Bedwetting Adults

Enuresis (bedwetting)
in adults
What is enuresis?
Enuresis is emptying the bladder (urinary incontinence) during sleep.

Many people are aware that enuresis, or bedwetting, is a common issue
in childhood. However, it can continue from childhood into adulthood, or
start at any point in adulthood, including in people who did not have
bedwetting as children.
It can happen whenever the affected person goes to sleep, including at

night or during daytime naps, or may just happen occasionally.
If there have never been six months of dry nights every night, urinary
incontinence during sleep is known as primary enuresis. Primary enuresis
is thought to affect 1 – 2% of all adults. Wetting that has started after at
least six months of dry nights is called secondary enuresis. Secondary
enuresis is more likely to be a symptom of another underlying health
condition.
Enuresis is more common in women with other bladder problems, in

older adults and in some others, including people with Down syndrome.
What is the difference between enuresis (wetting the bed)

and nocturia?
Enuresis will only happen if the affected person is unable to wake to the
bladder signalling that it needs to empty. If the person is able to wake
up, they would get up and go to the toilet. Waking to go to the toilet is
called nocturia. It is usually not considered to be a medical problem,
unless it is happening two or more times a night.
Enuresis and nocturia can both cause embarrassment, frustration,

disturbed sleep and relationship issues. There is information about
nocturia in the Bladder & Bowel UK leaflet here.
1
Enuresis (bedwetting) in adults
What causes enuresis in adults?
Most people do not need to pass urine more than once a night and can
wake if they need to do this. Not being able to wake up in response to
the bladder signals causes enuresis. However, there are a number of
reasons why someone may need to pass urine at night.
These include:
The kidneys not being able to reduce the amount of urine they
produce at night in the way that they usually would. Arginine
vasopressin is a hormone that tells the kidneys to make less urine.
The body should produce more arginine vasopressin at night. If
someone is not making enough arginine vasopressin, urine production
at night will be closer to daytime levels.
If the bladder is not storing urine as well as it should be. This may be
because the bladder is smaller than it should be, or because the
muscles in the bladder wall are less stretchy than usual or are
tightening when they should be relaxed. Extra tightening of the
bladder wall muscles is called bladder overactivity. Many people with
this problem will need the toilet more frequently in the day than
usual, may get very little or no notice of needing to pass urine and
may get some daytime urinary incontinence (bladder leakage).
Urinary tract infection can cause wetting due to an increased need to

pass urine or due to scarring if there have been repeat infections.
Enuresis can be a symptom of type I and type II diabetes (both types

of sugar diabetes) as well as a rare condition called diabetes
insipidus. Diabetes insipidus is an inability to reduce urine production.
Enuresis can be caused by an obstruction somewhere in the urinary

tract (the bladder or the urethra – the tube that urine flows down
when going to the toilet). Blockages can be caused by stones in the
bladder or urethra, or an enlarged prostate in men.
Constipation. This can be severe enough to partially block the

urethra. Also, when there is constipation the full lower bowel can put
pressure on the bladder and result in it being able to hold less than
usual, which can result in enuresis.
2
Fizzy drinks and caffeine (tea, coffee, cola, many energy drinks and
hot chocolate contain caffeine) may irritate the bladder and cause
urinary problems.
Alcohol has a diuretic effect (it encourages the kidneys to make more
urine) and affects sleep, so may make it more difficult for the person
to wake to bladder signals.
Some medications including some used for mental health conditions,

diuretics (medications that increase urine production) and
medications to improve sleep, are linked with enuresis. If you think
that enuresis is being caused by a medication that you are taking
speak to your healthcare professional before stopping the
medication.
Sleep apnoea (stopping breathing while asleep) and snoring have

also been linked to enuresis.
Some neurological disorders or damage to the nerves controlling the

bladder muscles may result in enuresis.
Smoking, being overweight, not taking much physical activity and

high blood pressure are associated with enuresis in women.
Psychological problems including anxiety, depression, feeling tired all

the time have been linked to enuresis. However, it is not clear if they
happen because of the enuresis or make the enuresis worse.
For many adults with enuresis there may be more than one issue that is
causing or contributing to the bedwetting.
Should I speak to my healthcare professional about

enuresis? What will they do?
Enuresis should be investigated to make sure that a significant

underlying health problem is not being missed. Your GP or other
healthcare professional will ask you questions about any other bladder
problems, any medications you are taking, and what other illnesses you
have or have had in the past and whether you have had any surgery or
injuries.
3
They will check a urine specimen to make sure you do not have a urine
infection or type I or II diabetes (sugar diabetes) and may ask you to
complete a bladder diary. The bladder diary is usually a three day
record of your drinks and visits to the toilet to pass urine and any other
symptoms, such as bladder leakage and how strong the urge to visit the
toilet was.
Your GP or healthcare professional should explain the outcome of the

assessment to you and outline what they think is causing the enuresis
and the options for treatment. They may refer you for further
investigations or to a specialist service for support.
What treatment is there for enuresis in adults?
Recommended treatment will depend on what the assessment suggests

is causing the wetting. Sometimes simple lifestyle adjustments can be
helpful, regardless of the cause.
These include:
Drink plenty of water-based drinks during the day, but avoid all drink
in the last two hours before bed. Good daytime fluid intake can help
to improve the amount of urine the bladder can hold.
Avoid caffeinated, fizzy and alcoholic drinks, particularly in the

