontinence is persistent or complex. The doctor will perform a physical exam and carefully review the medical history. A urine sample will be collected to check for bladder infection or kidney disease. 

Blood tests will be ordered to assess blood sugar and electrolyte levels as well as kidney and heart function. An ultrasound may be performed to measure how much urine remains in the bladder after using the bathroom.

Important symptoms to report: 

• Pain or burning with urination
• Unusual thirst and excessive urination
• Significant weight gain or loss
• Dark, cloudy, discolored or foul-smelling urine 
• Loud snoring with daytime sleepiness
• Numbness, tingling and pain in the legs

Helpful information includes:

• Frequency of bedwetting episodes
• Daytime urination patterns
• Daily fluid intake, especially afternoon/evening
• Psychosocial concerns 
• Tobacco and alcohol use

Protecting Self-Esteem

Bedwetting can make adults feel embarrassed and anxious. This can lead to anger, depression and low self-esteem.  Personal relationships may be affected, especially if bedwetting develops with sexual dysfunction. Compassion and understanding from spouses and significant others is extremely important.

Support groups can be helpful as they allow adults to share their experiences and emotions in a safe environment.  Discreet incontinence products can help protect privacy and maintain self-esteem.   Incontinence products should be referred to as briefs or disposable garments rather than adult diapers.

Tips & Treatment Options

Basic interventions that can help prevent bedwetting:

• Eat a healthy diet to prevent constipation
• Avoid caffeine, carbonated drinks, and citrus juices 
• Avoid smoking and alcohol intake
• Increase fluid intake during the day
• Scheduled bathroom use every few hours during the day
• Limit fluid intake after school and before bed
• Use the bathroom twice before going to bed

An alarm may be set once or twice during the night to urinate.  A diary can be used to track wet and dry nights to determine which interventions are helpful. Regularly scheduled bathroom trips timed at increasing intervals will help the bladder become used to holding urine for longer periods of time.

Counseling may be beneficial for adults who are struggling with stress and anxiety.  Medications may be used to treat bedwetting caused by bladder infection, kidney disease or hormone imbalances. 

Disposable incontinence underwear can help adults sleep comfortably through the night. Wearing boxer shorts over the incontinence underwear can help protect privacy and self-esteem. Protective creams may be needed to prevent skin breakdown. A waterproof incontinence mattress is extremely helpful for easy morning clean up and odor prevention.

Related:

Bedwetting in Teenagers

Bedwetting: Tips & Treatment Options

The 5 Types of Incontinence

References

Hartford HealthCare. (2021). Urinary frequency and night-time voiding (Nocturia).  Retrieved from  https://hartfordhospital.org/services/womens-health-services/conditions-treatments/nighttime-urinary-voiding#:~:text=There%20are%20a%20few%20reasons,the%20kidneys%20pass%20more%20urine.

Kantengwa, S. (2016). Dealing with bedwetting in adults.  Retrieved from 

https://www.newtimes.co.rw/section/read/202013#:~:text=Dr%20Ndata%20also%20suggests%20certain,are%20bladder%20irritants%20and%20diuretics.

Mayo Clinic. (2017). Bed-wetting. Retrieved from https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685

Mayo Clinic. (2017). Adult bed-wetting: A concern? Retrieved fromhttps://www.mayoclinic.org/diseases-conditions/urinary-incontinence/expert-answers/adult-bed-wetting/faq-20058456

National Association for Continence. (2018). Could alcohol consumption be contributing to your incontinence or bedwetting problem? Retrieved from 

https://www.nafc.org/bhealth-blog/could-alcohol-consumption-be-contributing-to-your-incontinence-or-bedwetting-problem

National Association for Continence. (2018). Adult bed-wetting (Sleep enuresis). Retrieved from

https://www.nafc.org/adult-bedwetting

National Kidney Foundation. (2021). Secondary nocturnal enuresis. Retrieved from https://www.kidney.org/patients/bw/BWbedwetSecondary 

Watson, S. (2020).  Adult incontinence: What you should know.  Retrieved from https://www.healthline.com/health/overactive-bladder/adult-incontinence

Virtual Medical Centre.  (2012). Impact of bed wetting. Retrieved from https://www.myvmc.com/lifestyles/impact-of-bed-wetting/#:~:text=A%20Hong%20Kong%20study%20looking,didn’t%20wet%20the%20bed. 

WebMD. (2021).  What causes bed-wetting in adults? Retrieved from https://www.webmd.com/urinary-incontinence-oab/bed-wetting-in-adults