4 Causes of Bedwetting in Adulthood and How to Break the Cycle
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As young children, many of us experienced bedwetting, a phase we often considered normal and temporary. However, as we grow older, we expect to leave such habits behind. Yet, for millions of adults, bedwetting, or enuresis, can persist or develop later in life. In fact, more than 5,000,000 Americans struggle with this issue, highlighting that bedwetting in adulthood is more common than most realize.
If you’ve experienced this yourself—whether it has been a lifelong issue or a recent development—you know it can be a frustrating and embarrassing condition. The good news is that waking up to wet sheets doesn’t have to be a permanent part of your life.
What is nocturnal enuresis?
Nocturnal enuresis, commonly referred to as bedwetting, is the involuntary release of urine during sleep. While it is often associated with childhood, bedwetting in adulthood has distinct causes and characteristics.
There are two main types of enuresis:
- Persistent Primary Nocturnal Enuresis: This begins in childhood when an individual has never achieved consistent nighttime bladder control. It affects about 2–3% of adults over 18.
- Adult-Onset Secondary Enuresis: This occurs when bedwetting begins later in life, often due to specific medical or psychological triggers.
It’s important to differentiate enuresis from nocturia, which also occurs due to underlying urinary tract-related conditions. Nocturia is defined as waking up two or more times at night to empty your bladder. Why don’t people with enuresis get up to go to the toilet? Although some research suggests psychological factors, that question remains unanswered.
Why Does Bedwetting in Adulthood Occur?
You may have tried strategies like reducing fluids before bed or waking yourself during the night, yet still find yourself dealing with wet sheets. Here are four common causes of bedwetting in adulthood that could explain your situation:
- Hormonal Changes
As we age, the body’s production of Antidiuretic Hormone (ADH)—which reduces urine production at night—may decline. Insufficient ADH can result in larger volumes of urine that the bladder cannot hold. - Small or Overactive Bladders
Bladder capacity and function play a crucial role. A “small” bladder may not physically hold much urine, while an overactive bladder contracts at inappropriate times, leading to leaks. - Diabetes
Diabetes mellitus and diabetes insipidus can both contribute to bedwetting in adulthood. High blood sugar levels or hormonal imbalances in these conditions can increase nighttime urine production. - Stress and Anxiety
Stress can affect the body in unexpected ways, including triggering enuresis. The physical response to stress during sleep can sometimes result in bedwetting episodes.
Are there any risk factors for nocturnal enuresis?
If you are among the 1 in 100 adults experiencing enuresis, you may relate to the prior adult bedwetting causes or the following common risk factors:
- Enlarged prostate gland
- Neurological disorders
- Genetic predisposition
- Obstructive sleep apnea
- Urinary tract infection
- Excessive alcohol and caffeine consumption
- Kidney problems
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How is adult bed-wetting diagnosed?
If you have experienced occasional or one-time bedwetting, you probably don’t have anything to worry about. But if those small accidents turn into nightly occurrences that are impacting your quality of life, it might be time to talk with your doctor. At your appointment, your doctor will begin with a physical exam and ask general questions about your health. For this reason, try to make a note of the following:
- Frequency and time of bedwetting
- Amount of urine leaked each night (a lot or a little)
- Consumption of liquids before sleep
- Any other symptoms during the day
To better diagnose the problem, your doctor may also run a few tests such as:
- Perform a physical exam
- Urinalysis: It uses a small sample of urine to check for any conditions involving the urinary tract – kidneys, ureters, bladder, and urethra.
- Urine culture: To diagnose a urinary tract infection, urine is tested to find germs (bacteria) that can cause an infection.
- Uroflowmetry: This involves urinating into a specialized funnel that measures the production of urine and the rate of flow over time.
Short-term Management
In the short-term, if you are looking for ways to manage bedwetting, there are a few things that you can do to make your life easier in the mornings.
- By wearing absorbent pads or protective underwear, you can keep your skin from getting irritated. Try to find ones that are comfortable and fitting for the best results.
