Question:

I am 28 year old male. For last few years, occasionally, I urinate (in dream) but actually I urinate in bed. I am neither smoker nor any kind of alcoholic/tobacco etc. Many times, I awake in night, when I feel to urinate but only some times I urinate in a dream and in a bed. I really feel shame and reluctant in presence of my wife.

I don’t remember about the previous incident, but at last time I am sure that though I had urinated in the bathroom before bed time, I dreamed and wet the bed.

Answer:

Bed wetting, also known as urinary incontinence during sleep or enuresis, is normal up to 3-4 years of age. Afterwards, the occurrence of urinary incontinence during sleep is termed secondary enuresis and is not considered normal in adults. The causes of adult urinary incontinence during sleep are varied and require a thorough evaluation.

Many 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. These conditions may include obstructive sleep apnea (repetitive airway closing in sleep), congestive heart failure, diabetes, nighttime seizures, depression, severe psychological stress, and dementia. Problems or disorders of the urinary tract system that can result in enuresis include urinary tract infections, an overactive bladder muscle or loss of control of the bladder sphincter. Of course, the excessive intake of fluids or substances that promote urination (i.e. diuretic medications, caffeine, and alcohol) can lead nighttime bedwetting.

Seizures are probably the most pressing concern. Commonly associated with urinary incontinence, seizures can result in cause tongue biting and muscle pain.

The possibility of abnormal sleep architecture resulting in difficulty arousing to the urge to urinate needs to be considered, particularly in young adults. Individuals with history of night terrors or sleep walking may continue to have difficulty arousing during their early adulthood. Changes in sleep architecture may also occur when one takes any of a variety of medications or herbal supplements. Antidepressants and over the counter sleep aids may result in abnormal behaviors during sleep.

There are several treatment strategies that range from behavioral to pharmacological (medications). It is imperative, however, to determine the cause of the bed wetting so that the appropriate treatment can be prescribed. This should start with an evaluation by your doctor first to determine the likelihood of seizures, anatomical abnormality, or bladder reflex abnormality, and to review your medications. If no cause is readily identified, you may need to undergo a sleep study to rule out a primary sleep disorder as well as some of the less obvious causes.

In the meantime, I recommend that you reduce your drinking within four hours of bedtime. You may want to urinate immediately before bedtime and try to awaken once within few hours to empty your bladder. These are temporary measures, however, and full evaluation by a physician is strongly recommended.

For more information:

Go to the Sleep Disorders health topic.