Erica Brownfield, MD


November 18, 2003


I am an internist practicing in Israel. I recently saw a 28-year-old previously healthy man who came to be evaluated for recent-onset bedwetting. Standard urinalysis, culture, and sequential multichannel autoanalyzer results were all negative. I am trying to determine if there is a psychological component. Do you have any other ideas or experience with a similar presentation?

Zachary Kleinbaum, MD

Response from Erica Brownfield, MD

It is estimated that 0.5% to 2% of adults have nocturnal enuresis (NE), or involuntary loss of urine that occurs only at night.[1] This disorder is not considered a disease itself, but rather a manifestation of underlying medical conditions. Numerous causes have been investigated, and various theories have been proposed. There is evidence of a genetic predisposition to NE.

The cause of NE is typically due to 1 or more of the following:

  • a problem waking up to the sensation of a full or contracting bladder

  • an increase in urine production at night

  • a bladder that acts small.

Such problems can be caused by detrusor instability or another functional bladder disorder, small bladder capacity, sleep disorders, or possible psychological factors (unclear if causal or due to underlying systemic disease).

It is important to take a thorough history and especially to determine if daytime symptoms are also present. If so, overactive bladder, spinal cord abnormalities with associated neurogenic bladder, urinary tract infections, constipation, and obstructive sleep apnea should be considered in the differential diagnosis. A physical exam, including a neurologic exam and urinalysis, should be routinely performed on a patient with this problem. Referral to a urologist is also appropriate so that further testing can be selectively done in those who require it. Treatment is optimally aimed at the underlying cause and consists of medical and surgical therapies. In addition, bed-wetting alarms, as well as other alternative treatments, exist.