Nighttime Incontinence
Experiencing nighttime incontinence as an adult is no doubt a stressful and even humiliating experience. Many of us remember occasionally wetting the bed as a child, and it can feel like a loss of control to find it’s happening again as an adult.
Urinary incontinence is a broad term that can cover all kinds of involuntary leakages of an amount of urine that happen day or night. Experiencing leakages only in bed can have different explanations than the broader 5 types of incontinence.
If you’re experiencing urine leakage throughout the day and night, we recommend learning more about those 5 types of urinary incontinence and - of course - speaking to your healthcare provider.
Nocturia Versus Nocturnal Enuresis
Let’s get a little technical with some language you might encounter when you start researching and reading about adult bedwetting.
First, there’s nocturia. This is when you wake up at different times a night because you need to pee. With nocturia, you make it to the washroom on time, but there’s the inconvenience and possible exhaustion of waking up throughout the night.
Nocturia can be part of the experience if you do suffer from urinary incontinence, but if actual leakages don’t occur, it’s not the same thing. Nocturia may be caused by many diseases, including diabetes, high blood pressure, and heart disease.
Second, there’s adult nocturnal enuresis. This is the technical term for adult bedwetting, which affects 4.2 million American adults. Wetting the bed can strike any person at any time they’re asleep. There are a number of different causes.
Of course, any type of incontinence can cause you to wet the bed (in addition to daytime leaks), but there are other causes that are more peculiar to sleep and time in bed. Let’s explore.
What Causes Incontinence When Sleeping?
1. Nighttime Urinary Incontinence
The broadest explanation is any type of urinary incontinence, which will result in involuntary leaks at *any* time of day. Here’s a quick summary of the 5 types of urinary incontinence that can also cause nighttime urinary incontinence:
|
Type |
How / When it Manifests |
Some Possible Causes |
|
Stress Incontinence |
Stress incontinence causes urine loss during physical exertion, whether it be exercise or more physical reactions like coughing, sneezing, laughing, etc. |
Pregnancy, childbirth, menopause, trauma from surgery. |
|
Urge Incontinence |
Urge urinary incontinence manifests as an impossible-to-ignore feeling that you need to urinate right this second, or you’ll burst, even if you just went or felt fine just minutes before. |
Pregnancy that puts pressure on the bladder, childbirth, menopause, and trauma from surgery. Overactive bladder (OAB). Also, neurological diseases like Parkinson’s disease and multiple sclerosis (MS) can cause severe urge incontinence. |
|
Mixed Incontinence |
A combination of stress and urge incontinence. |
Any combination of the causes of stress and urge incontinence. |
|
Overflow Incontinence |
If pee “dribbles” or is unsteady you may have overflow incontinence. The inability to completely empty the bladder can lead it to overflow and cause unexpected urine leaks. |
More common in men (caused by an enlarged prostate). In women, it can indicate weak bladder muscles, nerve damage from diabetes, alcoholism or neurological damage, or an underactive bladder. |
|
Functional Incontinence |
This is when you experience urine loss, but the cause is not associated with any problems with the urinary system. |
Physical or cognitive impairment, such as Alzheimer’s, immobility, etc. |
2. Overactive Bladder (OAB)
Generally, the amount of urine we produce at night decreases, and most people can sleep 6-8 hours without needing to get up and use the washroom. However, many people with an overactive bladder also experience nocturia.
Indeed, approximately 16% of people over the age of 18 have an overactive bladder (OAB). Even worse than nighttime incontinence, if you’re a very sound sleeper, you may not wake up, and then the result can be wetting the bed.
3. ADH Hormone Imbalance
As mentioned, at night, we make less urine. This is governed by a hormone called ADH, which inhibits urine production. We usually produce more ADH at night. But if hormones are imbalanced, you may not produce enough ADH and you may need to pee more often, or may even experience bedwetting.
4. Certain Medications
Certain medications irritate the bladder, and if taken at bedtime, they can result in nocturia and/or nocturnal enuresis (bedwetting). If you suspect this is the case, work with your doctor or pharmacist to see if there are alternatives or if the timing of taking medication can be altered to minimize its impact on your sleep.
5. Urinary Tract Infection (UTI)
A UTI can cause incontinence during the day or night, but it may only manifest at night if you’re a particularly sound sleeper. UTIs often have other symptoms, including a burning sensation when peeing. Your doctor will prescribe a course of antibiotics to clear up a UTI. It is important to be treated, or else the infection could spread to your bladder or kidneys.
6. Stress
Stress can affect us in many ways, especially when it is inhibited. Nightmares, night terrors, or bedwetting can also be the result of unaddressed stress.
7. Other Medical Conditions
As you can see, there are many possible and very different explanations for nocturnal bedwetting. In addition to all of the above, it can also be connected with the following:
- Diabetes
- Urinary tract stones
- Neurological disorders
- Anatomical abnormalities
- Urinary tract calculi
- Bladder cancer
- Obstructive sleep apnea
This just underscores the importance of seeing your doctor to uncover the real reason and the appropriate treatment if you’re experiencing adult bedwetting.
How Do I Stop Urinary Incontinence at Night?
Here are some steps you can take to help you get through the night leak-free.
Immediate Steps to Manage Urinary Incontinence
These are mostly changes you can make on your own to mitigate urinary incontinence, day or night:
Limit Your Fluid Intake Before Bedtime
Try not to drink any liquids after 6pm.
Avoid Foods and Beverages That Are Bladder Irritants
Foods and drinks that irritate your bladder include spicy or excessively sugary foods or beverages, caffeine, and alcohol. Avoiding these bladder irritants can have an immediate impact on urinary incontinence.
Try Double-Voiding
Before bedtime, go to the bathroom and then wait 10 minutes (perhaps brush your teeth etc in the interim) and then pee again. Using the bathroom several times before bed will help ensure your bladder is empty.
Try Leakproof Underwear, or Incontinence Pads
Leakproof underwear protects you should an accident occur and can absorb as much urine as 8tsp. Other products to consider purchasing: A leakproof mattress cover to protect your bed, though you will still have to manage wet sheets.
Medium to Long Term Strategies
The following won’t have an immediate impact on nighttime urinary incontinence but can be very helpful in the medium and long term:
Bladder Control Training
Bladder training can strengthen the pelvic floor muscles. One method involves peeing at certain scheduled times each day and ignoring the urge to urinate at other times.
Kegels or Pelvic Floor Exercises
These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum.
Bedwetting Alarm System
Bedwetting alarm products will trigger if you begin to leak so that you wake up and can make it to the bathroom.
Medications
If none of the above works, work with your doctor to see if there is a medical solution to help prevent bedwetting.
Surgical Solutions
In severe cases, your doctor may advocate for a surgical solution. Possible surgeries include:
Surgery is always a major decision. You should work closely with a healthcare provider to determine if it’s the right option for you. It’s likely they’ll want to rule out some of the more approachable lifestyle changes first.
Regardless of what course of treatment you pursue, you should absolutely know you’re not alone experiencing adult bedwetting. Don’t be embarrassed to discuss your experience with your healthcare provider!
Written by Jane Flanagan — Updated on April 5, 2022.
We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.