Nocturnal enuresis, commonly known as bed wetting, is a condition that causes significant distress and anxiety in adults. While often associated with childhood, it affects an estimated one to two percent of adults over the age of 18. The sudden onset of adult bed wetting often prompts concern about underlying health issues, including psychological trauma. Adult bed wetting, however, has a broad range of potential causes that require medical investigation.
Adult Enuresis: Defining the Condition
Adult enuresis is the repeated, involuntary passage of urine during sleep. Doctors classify the condition into two main categories based on the patient’s history.
Primary nocturnal enuresis describes a lifelong condition where the individual has never achieved a consistent period of nighttime dryness lasting more than six months. This form often relates to factors like genetics, reduced bladder capacity, or a deficiency in the hormone that slows nighttime urine production.
Secondary nocturnal enuresis occurs when an adult begins wetting the bed after having been dry for a minimum of six consecutive months. This type signals a disruption in the body’s normal mechanisms for bladder control or urine production during sleep. Because it represents a change from a previously dry state, secondary enuresis is the form that prompts investigation into new medical conditions, severe stress, or trauma.
The Connection Between Trauma and Adult Enuresis
Psychological trauma, particularly Post-Traumatic Stress Disorder (PTSD), can disrupt the complex brain-bladder communication pathway, leading to secondary enuresis. Trauma and chronic severe stress activate the body’s fight-flight-freeze response, governed by the autonomic nervous system. This activation leads to sustained sympathetic nervous system arousal, even during sleep, which interferes with continence.
The dysregulation of the autonomic nervous system can affect the detrusor muscle, which contracts the bladder. This sustained stress response is sometimes linked to altered secretion of cortisol, a stress hormone, affecting overall regulatory functions. For some individuals with PTSD, involuntary urination can function as a psychological regression in response to overwhelming emotional distress. This phenomenon is documented in clinical contexts, such as among military veterans who experience combat-related trauma.
Primary Medical and Physical Causes
For many adults, the cause of secondary enuresis is not psychological but directly related to an underlying physical condition. These conditions fall into several categories:
Bladder and Urinary Tract Issues
An overactive bladder, urinary tract infections (UTIs), or the presence of bladder stones can all cause sudden or frequent involuntary contractions of the bladder muscle that overwhelm the sphincter during sleep.
Systemic Diseases
Systemic diseases that affect the entire body can also manifest as nocturnal enuresis. Type 2 Diabetes, for example, can lead to increased urine production at night, known as nocturnal polyuria, due to the body attempting to flush out excess glucose. Obstructive sleep apnea (OSA) is another frequent cause, as repeated drops in blood oxygen levels stimulate the heart to release a hormone that increases kidney fluid excretion.
Neurological and Medication Factors
Other physical causes include neurological conditions that interfere with the nerve signals between the brain and the bladder. Diseases such as multiple sclerosis, Parkinson’s disease, or the after-effects of a stroke can impair the ability to recognize a full bladder or suppress the urge to urinate. Additionally, a number of medications can have nocturnal enuresis as a side effect, including certain psychiatric drugs and diuretics used to manage blood pressure or heart conditions. In men, prostate enlargement can also obstruct the flow of urine, leading to incomplete bladder emptying that contributes to overflow incontinence at night.
When to Seek Professional Help and Diagnosis
The onset of adult enuresis always warrants a professional medical evaluation to determine the precise cause. The initial step is typically a consultation with a primary care physician who will conduct a thorough physical examination and review the patient’s medical history. This evaluation often includes simple laboratory tests, such as a urinalysis, to check for signs of infection, blood, or high glucose levels that might indicate diabetes.
A key diagnostic tool is the bladder diary, where the patient tracks fluid intake, voiding times, and episodes of wetting for several days. This diary helps physicians assess the volume of urine produced at night and the bladder’s functional capacity. Depending on the initial findings, the primary care physician may refer the patient to a specialist, such as a urologist or a mental health professional.
Urologists may perform specialized tests, including ultrasound imaging or urodynamic studies, to assess the physical function of the bladder and urinary tract. Once the underlying cause is identified, treatment can be targeted, ranging from medication to reduce nighttime urine production or bladder overactivity, to behavioral therapies like fluid management and bladder training. If the condition is linked to psychological stress or trauma, a mental health professional can provide trauma-focused therapy to address the root emotional cause.