Nighttime Incontinence

TEAM KNIX / YOUR BODY

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. 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

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Type 

How / When it Manifests

Some Possible Causes

Stress Incontinence

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

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 which puts pressure on the bladder, childbirth, menopause, trauma from surgery. Overactive bladder (OAB). Also neurological diseases, like Parkinson’s disease and multiple sclerosis (MS).

Mixed Incontinence

A combination of stress and urge incontinence.

Any combination of the causes from 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 Alzeimher’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 who 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 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 Incontinence at Night?

Here are some steps you can take to help you get through the night leakfree.

Immediate Steps

These are mostly changes you can make on your own:

  • 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.
  • 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. These products protect 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, but can be very helpful:

  • 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: These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum.
  • Bedwetting alarm: 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 includes:

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!