Why Does Adult Bedwetting Happen?

Bedwetting (medically known as nocturnal enuresis) is typically associated with young children. But wetting the bed at night can also happen to adults. While it's nothing to be ashamed of, enuresis may be a symptom of bladder control issues, or it may be a sign of an underlying health condition. Seeing a healthcare provider to get to the root cause of bedwetting is essential for getting effective treatment and reducing the chances of accidents overnight. 

This article discusses the potential reasons for adult bedwetting and provides information on treatment options.

Causes

Nocturnal enuresis, or involuntarily urinating during the nighttime, happens when a person's bladder doesn't respond to signals that it needs to empty while sleeping. There are several possible reasons this may occur.

Sleep Apnea

The sleep disorder known as sleep apnea causes a person's breathing to stop briefly while sleeping. These breathing interruptions cause a drop in oxygen levels and can also affect bladder control.

Research shows that adults (and children) with sleep apnea may be likely to experience bedwetting as a result.

Urinary Tract Infection (UTI)

A urinary tract infection (UTI) is a common infection that affects the urinary system, which includes the kidneys, bladder, and urethra (the tube through which urine exits the body).

Notable UTI symptoms include an increased urge to urinate and difficulty controlling urination. This can lead to involuntarily bedwetting at night.

Hormonal Issues

Issues with a certain hormone in the body, antidiuretic hormone (ADH), can also prompt adult bedwetting.

The normal release of ADH at nighttime signals the kidneys to decrease urine production, reducing the urge to pee while sleeping. But an imbalance of ADH can lead to increased urine production and, ultimately, bedwetting.

Overactive Bladder Muscles

Some people have overactive bladder muscles that contract involuntarily, even when there's not much urine in the bladder. This leads to a sudden urge to urinate that can be difficult to control, which may result in nocturnal enuresis.

It's estimated that most adults who experience bedwetting likely have overactive bladder muscles.

Lifestyle Factors

Some daily lifestyle habits have the potential to affect your bladder or your sleep cycle, which could in turn prompt enuresis. Some of these factors may include:

• Alcohol and caffeine consumption, which can increase urinary production and alter the sleep cycle function
• Use of certain medications, such as some sedatives or psychiatric medications, that cause a rapid increase in urine production 
• Low levels of physical activity, linked to sleep disturbances and frequent nighttime urination
• Stress or anxiety, both of which are known to interfere with normal sleep patterns
  

Diagnosis

Adult bedwetting can be a symptom of other underlying health conditions, such as diabetes or a urinary infection. This is why it's important to uncover the root cause of your enuresis and get a proper diagnosis.

During an appointment with a healthcare provider, you can expect them to:

• Review your medical history, including whether you've experienced any lifestyle, diet, or medication changes or whether you've been recently diagnosed with a condition such as diabetes
• Go over all recent symptoms, including nighttime and daytime changes in bladder control
• Perform a physical exam, which may include a test to see if you release urine under simple stress like coughing
• Take a urine sample to test for infection, traces of blood, or other abnormalities
• Conduct tests such as a neurological exam to identify potential sensory or reflex issues, urodynamic testing to look at how the bladder is storing and releasing urine, or a cystogram to determine the volume of urine left in the bladder after using the bathroom
  

To make a diagnosis, a healthcare provider will take into account the results of these various tests plus how often you've been experiencing nighttime bedwetting.

Treatment

After other underlying medical conditions have been ruled out, a healthcare provider can recommend a treatment plan for nocturnal enuresis that works for you. There are several effective treatments available based on your individual needs and preferences.

Lifestyle Changes

A first course of treatment may include making some behavioral, lifestyle, and habit changes, such as:

• Stopping fluid intake late in the evening
• Avoiding certain drinks like caffeine or alcohol that increase the production of urine
• Learning bladder and pelvic floor exercises (like Kegels) to strengthen bladder muscles
• Wearing an adult pull-up diaper, if needed, to avoid an accident
• Practicing meditation techniques or utilizing talk therapy to tackle stress reduction

Medication

While there is no specific medication that will "cure" bedwetting, there are a few options that may help decrease urine production during sleep or allow the bladder to hold more urine. Medications that are often used for this purpose include:

• Nocdurna (desmopressin acetate) to mimic a body chemical that controls urine production
• Chlor-Trimeton (chlorpheniramine maleate) to help relax overactive bladder muscles
• Ditropan (oxybutynin) to help reduce or stop bladder contractions, while increasing the capacity of the bladder

Your healthcare provider will go over all risks and benefits of a medication before prescribing it.

Surgery

If lifestyle tweaks and medication haven't been successful, or if your case is severe enough, a surgical procedure may be considered. Options may include:

• Sacral nerve stimulation, which safely alters nerve activity to calm overactive bladder muscles
• Augmentation cystoplasty, a type of surgery that enlarges the bladder
• Detrusor myectomy, a major surgery that involves removing muscles surrounding the bladder to control contractions

When To See a Provider

Because enuresis can be the result of another underlying medical condition, experts recommend that all adults experiencing nighttime bedwetting see a healthcare provider as soon as possible. They'll be able to review your medical history, discuss symptoms, and perform any tests needed to get an accurate diagnosis, and they can rule out any other serious medical conditions. From there, you'll be on the road to the best treatment option.

Summary

Bedwetting (nocturnal enuresis) is an issue commonly associated with young children. But when it happens as an adult, it could be the sign of an underlying condition, such as sleep apnea, a UTI, or overactive bladder muscles. Depending on the cause, treatment options can include lifestyle modifications, medication, and, in serious cases, surgery.

A Word From Verywell

If you're experiencing bedwetting as an adult, know that you're not alone. Nocturnal enuresis is estimated to occur in up to 2% of adults in the U.S. And that number may actually be even higher, as some experts suspect adult bedwetting isn't accurately reported due to feelings of embarrassment or shame. Fortunately, there are many treatment options available to help improve your quality of life.