evening. This is because these can irritate the bladder lining and
caffeine and alcohol may have diuretic effects (cause the kidneys to
make more urine.)
Discuss the use of sedatives (medication for sleeping) with your

healthcare professional. They change sleep and can make it more
difficult to wake to bladder signals.
Weight reduction, if you are overweight, may help by improving

snoring and sleep apnoea, which can cause or be linked to enuresis.
If the above lifestyle options do not help, then treatments that target the
cause of bedwetting may be an option.
4
Inability to reduce overnight urine production
If the kidneys are making too much urine at night then medication to
help reduce this may help. Medication called Desmopressin may be
suitable for some adults who are under 65 years old. Noqdirna may be a
suitable alternative for some older adults.
Both Desmopressin and Noqdirna must be prescribed by a healthcare

professional and are usually taken up to an hour before bedtime. They
are not suitable for everyone and people over 65 years old may need
blood tests to make sure that the treatment is suitable both before
starting it and after four to eight days of taking it and again after a
month of treatment.
If you are taking either Desmopressin or Noqdirna, you must not drink
for an hour before having them and for eight hours afterwards.
Problems with bladder storage
If the bedwetting is caused by a problem with the way the bladder is

storing urine, then medication to help this may be an option.
Anticholinergic medications help the bladder wall muscle to stay relaxed
during bladder filling and therefore may increase the amount of urine
that the bladder can hold overnight.
Enuresis due to diabetes
If enuresis is associated with diabetes, good management of blood

sugar levels and fluid intake may be helpful. Discuss your diabetic
treatment and enuresis with your specialist nurse or other healthcare
professional.
Obstruction in the urinary tract
You may need to have scans or other investigations if an obstruction is

suspected. This would then be treated. Options might include
prostatectomy (having all or part of the prostate removed if it is
enlarged), having the urethra dilated (stretched) if it is narrow, or
having stones removed, if they are present.
5
Problems with constipation
Constipation is usually treated with increased water-based drinks,

dietary changes, including eating more fruit and vegetables and other
high fibre foods and using laxatives (medications to help bowel
emptying). Good management of constipation may help to resolve
enuresis.
Enuresis as a side-effect of some medications
If the enuresis starts when you are on medicines for mental health
problems or diuretics (water pills, usually used to treat heart problems),
then speak to the person who prescribed the medicines. It may be
possible for you to change to different treatments that do not cause
enuresis. Do not stop taking prescribed medication without talking to
your healthcare professional.
Sleep apnoea and snoring
You may be referred to a respiratory (breathing) clinic to discuss

options to treat problems with breathing during sleep. This can help to
reduce or make enuresis better for some people.
Neurological disorders
Some neurological conditions or injuries can affect the nerves or part of

the brain that helps to control the bladder. There may be appropriate
treatments to help with this. Your healthcare professional should be able
to advise you.
What other information is there?
If the enuresis is caused by more than one problem, it may need more
than one treatment to help.
It is important that you talk to your healthcare professional about any

changes to your bladder or bowel health and any new bladder and/or
bowel symptoms, as they may indicate a different underlying condition
that can and should be treated.
For further advice, help and signposting to NHS services contact Bladder
& Bowel UK here or on telephone 0161 214 4591.

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Enuresis (bedwetting)

Enuresis is emptying the bladder (urinary incontinence) during sleep.

It can happen whenever the affected person goes to sleep, including at

Enuresis is more common in women with other bladder problems, in

What is the difference between enuresis (wetting the bed)

Enuresis and nocturia can both cause embarrassment, frustration,

What causes enuresis in adults?

Urinary tract infection can cause wetting due to an increased need to

Enuresis can be a symptom of type I and type II diabetes (both types

Enuresis can be caused by an obstruction somewhere in the urinary

Constipation. This can be severe enough to partially block the

Some medications including some used for mental health conditions,

Sleep apnoea (stopping breathing while asleep) and snoring have

Some neurological disorders or damage to the nerves controlling the

Smoking, being overweight, not taking much physical activity and

Psychological problems including anxiety, depression, feeling tired all

Should I speak to my healthcare professional about

Enuresis should be investigated to make sure that a significant

Your GP or healthcare professional should explain the outcome of the

What treatment is there for enuresis in adults?

Recommended treatment will depend on what the assessment suggests

Avoid caffeinated, fizzy and alcoholic drinks, particularly in the

Discuss the use of sedatives (medication for sleeping) with your

Weight reduction, if you are overweight, may help by improving

Inability to reduce overnight urine production

Both Desmopressin and Noqdirna must be prescribed by a healthcare

Problems with bladder storage

If the bedwetting is caused by a problem with the way the bladder is

Enuresis due to diabetes

If enuresis is associated with diabetes, good management of blood

Obstruction in the urinary tract

You may need to have scans or other investigations if an obstruction is

Problems with constipation

Constipation is usually treated with increased water-based drinks,

Enuresis as a side-effect of some medications

Sleep apnoea and snoring

You may be referred to a respiratory (breathing) clinic to discuss

Some neurological conditions or injuries can affect the nerves or part of

What other information is there?

It is important that you talk to your healthcare professional about any

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