About adults and bedwetting

About one in 100 adults experiences bedwetting at night, called nocturnal enuresis. Some people produce too much urine at night or may have an overactive or unstable bladder, also causing daytime symptoms of frequency, urgency and leakage. Stress and anxiety can be factors, while occasionally there may be a urinary tract infection. See your doctor for assessment; a diary showing your bladder habits and fluid intake for the previous week may be helpful. Treatments include medications, bladder training and enuresis alarms.

Not just a childhood condition

Some people wet the bed all their lives. Others become dry during childhood, but later start wetting the bed again. Bedwetting affects different people in different ways. The practical problems of coping with wet bedding, even at home, can be considerable, especially if you do not have good washing and drying facilities.

Lifestyle concerns

You may find that you worry about staying away for the night, going on holiday or business trips, going to college or moving away from home. You may find you don't want to get into a relationship in case your new partner finds out. It may cost you a lot of money to wash and dry bedding or buy disposable products.

However, in most cases, with the right advice and support, something can be done to improve the situation, sometimes even cure bedwetting. Even if you tried everything when you were a child, it is always worth trying again. New methods and treatments are becoming available all the time.

What causes bedwetting?

Most people produce most of their urine during the day and very little at night. Some people who wet the bed produce urine at a constant rate throughout the day and night, and this may explain why the bladder needs emptying at night (although not why you don't wake). However, it is not true that most people who wet the bed sleep more deeply than other people.

Some people have an overactive, or "unstable" bladder, and this can cause daytime problems as well as at night, such as passing urine very often (frequency), having to rush to the toilet (urgency) and accidentally leaking urine on the way (urge incontinence). The cause of this unstable bladder is often unknown.

Occasionally, a urinary tract infection (UTI) or other bladder problems may cause bedwetting. Stress or anxiety may sometimes start the problem, with the wet nights continuing long after the stress is over.

What help is available?

The first step is to talk to your family doctor or local nurse continence advisor. Some people feel too embarrassed to talk about bedwetting. Take this article with you if you think it may help to start the conversation.

Your doctor or continence advisor will want to know about your bladder habits. You may find it useful to keep a diary for about a week before your appointment showing how often you pass urine, how much you drink and when you are wet. A sample of your urine may be tested for infection. Sometimes a doctor will recommend that you attend the hospital outpatient department for a bladder test ("urodynamic" studies).

Medications

Your doctor will assess your symptoms and may prescribe an appropriate medicine to control your bedwetting. It is important your doctor knows whether you have daytime symptoms.

One type of medicine (eg. desmopressin) works by reducing the quantity of urine produced overnight. Another type (eg. oxybutinin) works by relaxing the bladder, allowing it to hold more urine.

Medication can often control bedwetting and may provide a long-term solution to the problem.

Enuresis alarm

Enuresis alarms are designed to wake you up when you start to wet, either by sounding a buzzer or by vibrating, which may be preferable if you are sharing a bedroom. Gradually your body learns to hold the urine, or to wake so you can empty the bladder. Nobody knows why this works, but it often does. Modern alarms are small and discreet, and can be worn close to the body.

An alarm is most successful if used with professional supervision (eg. from your continence advisor). Call the freephone helpline - 0800 650 659 - for a list of contacts.

Complementary therapies

While there is limited scientific research as yet, some people find homoeopathic medicines, hypnosis or acupuncture can be beneficial. It is important to obtain advice from a trained practitioner.

How can I help myself?

Fluid intake 
You need to drink at least 6-8 glasses of fluid (ie. water, tea, coffee, milo, soup, etc) every 24 hours. If you don't drink enough, your body may not be able to get rid of its waste products efficiently. It doesn't matter when you drink, but you may find it sensible to drink mostly during the day, with less fluid in the evening.

Some people find that drinks with caffeine (such as coffee, tea, cola and some other fizzy drinks) irritate the bladder. Try cutting down on these, especially in the evening. It is worth experimenting with different drinks to see if they all have the same effect.

Alcoholic drinks make the bedwetting worse. This may be the effect of the alcohol itself, or the extra fluid, especially in beers and other long drinks. Low-alcohol drinks may be better.

Waking at night
You should ensure you empty your bladder before you go to sleep. Some people find that waking to empty their bladder, by setting an alarm clock for a couple of hours after going to bed, can save a wet bed, although of course it does not "cure" the problem. If you do this, vary the time you set the clock for, otherwise your bladder may get into a habit of emptying at the same time, whether you are awake or not.

Bladder training
If you have a daytime problem of frequency and/or urgency, or pass urine very often at night, it may help to increase the amount of urine your bladder can hold. A "normal" bladder should hold up to two cups (400-450ml) of urine. If yours doesn't hold this much, practice "holding on" and going to the toilet less frequently during the day. This takes a lot of willpower. It may help to keep a record or chart. See also: Bladder training

Practical management

It is often said that a problem shared is a problem halved, and this can be true of bedwetting. Talking about it can be a tremendous relief, especially when you realise that most people will be sympathetic and supportive.

Bedwetting can seem like a real barrier if you want to start a new relationship. Talking openly and honestly, before the situation arises, can sometimes bring you closer to a partner - you have shown enough trust to share your problem.

Products to protect bedding

Protecting your mattress and bedding does not mean you have to sleep wrapped in plastic. Newer 'breathable' waterproof fabrics are a lot more comfortable and less hot. Avoid nylon bedclothes and nightwear, which tend not to absorb sweat and smell. Washable absorbent undersheets come with cotton or 'stay-dry' facings and some are available in double-bed size. Disposable sheets and underpads may be useful away from home. Some hotels will provide bed protection if you ask in advance.

Fresh urine should not smell, and as long as you have a good wash each day and keep wet sheets in an airtight container until washed, odour should not cause a problem.

Further information

Contact the New Zealand Continence Association (which also runs a free helpline) - details below under 'Further Information and Support' .

Original material provided by the New Zealand Continence Association, and edited by everybody, August 2005. Reviewed by everybody, September 2011.