Bedwetting in Adults: Causes, Treatments and Tips on How To Stop

Key takeaways:

• Adult bedwetting, also known as nocturnal enuresis, affects about 2.3% of adults.
• It can be a result of genetics, underlying medical conditions, lifestyle factors, or certain medications. 
• Treatment options for adult bedwetting include medications, surgical procedures, and lifestyle modifications.
• Bedwetting can also be managed with the use of bedwetting alarms, alarm clocks, and absorbent bed sheets.

Bedwetting, also known as nocturnal enuresis, is the act of urinating involuntarily at night. There are two types of bedwetting, which are: primary nocturnal enuresis and secondary nocturnal enuresis. 

Primary nocturnal enuresis occurs in children or adults who have never had a dry night for six consecutive months. Secondary nocturnal enuresis is seen in children or adults who have had a complete 6-month duration of dry nights before wetting the bed again.

While bedwetting is quite common in children, it can also be found in adults, but in rare cases. In a study carried out, the overall prevalence of primary nocturnal enuresis in adults was placed at 2.3%. It also occurs more in males than in females.

Causes of adult bedwetting

Adult bedwetting does not sprout out of thin air. Bedwetting in adults can be caused by several factors, including the following:

1. Genetics

Studies have shown that bedwetting seen in adults can be hereditary. Having one parent that used to bedwet places one at a risk of bedwetting, even as an adult, by a percentage of 40%. Having two bedwetting parents increases the chances by 77%.

2. Hormonal imbalance

Bedwetting in adults may also be associated with inadequate antidiuretic production or response. 

Antidiuretic hormone (ADH) is a hormone that regulates blood pressure and the amount of urine production. If the body makes the right amount of ADH and the kidney responds to this hormone appropriately, then little urine is produced. So, in the presence of any inadequacy in the function of this hormone, bedwetting in an adult may occur. 

3. Constipation

During constipation, especially chronic constipation, the rectum becomes filled with feces, causing it to expand. This expansion puts pressure on the bladder, which could lead to bedwetting.

4. Overactive bladder (OAB)

Overactive bladder is a chronic condition that causes the bladder to contract involuntarily (tightening of the bladder), causing urine to be pushed out. It is common in adults and may affect the quality of life of people suffering from it.

Overactive bladder is characterized by an urgency to urinate frequently and can also cause adults to bedwet. 70-80% of adults who experience bedwetting have been found to have overactive bladders.

5. Weak pelvic muscles

Weak pelvic floor muscles may contribute to urinary incontinence, which includes bedwetting and is more common in older women.

Normally, the pelvic floor muscles relax while making a bowel movement or while peeing, and tighten right after you are done, which is not the case when the pelvic muscles are weak.

Weak pelvic floor muscles can lead to bladder control issues, including bedwetting.

6. Sleep apnea

Sleep apnea is a sleeping disorder where breathing repeatedly stops at intervals and starts again throughout the night. Sleep apnea can increase bladder pressure, leading to frequent urination at night.

Severe obstructive sleep apnea, the most common type of sleep apnea, can lead to secondary enuresis (bedwetting) in adults.

7. Diabetes

Both type 1 and type 2 diabetes can cause polydipsia (excessive thirst) and polyuria (frequent urination), including nighttime urination. The body cannot manage its fluid levels, leading to bedwetting in adults. 

8. Medications

Certain medications come with side effects, and bedwetting can manifest as one of these side effects. Sleeping pills may contribute to bedwetting as they reduce the awareness of a full bladder during sleep.

Also, drugs used to treat mental disorders, such as thioridazine, clozapine, and risperidone, can cause bedwetting in adults. 

Treatment for adult bedwetting

Adult bedwetting can be treated depending on the underlying cause. A doctor can help determine the best course of treatment. The following are some treatment options doctors may recommend for adult bedwetting:

Medications

Some drugs or medication can help manage adult bedwetting, such as:

• Desmopressin: This drug mimics the action of antidiuretic hormone (ADH). ADH, also known as vasopressin, helps the body retain water and reduces urine output. By treating adult bed-wetting with desmopressin, nighttime urine production can be controlled.
• Imipramine: This medication can be used to treat adult bedwetting as it relaxes the bladder muscles, increasing the bladder’s ability to hold urine. However, this medication is to be taken with caution, as it can easily be overdosed on. Consult a doctor before you begin to take it. 
• Anticholinergic drugs: Anticholinergics like tolterodine, oxybutynin, darifenacin, trospium chloride, and solifenacin can be used to treat bedwetting in adults. They relax the bladder muscle to reduce urinary urgency.

