Adult Bed-Wetting Causes (Sleep Enuresis) | Adult & Pediatric Urology

Adult Bed-Wetting Causes (Sleep Enuresis)

For many adults, it is hard to even talk about something that they often think of as a “kid thing," but the truth is that 5,000,000 Americans struggle with adult bedwetting, also known as sleep enuresis.

It's worth noting that bedwetting in adults is actually different than what children go through. And while that might not remove the embarrassment, you must know that nocturnal enuresis is involuntary and not your fault.

However, when adults wet the bed it is often an indication of an underlying illness, disease, or a symptom of other untreated medical conditions.

What is nocturnal enuresis?

Enuresis can be divided into two forms — persistent primary nocturnal enuresis and adult-onset secondary enuresis. Persistent primary nocturnal enuresis begins during childhood, where nighttime dryness has not been achieved for more than six months. According to the National Association for Continence, about two to three percent of male and female adults older than 18 years have this type of nocturnal enuresis.

Adult-onset secondary enuresis is defined as the individual has had a period of being dry and then starting to wet at some point in their lives. This bedwetting condition generally affects individuals closer to 60 years old.

Here are a few Adult Bed-wetting Causes (Sleep Enuresis)

  • Urinary tract infection (UTI).
  • Smaller than average bladder size.
  • Prostate gland enlargement.
  • Stress or anxiety.
  • Overactive or unstable bladder.
  • Side effects of medication.
  • Sleep apnea.

Determining Adult Bed-Wetting Causes

Discovering the cause of bed-wetting can be tricky as it is often an underlying cause of another medical condition. When seeking treatment for your nocturnal enuresis you can expect one or more of the following routine tests

  • A physical examination
  • A neurological examination
  • Urine tests
  • Urologic examination
  • Ultrasound of kidneys and bladder

To help your doctor better determine the causes of your troubles, it's recommended that you keep track of important bed-wetting information such as:

  • When your accidents are most likely to occur (time of day or night)
  • Amount of urine voided
  • Daily intake patterns of fluids
  • Types of fluids ingested and whether they contain caffeine or alcohol.
  • The number of dry nights vs the number of wet nights
  • Recurrent urinary tract infections
  • How your urine stream looks when going to the bathroom (strong and steady or weak and dribbling)

Adult Bed-Wetting Treatment Options

While there is a slew of reasons you may be wetting the bed, there are a handful of management techniques that can make all the difference when the goal is waking up dry. One of the biggest mistakes adults make is not using the correct products for protection - look for products specifically designed for overnight use, as these are more absorbent and can hold greater amounts of urine. Fit is also a big factor, so pay attention to the guides provided and don't get anything too big or too small, as it can result in leaking during the night.

Behavioral Treatments 

  • Monitoring Fluid Intake. Limiting intake of fluids in the late afternoon and evening before bedtime causes a decreased amount of urine produced at night.
  • Bedwetting Alarm System. Multiple variations of the alarm exist, ranging from vibrating to sounding alarms and wet-detection devices that can be attached to the underwear or a pad on which the individual sleeps.
  • Waking. This involves randomly setting an alarm to go off in the night in order to wake one for urination. The randomness keeps from training the bladder to need to empty at a set time.

Surgical Treatments

The involvement of surgery when attempting to treat severe detrusor overactivity is limited and should only be considered when all other less invasive treatment options have proven to be unsuccessful. All of the procedures mentioned below have associated risks that must be considered and discussed with a healthcare professional.

  • Sacral Nerve Stimulation. Sacral nerve roots are stimulated by neuromodulation, a process where neurotransmitters control various neuron groups. This increases the external sphincter tone causing the detrusor muscle neurons to stop the activity. When detrusor muscle neurons have a decreased activity level the muscle will not contract constantly, which ultimately causes less frequent urination episodes. SNS is recommended for people with moderate to severe urge incontinence and for whom other treatments have not been helpful or for whom prescriptions are contraindicated.
  • Clam Cystoplasty. This is a surgical treatment where the bladder is cut open and a patch of the intestine is placed in between the two halves. The goal of this procedure is to reduce bladder instability and increase bladder capacity.
  • Detrusor Myectomy. This process is also known as an auto augmentation that involves removing a portion or all of the exterior muscles surrounding the bladder. It intends to strengthen bladder contractions while reducing the number of them.

Medications

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

Potential Skin Conditions

Unfortunately, bed-wetting can also cause other problems, like adverse skin conditions. These issues can be very uncomfortable, and if left treated, could continue to get worse.

The key to prevention is ensuring that the incontinence product being used is the right size and absorbency level. If it doesn’t fit well or can’t handle the leakage level, skin irritations can occur.

Another way to prevent incontinence-related skin conditions is to address the area quickly by keeping it clean and dry as much as possible.

The outlook

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.

What you can expect at a doctor’s appointment

Your doctor may ask some of the following questions to better understand your circumstances:

  • How much urine is voided?
  • What are your drinking patterns?
  • When do accidents occur?
  • How often do accidents occur?
  • Do you have a history of urinary tract infections?
  • What types of liquids do you drink?

At your doctor’s appointment, you can expect:

  • A physical examination.
  • Neurological evaluation.
  • Urine tests to determine the contents of the urine.
  • Ultrasound of kidneys and bladder.

As embarrassing as it may seem to you, bedwetting for adults can often be an indication of an underlying illness, disease or symptom of another untreated medical condition. If you have any questions or concerns, consult with a healthcare professional immediately.

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