Bed-wetting is often associated with childhood. Indeed, up to one-quarter of children experience problems with nocturnal enuresis, or urinating while asleep. Most children grow out of the condition when their bladders become larger and better developed.
Research suggests bed-wetting occurs in 1 to 2 percent of adults. However, the number may be higher. Some adults are likely embarrassed or unwilling to talk with their doctor about the problem.
If you experience occasional or one-time bed-wetting as an adult, you likely have nothing to worry about. Accidents can happen. Persistent and frequent enuresis, however, is cause for concern and merits a talk with your doctor. Let’s take a look at what might be causing the condition and how these issues are treated.
Antidiuretic hormone (ADH) signals your kidneys to slow down the production of urine. Your body produces more of the hormone at night to prepare you for sleep. This helps limit your need to urinate while you’re asleep. However, some people don’t produce enough ADH or their bodies don’t respond to it well. ADH abnormalities seem to have a role in nighttime bed-wetting, although there are several theories that suggest a variety of factors combine to cause the problem.
A combination of problems with ADH, difficulties in waking and sleeping, along with daytime bladder issues, often lead to this condition.
A simple test can measure the level of ADH in your blood. If the level is low, your doctor may prescribe a medication such as desmopressin (a laboratory-made ADH). Your doctor may also look for underlying conditions that could be impacting ADH levels.
A small bladder isn’t actually smaller in size than other bladders. Instead, it feels fuller at lower volumes, meaning it functions as if it’s smaller. That means you may need to urinate more frequently, including at night. A small bladder may be tricky to manage during your sleep, and bed-wetting may occur.
Bladder training is helpful for people with a functionally small bladder. This strategy helps your body anticipate regular voiding by holding urine for longer stretches of time. You may also want to set an alarm for overnight and wake up to urinate.
Detrusor muscles are the muscles of your bladder. They relax when your bladder fills and contract when it’s time to empty. If these muscles contract at the wrong time, you may not be able to control urination. This condition can be called overactive bladder (OAB).
Your bladder muscle contractions may be caused by abnormal nerve signals between your brain and your bladder or an irritant to the bladder, such as alcohol, caffeine, or medications. These products can make the muscles less stable. That may make you need to urinate more frequently.
Diagnosing cancer may require a physical exam, as well as some imaging tests. A biopsy is usually necessary to identify cancer. Treating the cancer can help shrink or eliminate the tumor. That may help prevent future episodes of bed-wetting.
Diabetes with uncontrolled blood sugars can change urination. When blood sugars are high, the amount of urine increases as the kidneys try to manage sugar levels. This can lead to bed-wetting, excessive urination (more than 3 liters per day), and frequent urination.
Treating diabetes often eases the variety of urinary symptoms. Treatment of diabetes typically requires a combination of lifestyle changes, oral medications, or insulin injections. Your treatment plan depends on the type you have and your overall health.
Obstructive sleep apnea is a sleep disorder that causes you to stop and start breathing repeatedly. One study found that 7 percent of people with this sleep disorder experience bed-wetting. Urinating during your sleep may become more frequent as the sleep apnea worsens.
Treating sleep apnea with continuous airway pressure therapy will help you breathe and sleep better. It can also reduce secondary symptoms, such as bed-wetting.
Some prescription medications can make you urinate more frequently and increase bladder contractions. This may lead to bed-wetting. These medications include sleep aids, antipsychotics, and others.
Switching medications may stop nighttime urination. If the medication is necessary to treat another condition, lifestyle changes may help you prevent bed-wetting. Never stop a medication without talking with your doctor.
Bed-wetting is commonly shared from generation to generation. It’s unclear which genes are responsible for passing down this condition. But if you have a parent who experienced nocturnal enuresis, you’re more likely to experience it as well.
Before a doctor will diagnosis unspecified nocturnal enuresis, they’ll conduct several exams and tests to rule out other possible causes. Treatment for unexplained bed-wetting relies on treating symptoms and preventing future episodes. This can include lifestyle changes and medications.