Surgical options

Treatment of adult bedwetting with surgery may be recommended if other less invasive treatments do not work. This type of bedwetting is often due to structural abnormalities or severe neurological disorders. Some surgical options include the following:

• Clam cystoplasty: Clam cystoplasty is a surgical procedure that enlarges the bladder. It involves cutting the bladder open and then expanding it using a patch of the intestine. This procedure increases the bladder's capacity.
• Sacral nerve stimulation: The sacral nerves help control frequent bladder movement. In some people, these nerves don’t function properly, which may cause them to bedwet. This surgical procedure uses mild electrical signals to stimulate the sacral nerves. This process tightens the external sphincter (a muscle that controls urine flow) while relaxing the bladder muscle. This results in reduced bladder movement, controlling adult bedwetting. 
• Detrusor myectomy: During a detrusor myectomy, some or all portions of the exterior muscle surrounding the bladder are removed to reduce bladder overactivity.

Lifestyle Modification

Bedwetting in adults can be managed through several lifestyle modifications. Here are some lifestyle and home remedy tips that may help you stop bedwetting.

Regulation of fluid intake

Excessive consumption of fluids can contribute to bedwetting in adults. It can be regulated through the following ways: 

• Drink more fluids during the day and limit fluid intake to 2-4 hours before bedtime.
• Avoid or limit the intake of caffeinated, alcoholic, and carbonated drinks, as they can irritate the bladder. Avoiding them may help reduce bedwetting.

Establishing a bladder routine

This can be achieved by:

• Training the bladder by urinating at set times during the day.
• Emptying the bladder before going to bed. This can be achieved by double voiding (urinating, waiting a few minutes, and urinating again).

Diet and weight management

• Avoiding spicy and acidic foods can help reduce bedwetting, as they can irritate the bladder. 
• Consume fiber-rich foods, such as fruits, vegetables, and whole grains, as they help with constipation, which could contribute to bedwetting. Also, foods rich in vitamin D, such as oily fish (mackerels, salmon, sardines), red meat, liver, and egg yolk, could help with bedwetting in adults.
• Being overweight can weaken the bladder and put pressure on it. Thus, maintaining a healthy weight can help reduce bedwetting.

Improving sleep quality

• Sticking to a particular sleep routine can help reduce bedwetting in adults. 
• Some sleeping positions, like sleeping on the stomach or bac,k can put pressure on the bladder and may cause the body to respond slowly to bladder signals. The best sleeping position that may help prevent bedwetting is sleeping on the side with slight knee elevation.

Management techniques for adult bedwetting

Even with treatment and lifestyle modifications, managing bedwetting can still be challenging. However, you can use certain strategies and tools to make it easier and further improve life quality and comfort.

Use of absorbent sleeping sheets

Using a waterproof mattress and absorbent bed pads protects the bedding and makes cleanup easier. Some adults may also use absorbent undergarments for added protection.

Use of bedwetting alarm system

A bedwetting alarm sounds when it detects moisture, prompting you to wake up and use the toilet. It has been proven to be effective for adults with primary enuresis (who have been bedwetting since childhood), as it trains the brain to respond to the sensation of a full bladder over time. 

Setting alarms

The use of an alarm clock to wake up at scheduled intervals to urinate can also be used to manage bedwetting. 

Pelvic floor exercises

One of the main causes of bedwetting in adults is weak pelvic floor muscles. These muscles control bladder movement, so when they are weak, a person will most likely experience loss of bladder control, causing urine to leak while sleeping.

Practicing pelvic floor exercises, also known as Kegel exercises, can help strengthen your pelvic floor muscles and manage bedwetting better. 

Seeking medical help

While it can be embarrassing for some people with this condition to seek medical help, it is important that they do. Understand that healthcare professionals are not there to judge you or make fun of you, but rather to help you live a healthier and more comfortable life.

Consider seeking medical help if:

• Bedwetting starts suddenly in adulthood.
• Bedwetting occurs frequently and affects the quality of life. 
• It is accompanied by additional symptoms like excessive thirst and/or the presence of blood in the urine. 

Healthcare specialists for bedwetting

There are some healthcare specialists that can be consulted to get relief from bedwetting. They include:

• Urologists: These healthcare experts specialize in urinary tract disorders and bladder dysfunction that may contribute to bedwetting.
• Nephrologists: They specialize in kidney-related conditions that may also contribute to bedwetting.
• Neurologists: Neurologists address neurological conditions that affect bladder control. They may be part of your bedwetting treatment team.
• Somnologists: Somnologists are sleep specialists who diagnose and treat sleep disorders that may contribute to bedwetting.