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Sleep Disorders

Adult bed wetting

07/05/2006

Question:

I am a 45 year old lady and I have started wetting the bed, but I don`t know why.  I have had a problem sleeping if I don`t got to bed first.  Otherwise, I can`t get to sleep.  My husband sores badly and I wake up often during the night by this.  I have him turn over, but sometimes I have to go to another room to sleep.  I also work 12 hours so I am pretty tired.  When I wet the bed, I don`t eve know that I am going until it`s too late.  Sometimes I am dreaming that I am using the bathroom and I wake up wet. 

This is very upsetting to me.  Lately it has been more often -- not every night, but once weekly.  I take a fluid pill for B/P, but a low dose, and I take it at like 5:00 AM, so that should not be the problem.  I also don`t drink a lot , and hardly any at night.  Please help me if you can. 

Answer:

It is not clear to me from your question if you are having trouble with urinary incontinence (the inability to control urination) when you are in bed and awake or only when sleeping. The 2 situations can have very different causes (though some may be the same) and this is important to know from the standpoint of how you should be evaluated.

If your primary problem is wetting the bed once you lie down, but are awake, then you should seek the help of a Urologist (a doctor who specializes in the bladder and kidneys). This type of incontinence has many causes that may include medication side effects, the result of other medical problems (such as heart failure or diabetes), psychological disorders, urinary tract infections, or problems with the muscles or nerves of the bladder and the bladder sphincter (the muscle that helps to keep urine from leaking out). A Urologist will take a history and perform an examination to determine if further testing is needed or if a trial of specific therapy is indicated.

Bed wetting during sleep, also known as sleep enuresis, often has different underlying causes. Sleep enuresis is quite common in children but begins to decrease in frequency once above the age of 5. Only about 1-2% of 18 year olds will have this problem and it becomes even less frequent in adulthood until urinary incontinence becomes a problem with aging (mostly in the elderly population).

Most cases of sleep enuresis in adulthood are due to other underlying medical problems and do not represent a problem with the urinary system per se, though urinary tract disorders can also lead to enuresis. These conditions include obstructive sleep apnea (repetitive airway closing in sleep), congestive heart failure, diabetes, urinary tract infections, nighttime seizures, depression, severe psychological stress, and dementia. Of course, the excessive intake of fluids or substances that promote urination (i.e. diuretic medications, caffeine, and alcohol) can also lead nighttime bedwetting.

I recommend you discuss this issue with your primary care physician. Specific factors in your history will be useful in determining how best to further evaluate and treat this problem. Referral to a Sleep Specialist in your area may be needed. If you would like further information about sleep disorders or sleep itself, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you. Good Luck!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University