What Causes Adult Bedwetting?

Bedwetting in adults (medically known as nocturnal enuresis) may be a sign of an underlying health condition. Bladder control issues at night can be caused by an overactive bladder, urinary tract infection, or sleep apnea.

Adult bedwetting should be evaluated by a healthcare provider. Finding the root cause of overnight accidents is essential for determining effective treatment. 

This article discusses adult bedwetting. It explains the underlying causes of bedwetting in adults and provides information on treatment options.

Causes of Adult Bedwetting

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 involuntary 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 70% to 80% of adults who experience bedwetting likely have overactive bladder muscles.

Small Bladder

Some people have a smaller functional bladder capacity. Sometimes referred to as having a small bladder, the organ itself isn’t small, but rather it is able to hold less. This can result in bedwetting. 

Diabetes

Undiagnosed or poorly controlled diabetes can cause excessive production in urine. When it occurs during sleep, it is known as nocturnal polyuria. This can lead to bedwetting. 

Cancer

Bladder cancer and prostate cancer are potential underlying causes of nocturnal enuresis in adults. 

Neurological Disorders

Several neurological diseases and disorders are associated with bedwetting in adults. Multiple sclerosis, Parkinson’s disease, spinal cord injury, stroke, and other neurological conditions can cause bladder control problems.

Lifestyle Factors

Some daily lifestyle habits have the potential to affect your bladder or your sleep cycle, which could, in turn, prompt enuresis. Lifestyle factors associated with adult bedwetting include:

• Alcohol and caffeine consumption, which can cause increase urinary production and alter the sleep cycle function
• Sedatives or psychiatric medications, which can cause a rapid increase in urine production 
• Lack of physical activity, which is linked to sleep disturbances and frequent nighttime urination
• Stress and anxiety, both of which may interfere with normal sleep patterns
  

How Is Adult Bedwetting Diagnosed?

Adult bedwetting can be a symptom of other underlying health conditions, such as diabetes or a urinary infection. Thus, 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.

Your healthcare provider may also conduct tests, including:

• A neurological exam to identify potential sensory or reflex issues
• Urodynamic testing to look at how the bladder is storing and releasing urine
• 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, in addition to how often you've been experiencing nighttime bedwetting.

How Do You Stop Bedwetting?

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) mimics a body chemical that controls urine production.
• Chlor-Trimeton (chlorpheniramine maleate) helps relax overactive bladder muscles
• Ditropan (oxybutynin) helps 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

Tips for Handling Bedwetting

If you or someone you care for is having a problem with bedwetting, there are a few options to try to make cleaning up easier.

Wearing absorbent underwear or adult diapers is often enough to contain nighttime accidents. Absorbent pads can also be placed on the bed to prevent the bed from getting soaked. Absorbent pads and underwear are available in both disposable and reusable options.

To avoid contaminating mattresses with urine, the Centers for Disease Control and Prevention (CDC) recommends using a fitted, protective mattress cover. If possible, find one that is washable, waterproof, and zips off. That makes it easy to remove, wash, and disinfect when accidents happen at night, leaving your mattress clean and dry.

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. They can hopefully rule out any other serious medical conditions and from there, you'll be on the road to the best treatment option.

Summary

Bedwetting (nocturnal enuresis) in adults may be a sign of an underlying health condition. Nighttime accidents can be due to urinary tract problems, diabetes, sleep apnea, Parkinson's disease, hormones, and certain medications, and should be assessed by a healthcare provider.

To prevent accidents, limit fluid intake in the evening, avoid alcohol and caffeine, and address any health issues. Use a waterproof mattress cover to protect bedding, and wear adult diapers or absorbent underwear to help contain leaks.

If lifestyle changes do not work, other treatments for bedwetting may include medication, pelvic floor physical therapy, and possibly 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 3% 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.