The following neurological disorders may impair bladder control:
- multiple sclerosis
- seizure disorders
- Parkinson’s disease
This can lead to frequent or uncontrolled urination while you sleep.
Treating the disorder can help ease symptoms, as well as secondary complications like bed-wetting. If the bed-wetting doesn’t stop, your doctor may prescribe specific treatment. This can include lifestyle changes, medications, and more.
A blockage or obstruction in your urinary tract
Blockages can impair the flow of urine, such as:
This may make voiding difficult. At night, this can cause unexpected urine leakage and bed-wetting.
Likewise, pressure from a stone or tumor may make muscles in the bladder contract unnecessarily. This can lead to frequent and uncontrolled urination.
Sometimes a procedure is needed to remove larger stones or break them down. Smaller stones typically will pass on their own.
Cancer treatment can shrink some tumors, but others may need to be removed with surgery. Once the blockages are removed, you should have greater urinary control and less bed-wetting.
Urinary tract infection
A urinary tract infection (UTI) can cause frequent and unexpected urination. A UTI often causes inflammation and irritation of the bladder which can further worsen incontinence and bed-wetting at night.
Treating the UTI should stop the enuresis. If you have recurring UTIs, you may experience bed-wetting more frequently. Work with your doctor to find an underlying cause for the recurrent UTIs so you can prevent future infections and bed-wetting.
Urine flows from your kidneys through your ureter to your bladder. When it’s time to urinate, your bladder will contract and send urine through your urethra and out of your body. If any element of that system is narrowed, twisted, kinked, or misshapen, you may experience symptoms or difficulties with urination. This includes bed-wetting.
Your doctor can use imaging tests, such as an X-ray or ultrasound, to look for abnormal structures. Some may be fixed with surgery. In other cases, your doctor may suggest lifestyle treatments and medication to help you stop urinating in your sleep.
Treatment for adult bed-wetting can be divided into three main categories:
- Monitor fluid intake. Try to slow your fluid intake in the afternoon and evening. Drink more in the early morning when you can use the bathroom easily. Set limits for evening consumption.
- Wake yourself at night. Setting an alarm for the middle of the night can help you prevent bed-wetting. Getting up once or twice a night to urinate means you won’t have as much urine if an accident occurs.
- Make regular urinating a part of your routine. During the day, set a schedule for when you’ll urinate and stick to it. Make sure to urinate before bed, too.
- Cut down on bladder irritants. Caffeine, alcohol, artificial sweeteners, and sugary drinks may irritate your bladder and lead to more frequent urination.
Four primary types of medications are prescribed to treat adult bed-wetting, depending on the cause:
- antibiotics to treat urinary tract infections
- anticholinergic drugs can calm irritated or overactive bladder muscles
- desmopressin acetate to boost levels of ADH so your kidneys will stop producing as much urine at night
- 5-alpha reductase inhibitors, such as finasteride (Proscar), shrink an enlarged prostate
- Sacral nerve stimulation. During this procedure, your doctor will implant a small device that sends signals to the muscles in your bladder to stop unnecessary contractions.
- Clam cystoplasty (bladder augmentation). Your doctor will cut open your bladder and insert a patch of intestinal muscle. This extra muscle helps reduce bladder instability and increase control and capacity so you can prevent bed-wetting.
- Detrusor myectomy. The detrusor muscles control the contractions in your bladder. This procedure removes some of these muscles which helps decrease contractions.
- Pelvic organ prolapse repair. This may be needed if you have female reproductive organs that’re out of position and pressing down on the bladder.
If you’re an adult experiencing frequent bed-wetting, this may be a sign of an underlying issue or problem. It’s important to seek out treatment to stop the nocturnal enuresis and treat the issue that’s causing it.
Make an appointment with a doctor to discuss what’s happening. They’ll review your symptoms, health history, family history, medications and previous surgeries. The doctor may order a series of tests to look for an underlying cause. Finding a treatment will provide relief by limiting or stopping bed-wetting and any other symptoms you’re experiencing.