At least 1 percent of adults suffer from a bed wetting problem, which is also known as nocturnal enuresis. The cause of bed wetting in adults is not always clear, but an array of medical, physical or emotional problems may contribute to this condition. Also, the cause may differ based on age of onset -- specifically, if the enuresis started in childhood or appeared for the first time in the adult years. While is may be embarrassing to discuss this with a doctor, it is important for adults with enuresis to seek a medical evaluation to reveal the root cause of the problem.
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Bed wetting is more common in childhood, and unless a physical problem exists in the urinary tract or bladder, this condition usually resolves by the preteen years. Some adults who experience nocturnal enuresis have never fully outgrown it. According to a September 2013 report in "Current Bladder Dysfunction Reports," most of the cases of adult enuresis that have persisted since childhood, or recurred in the adult years, are related to increased urine production at night or an overactive bladder, rather than a physical problems such as an obstruction.
The Bladder Factor
An overactive bladder, related to the detrusor muscle in the bladder, is a common cause of adult bed wetting. Normally, this muscle relaxes to hold urine in, and contracts to let urine out. In people with an overactive bladder, the detrusor muscle contracts too often or at the wrong times, which can cause urine leakage or an uncontrollable need to urinate. Some people experience a frequent need to urinate due to a small functional bladder capacity, which causes the bladder to signal the need to empty at a smaller-than-normal volume. Increased production of urine also contributes to enuresis, and this may be caused by drinking too much fluids before bed, drinking alcoholic beverages, or a result of certain medications or conditions.
The most common cause of enuresis that begins in adulthood is obstruction that leads to retention of urine in the bladder. One cause is a bladder neck obstruction, where the neck of the bladder fails to open completely when urinating. Another reason for restricted urine flow from the bladder is enlargement of the prostate gland, which is located at the bottom of the bladder. These obstructions cause bladders to never fully empty, which can lead to the need to urinate urgently and frequently, contributing to incontinence, or a lack of control over urination, and bed wetting.
Other Medical Causes
A variety of medical conditions can also contribute to adult enuresis, including other structural problems with the bladder or urinary system, or any conditions that impact how the bladder makes, stores or releases urine. Factors that increase urination, such as urinary tract infections or poorly controlled diabetes can be also linked to bed wetting. Sleep apnea has also been associated with bed wetting, although the precise cause is unclear. People who sleep deeply, or adults who take sleeping pills, sedatives or tranquilizers are also at greater risk of nighttime enuresis.
Nocturnal enuresis can cause frustration, stress and anxiety, yet psychological factors are often assumed to contribute to bed wetting. However, this relationship deserves more scientific study. There is little reported research on emotional triggers of adult enuresis, and an April 2013 review in "American Family Physician" suggests that psychological factors in pediatric bed wetting are the result of the condition, and not the cause. Due to the physical and emotional maturation of adults, however, pediatric research on the causes of this condition cannot be assumed to hold true for adults. One study of adult women linked post-traumatic stress disorder to urinary incontinence, suggesting a need for more research to understand the relationship between psychological factors and enuresis.
Bed wetting can be an embarrassing and stressful problem, but it's essential that those affected do not suffer in silence. If you suffer from bed wetting -- even if you suffered from this condition as a child -- see your doctor. It's particularly important that any adult experiencing enuresis as a new symptom seek a medical evaluation right away, since they are more likely to have an underlying medical issue contributing to the problem.
Reviewed by Kay Peck, MPH RD