Dear Alice,

When I was a child, I used to wet the bed. This finally cleared up when I was about twelve. In the last month or so, it has come back — except it's even more embarrassing now because I'm twenty-eight and share my bed with my husband! It started when I had a bad cold, so I thought perhaps it was just stress incontinence caused by coughing while asleep. I do suffer somewhat from stress incontinence, but I learned to deal with it when awake by clamping my legs together whenever I cough or sneeze. I talked to my doctor about this, and he also thought it was due to coughing while asleep. He treated my cough and assured me that once the cough was gone, the bedwetting would be, too. Well, my cough has cleared up, but I am still wetting the bed almost every night! It's mortifying, and I feel like my husband finds me disgusting (not that I really blame him). He says it doesn't matter to him, but I feel like I ought to be put in a nursing home. Is there anything I can do to stop this?

Dear Reader,

Props to you for sharing your story about adult bedwetting. Although it may feel awkward, you’re certainly not the only person to have this experience. From what you’ve shared, your history of stress incontinence may have resulted in nocturnal enuresis (NE), or involuntary urination while asleep. NE can occur in both childhood and adulthood, though it’s more common among children and affects around two to six percent of the adult population. When NE reappears in adulthood after clearing in childhood, it’s called recurrent nocturnal enuresis or RNE.

Some causes of adult bed-wetting include:

  • Urinary tract blockage
  • Urinary tract infection (UTI)
  • Bladder problems (such as having limited capacity)
  • Obstructive sleep apnea
  • Diabetes
  • Enlarged prostate
  • Side effects of medication
  • Neurological disorders

Studies have concluded that, for women, stress incontinence is a factor in the development of NE. Keep in mind that stress incontinence is more common in women than in men. It may also be related to age, since muscles weaken as people grow older, making them more susceptible. Stress incontinence is unrelated to psychological stress and is, instead, usually a result of muscle weakness. In fact, stress incontinence occurs when the muscles and other tissues that support the bladder and regulate the release of urine, or pee, become weak. Some factors that can worsen stress incontinence include illnesses (such as your cough), obesity, smoking, or high-impact activities. 

Because NE may be affecting your quality of life, you might consider speaking with your health care provider further about getting checked out for any underlying concerns. If none can be found, you may want to ask them for a referral to a provider who specializes in gynecological or urological symptoms or seek out a second opinion from another health care provider. These providers may be able to do a more thorough evaluation to determine the cause and recommend next steps.

In the meantime, your health care provider may recommend:

  • Pelvic floor exercises: Also called Kegel exercises, these work to strengthen and train the muscles in your pelvic floor that control urine flow.
  • Prescription medications: One such medication, desmopressin, appears to help control the amount of urine a person produces. While this medicine is usually used to control symptoms of a certain type of diabetes, it’s been shown to be helpful for people who wet the bed as well.
  • Lifestyle modifications: Since smoking and obesity can both contribute to the problem, your provider may recommend making lifestyle changes to improve symptoms.
  • Fluid intake: It can be helpful to pay attention to how much and what types of liquid you consume. You may find certain patterns help or hinder wetting the bed. 

Here’s to dry days (and nights) ahead!

Alice!

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