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Causes of Bedwetting in Adults: Diagnosis and Treatment Options

Causes of Bedwetting

Bedwetting in adults differs from bedwetting in children in a couple of important ways.

First, childhood bedwetting is fairly common, whereas in adults, bedwetting is uncommon: at most, two percent of all adults experience it, according to data from the National Association for Continence.

Second, childhood bedwetting is considered an indicator of developmental problems with the bladder itself, whereas bedwetting in adults suggests an underlying medical condition that requires medical evaluation and, potentially, treatment.

What it is, what it’s not

Bedwetting (also known as sleep enuresis or nocturnal enuresis), and especially cases that begin only in adulthood (known as secondary enuresis), describe the loss of bladder control during the night, mostly while the patient is asleep.

It can be considered a source of embarrassment for adults, who may have suffered from early problems with wetting the bed as a child. This could be one reason why it’s so hard for patients to talk about it at the doctor’s office.

Adult patients need to be encouraged to be open about this condition and to be aware that their issues with urinary incontinence at night are not typically voluntary or the result of personal weakness on their part.

Causes of Bedwetting in Adults

The list of potential causes runs quite long and points to a diversity of medical problems it could be related to:

  • Adverse side effects of medications (hypnotics, insomnia medications, psychiatric medications)
  • Antidiuretic hormone (ADH) imbalance
  • Bladder cancer
  • Constipation
  • Detrusor muscle instability
  • Diabetes
  • Enlarged prostate gland (men)
  • Genetics
  • Kidney disease
  • Neurological disorders
  • Obstructive sleep apnea (OSA)
  • Pelvic organ prolapse (women)
  • Prostate cancer (men)
  • “Small” bladder (low functional bladder capacity)
  • Stress, anxiety, and other psychological concerns
  • Urinary tract infection
  • Urinary tract stones

Risk Factors

Aside from being an inherited problem, gender also plays a role in nocturnal enuresis. Men more commonly suffer from it than women. Age may or may not play a role, however. Young people may just as easily develop secondary enuresis as the result of any number of the causes listed above as any of their older peers.

The sleep apnea connection

Soaked sheets point to one obvious connection between bedwetting in adults and sleep. However, it’s important to remember that bedwetting and obstructive sleep apnea (OSA) can sometimes go hand in hand. A small percentage of adults may suffer from secondary enuresis as their untreated symptoms of OSA worsen.

Patients with undiagnosed OSA who also experience bedwetting may complain of nocturnal bruxism, tossing and turning, and excessive daytime sleepiness. They may have physical characteristics that point to risk factors for OSA, like thick necks, receding jawlines, obesity, oversized tissues in the upper airway (such as the tongue or tonsils), and/or hypertension. A sleep study can quickly rule in (or rule out) OSA as the root cause of their enuresis.

Once the OSA is identified and treated, usually with continuous positive airway pressure (CPAP), the bedwetting tends to resolve as well. It’s worthwhile to note that children who are diagnosed with OSA also see accompanying symptoms of enuresis disappear once they are treated.

Testing and treatments

Several tests can be conducted to try to establish the root cause of bedwetting in adults:

  • Neurological assessment
  • Physical examination with medical and family history
  • Polysomnogram to rule out OSA
  • Post-void residual urine measurement
  • Urinalysis and urine culture
  • Uroflowometry
  • Ultrasound of kidneys and the bladder

The patient planning to visit a specialist about their bedwetting problem might be advised to bring along a diary that captures a night-to-night record of accidents (or dry nights) to benefit their discussion with the physician. The data recorded should include the amount of urine voided, daily fluid intake amounts and patterns, lists of alcoholic or caffeinated beverages consumed, and observations about the urine stream. Notes about recurrent UTIs, family history of bedwetting, or family history of sleep apnea or snoring could also be useful.

Medical treatments for sleep enuresis include:

  • Anticholinergic drugs for bladder irritation
  • Antibiotics to treat UTIs
  • Darifenacin to relieve spastic bladder
  • Desmopressin acetate to increase ADH levels
  • DHT-blocking medications to reduce prostate swelling
  • Oxybutynin or tolterodine to relax the detrusor muscle
  • Positive airway pressure (PAP) therapy (if OSA is diagnosed)
  • Insulin and glucose management therapies (if diabetes is diagnosed)
  • Improved treatment compliance for patients with preexisting OSA or diabetes

Management of bedwetting in adults

Patients can also manage their sleep hygiene to improve their odds of having dry nights, such as:

  • Setting fluid intake limits (amounts and times)
  • Reducing or removing caffeine or alcohol from the diet
  • Practicing planned urination throughout the day
  • Voiding the bladder at bedtime regardless of the severity of the urge
  • Setting a nighttime bathroom alarm to voluntary rise to void the bladder
  • Wearing absorbent briefs to avoid frequent bed changes
  • Using a special cover to protect the mattress
  • Applying special skin-care products made to soothe irritated skin, should bedwetting occur
  • Setting a bedwetting alarm system to detect wetness

A final word about enuresis and OSA

The reason why an adult might have bedwetting as a symptom for OSA isn’t well understood, and there may be multiple factors involved. Regardless, there exist enough well-known markers for OSA to consider assessing for this sleep disorder in patients with complaints of bedwetting.

Adults suffering from enuresis who have otherwise normal urology test results have been shown (in records dating back 40 years) to suffer from OSA as a comorbidity; still, primary care providers today don’t always recognize the relationship between the two conditions (Brown MA, Jacobs MB & Pelayo R, Western Journal of Medicine, 1995 ).

The bottom line? If your adult patient complains of enuresis and exhibits classic symptoms and signs of OSA, you are best advised to refer them for a sleep study, which could yield not only a diagnosis, but an effective treatment for both problems.

Seattle-area physicians can reach our staff at Sound Sleep Health at 3 locations in the greater Seattle/Kirkland areas.

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