Nocturnal enuresis (bedwetting) is a common medical condition in children, but what is less well known is that for 1 – 2% of children it continues as they become teenagers and adults. It can also restart at any time in life.

Nocturnal enuresis is a medical condition where the bladder empties during sleep. It is more common in women, older adults, and people with Down syndrome. It happens when the bladder needs to empty during sleep, but the brain is unable to wake the person to the bladder signals. The wet bed is outside the person’s control, but still may cause embarrassment, shame, frustration, and disturbed sleep. It can also affect intimate relationships.

What causes nocturnal enuresis in teenagers and adults?

There are different reasons why the bladder may need to empty at night:

• Normally the kidneys produce less urine at night than they do during the day. If the individual is not able to produce enough of a hormone that reduces urine production at night, the kidneys will continue to produce daytime amounts of urine and the bladder will not be able to hold it all.  
• If the bladder is smaller than it should be, or if the muscles in the bladder are tightening during bladder filling (they should be relaxed during bladder filling) the bladder will not be able to hold onto the urine and will empty. 

If either or both these problems are present, along with an inability to wake to the bladder signals the bladder will empty into the bed.

Are there any other causes for enuresis in teenagers and adults?

• Urinary tract infections can cause nocturnal enuresis. This is because they are associated with an increased need to pass urine.
• Fizzy drinks and drinks with caffeine in them (tea, coffee, cola, hot chocolate and many energy drinks contain caffeine) may irritate the bladder and cause wetting. Caffeine also has a diuretic effect (it encourages the kidneys to make more urine).
• Alcohol has a diuretic effect, and it has an impact on sleep. It may make it more difficult to wake to bladder signals.
• Constipation can result in difficulty emptying the lower bowel. The retained stools then put pressure on the bladder, which is in turn cannot hold as much urine as usual, resulting in wetting.  If the constipation is very severe, it can partially block the urethra (the pipe that connects the bladder to the outside), so the individual is not able to fully empty their bladder.
• Sleep apnoea (stopping breathing for a short time when asleep) and snoring have been linked to nocturnal enuresis. Treatment for this may help.
• Smoking, being overweight, high blood pressure and not taking much physical exercise have been linked to nocturnal enuresis in women.
• If there is a blockage in the bladder or water pipe (urethra), then nocturnal enuresis can happen. Blockages can be caused by stones in the bladder or urethra, or an enlarged prostate in men.
• Type I and type II diabetes (sugar diabetes) can cause nocturnal enuresis, particularly if poorly controlled. This is because high blood sugar levels result in increased urine production.
• Some medications, including diuretics (medicines that increase urine production), medicines used to improve sleep and some that are used for mental health conditions have been linked to nocturnal enuresis. If you think that your medicine may be causing the condition, speak to your healthcare professional before stopping your medication.

For many teenagers and adults there may be more than one cause for the nocturnal enuresis.

Can anything be done to help the nocturnal enuresis?

There are different treatments for nocturnal enuresis. If you have had treatment before that has not worked, it does not necessarily mean that there are no options for you now. The treatment you are offered will vary according to what your healthcare professional thinks is causing the problem. Some people need more than one treatment, and some may need to be referred for further investigations or to a specialist service for support.

Is there anything I can do to help myself with nocturnal enuresis?

Sometimes simple changes to lifestyle can be helpful. These include:

• Drink plenty of water-based rinks during the day.
• Avoid all drinks in the last two hours before bed.
• Avoid drinks that contain caffeine or alcohol and fizzy drinks.
• If you are overweight, try to lose some weight.
• If you are taking medication, discuss this with your healthcare professional.
• Try to avoid constipation, by ensuring you are drinking enough water-based drinks and that you have sufficient fruit, vegetables and fibre in your diet. If constipation is a problem, talk about the options with a pharmacist or your healthcare professional.

What other options are there to treat nocturnal enuresis?

If the measures above do not work, then treatments that target the underlying cause of the nocturnal enuresis may be an option. 

If your kidneys are making too much urine at night, a medication called Desmopressin may be suitable, if you are under 65 years old. For older adults Noqdirna may be an option. Both must be prescribed by a healthcare professional. They are not suitable for everyone, and older adults may need blood tests before and after starting treatment.

If your bladder is not storing urine as effectively as it should, then medication for this may be helpful. There are some medicines (called anticholinergics) that help the bladder wall muscle to stay relaxed while the bladder is filling and so help it to store urine more effectively.

If the nocturnal enuresis is caused by another problem, such as diabetes, a blockage in the urinary system, sleep apnoea or a side effect of medication you are taking, your healthcare professional may be able to suggest options or refer you to a specialist service.

Where can I get more support and information?

If you have nocturnal enuresis, do not suffer in silence, but speak to your healthcare professional. They may be able to offer an assessment and recommend treatment or refer you to a specialist.

It is important not to ignore any new bladder and/or bowel symptoms as these may suggest a different underlying condition that can and should be treated.

You can find more information on the Bladder & Bowel UK website – www.bbuk.org.uk/adults/adults-resources – or contact the Bladder & Bowel UK helpline for free confidential advice – www.bbuk.org.uk/enquiries/.