It can be alarming to wake up and realize you’ve peed the bed as an adult. Bedwetting, also known as nocturnal enuresis, is more common than you may think. Understanding the causes and available treatments can help you manage this condition.
What is bedwetting?
Bedwetting refers to uncontrolled urination while asleep after the age at which bladder control is normally achieved. For most, this milestone is reached by age 5. However, bedwetting remains a problem for many older children, teens, and adults.
In medical terms, bedwetting is called nocturnal enuresis. It is considered primary nocturnal enuresis when no underlying medical cause can be found. Secondary nocturnal enuresis refers to bedwetting that results from an underlying medical or psychological condition.
What causes bedwetting in adults?
There are several potential causes of adult bedwetting:
Overactive bladder
An overactive bladder causes a sudden urge to urinate that is difficult to control. This urge may lead to uncontrolled urination while asleep.
Urinary tract infections
Bladder infections can cause urgency and frequency of urination, sometimes leading to bedwetting.
Enlarged prostate
In men, an enlarged prostate puts pressure on the bladder, which can weaken bladder control.
Neurological disorders
Conditions like Parkinson’s disease, multiple sclerosis, stroke, and spinal cord injuries can affect the nerves that control the bladder, leading to incontinence.
Diabetes
Uncontrolled diabetes can cause frequent urination and bladder control issues.
Sleep disorders
Conditions like sleep apnea may increase bedwetting frequency.
Medications
Certain medications like sedatives, muscle relaxants, blood pressure medications, and psychiatric medications can increase urination and contribute to bedwetting.
Excessive fluid intake
Drinking too many fluids, especially before bed, can overwhelm the bladder’s capacity and lead to wetting while asleep.
Alcohol and caffeine
Alcohol and caffeine act as diuretics, increasing urine production and frequency of urination. This can lead to bedwetting.
Risk factors
The following factors increase the risk of experiencing bedwetting as an adult:
– Gender – Bedwetting is more common in males than females
– Family history – Having close relatives who experienced bedwetting growing up increases risk
– Being a deep sleeper – Heavy sleepers are more prone to bedwetting
– Urinary tract defects – birth defects affecting the urinary tract can cause lifelong bedwetting
– Small bladder capacity – A bladder that fills quickly and can’t hold much urine increases bedwetting likelihood
– Obesity – excess weight puts pressure on the bladder and can weaken sphincter muscles
When to see a doctor
Occasional bedwetting incidents may not require medical evaluation. However, if you are experiencing frequent or persistent bedwetting, it is advisable to see your doctor. They can check for underlying causes like UTIs, neurological issues, sleep disorders, or prostate problems.
See your doctor right away if bedwetting comes on suddenly or is accompanied by:
– Pain or burning during urination
– Blood in urine
– Weak urine stream or incomplete bladder emptying
– Frequent urination or new onset urge incontinence
– Back pain
– Abdominal pain
Prompt evaluation for new onset bedwetting in adults is recommended, as it may indicate a serious underlying medical issue needing treatment.
Diagnosing causes
To identify factors contributing to bedwetting, the doctor will perform:
– Physical exam – examines abdomen, genitals, rectum, and nerves
– Urinalysis – checks for infections and other abnormalities
– Blood tests – assess for diabetes and hormone imbalances
– Ultrasound – evaluates bladder and urinary tract anatomy
– Neurological exam – tests reflexes and nervous system
– Sleep study – analyzes sleep stages and breathing
– Bladder function tests – measure bladder capacity and urine flow
Treatment options
Treatments for bedwetting depend on the underlying cause but may include:
Medications
– Antibiotics – treat urinary tract infections
– Hormones – boost estrogen levels in postmenopausal women
– Antidiuretic hormone – reduces urine production overnight
– Anticholinergics – calm overactive bladder and reduce urgency
Bladder training
Practicing techniques to control urgency and prolong time between bathroom visits.
Pelvic floor physical therapy
Exercises to strengthen pelvic floor muscles involved in continence.
Biofeedback
Using sensors to monitor pelvic floor muscle activity and bladder fullness, then learning techniques to suppress urge and contract muscles.
Neuromodulation
Devices like a posterior tibial nerve stimulator modulate nerves to improve bladder control.
Lifestyle changes
– Limiting fluid intake in the evenings
– Avoiding bladder irritants like caffeine and alcohol
– Using absorbent bed pads or adult diapers while sleeping
– Establishing a bathroom schedule
– Managing constipation
– Doing regular pelvic floor exercises
In severe cases, surgery may be required, such as enlarging the bladder or implanting an artificial urinary sphincter.
Coping strategies
In addition to pursuing treatment, the following strategies may help cope with bedwetting:
– Limit fluid intake 2-3 hours before bedtime
– Urinate right before going to bed
– Avoid alcohol and caffeine
– Take prescribed medication properly
– Set a nighttime bathroom schedule
– Use absorbent bed pads and mattress covers
– Maintain bladder diary to identify triggers
– Practice stress management and relaxation techniques
– Join a support group to reduce stigma
When bedwetting requires medical attention
| Symptoms | Potential cause | When to see doctor |
|---|---|---|
| New onset bedwetting | Neurological disorder, prostate enlargement, sleep apnea | Right away |
| Bedwetting along with increased thirst and frequent urination | Uncontrolled diabetes | Within a few days |
| Burning during urination, foul-smelling urine | Urinary tract infection | Within 24 hours |
| Back pain, abdominal pain | Kidney stones, bladder obstruction | Urgently |
Conclusion
While embarrassing, bedwetting as an adult is fairly common and usually treatable. Identifying and addressing any underlying medical conditions is key. Lifestyle modifications, medications, pelvic floor training, and absorptive products can help manage symptoms. Don’t hesitate to see a doctor, especially with new onset bedwetting or associated pain. Ongoing treatment coupled with patience and self-care can help overcome adult bedwetting.