- Consider placing a waterproof mattress pad or cover over the bed to help them remain dry throughout the night.
- Employ bedwetting alarms to wake you if wetness is detected.
- Adjust your sleep routine by setting alarms to empty your bladder during the night.
Preventing Bedwetting in Adulthood?
It is unclear why with adult bedwetting, or enuresis, sufferers are not waking up, however with treatment options that range from small changes to large-scale operations, there is hope to have dry and relaxed mornings. Here are a few lifestyle and behavioral strategies that can reduce adult bedwetting.
Symptom Management
- Bladder volume control helps to increase functional bladder capacity. Training takes the form of gradually building the time between voiding the bladder and consuming more liquids. This looks like only voiding when full (even beyond what you think is full), letting the bladder expand and stretch.
- Bedwetting alarms can be found in underwear or mattresses and offer fast intervention. With a simple sound or vibration, you are notified of any wetness and can stop the flow of urine and finish in the restroom.
- Waking up to clear your bladder might be helpful to reduce the amount of urine that leaks on the bed by setting an alarm to use the bathroom. Make sure to not set the same time each night so that your body does not become routine to empty at that time no matter where you are.
- Stay away from alcohol before bed which relaxes muscles, including the pelvic floor muscles
- Dietary changes like cutting down on bladder irritants may also be helpful to reduce frequent urination. While it may be hard to give up caffeine, sugar, and alcohol, the benefit of removing these foods might outweigh their absence.
Strengthening the Pelvic Floors
- Pelvic floor exercise can help strengthen the urinary sphincter (bladder outlet valve) and pelvic floor muscles, which work to control urination. Kegel exercises are often the first line of treatment because they build the muscles, allowing better control over urinary leakage. There are a few ways to help train these muscles.
- Biofeedback helps master Kegel exercises through a vaginally inserted probe which allows you to learn if you are using the correct muscles.
- Electric stimulation (e-stim) contracts the pelvic floor muscles, essentially doing Kegels for you. Elitone is an FDA-cleared pelvic floor exerciser that delivers external therapeutic stimulation, allowing for comfortable movement during treatment. Elitone sends signals for both muscle exercise and the calming of overactive bladders.
Chemical Management
- Medications can help treat nocturnal enuresis. Research shows that desmopressin boosts the level of ADH so that your kidneys will reduce production of urine at night. Compression socks can also help keep urine production during the day by restricting storage of fluids in the legs. Other drugs can attack the risk factors of bedwetting, like antibiotics for urinary tract infections, anticholinergic drugs that calm overactive bladders, and 5-alpha reductase inhibitors which shrink an enlarged prostate. Please note many of these drugs have fairly intolerable side effects.
If medications and treatment are not effectively helping your adult bedwetting causes, your doctor might recommend surgery as a last resort. These are a few options:
- Nerve stimulation delivers signals to the muscles in your bladder to stop unnecessary contractions. This is done through an implant near the upper buttocks, that transmits signals with a thin wire near the sacral nerve, similar to a pacemaker.
- Sacral nerve stimulation is an implant implanted in the lower back to continuously send signals
- Elitone URGE is the only external stimulation that is FDA cleared
- Clam cystoplasty (bladder augmentation) is a much more invasive procedure that involves surgically increasing bladder capacity. During the operation, your doctors will insert a patch of intestinal muscle into the bladder wall. This extra muscle helps reduce bladder instability and maximize control.
- Detrusor myectomy is a similar major operation that removes the detrusor muscles that control the contractions in your bladder. This procedure is intended for overactive bladder and urge incontinence by targeting the strength and frequency of contractions.
Take the First Step Toward Dry Nights
Bedwetting in adulthood can feel isolating, but it is a manageable condition with the right guidance and treatment. By consulting your doctor and exploring available solutions, you can regain confidence and comfort. Millions of adults face this challenge—but with support, waking up to dry sheets is possible.
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