A urinary tract infection (UTI) can cause uncomfortable urinary symptoms like a frequent and intense urge to urinate, burning or pain when urinating, cloudy or foul-smelling urine, and pelvic pain. Some people with a UTI also experience accidental urination or leakage when they sleep. This is called nocturnal enuresis. Nocturnal enuresis from a UTI can occur in both children and adults.
While uncomfortable and disruptive, urinating during sleep with a UTI is usually not a cause for major concern. Proper treatment of the infection will typically resolve the symptoms. However, in some cases, frequent urination at night may be a sign of a more serious issue that requires medical attention.
What causes urinating during sleep with a UTI?
A UTI occurs when bacteria enter the urinary tract and multiply, infecting the urethra, bladder, ureters, or kidneys. The most common cause is the E. coli bacteria from the gastrointestinal tract. Sexual intercourse, pregnancy, catheter use, and other factors that introduce bacteria into the urinary tract increase UTI risk.
The infection causes inflammation and irritation of the bladder and urinary tract. This leads to strong, frequent urges to urinate as the bladder tries to flush out the infection. The inflammation also causes a decreased bladder capacity and weaker control of the urinary sphincters.
At night, the symptoms may lead to accidental urination during sleep before the person can wake up and get to the toilet. Some potential causes include:
– Increased nighttime urine production – The kidneys produce more urine at night which can overwhelm bladder capacity if already reduced by the UTI.
– Overactive bladder – Bladder contractions and urinary urgency caused by the UTI can lead to leakage.
– Weakened pelvic floor muscles – Pelvic muscles help control urination. Weakness from pregnancy, childbirth, aging, or other factors can contribute to leakage.
– Sleep disrupting bladder urgency – The intense and frequent need to urinate disrupts sleep cycles and full bladder awareness.
– Impaired nervous system control – The nervous system helps regulate urination, but impairment from spinal injuries, stroke, multiple sclerosis, or other neurological conditions can reduce control.
Risk factors
While anyone with a UTI may experience urinary leakage during sleep, some people are at higher risk including:
– Women – Women have a shorter urethra that allows bacteria quick access to the bladder. Pregnancy and menopause also increase UTI risk.
– Uncircumcised men – Uncircumcised men have a higher rate of UTIs than circumcised men.
– Diabetes – High blood sugar impairs the immune system and increases vulnerability to infection. UTIs are more frequent in people with diabetes.
– Blockages – Kidney stones, enlarged prostate, strictures, or other obstructions increase infection risk.
– Catheters – Catheters provide a direct route for bacteria to enter the urinary tract.
– Previous UTIs – Having a previous UTI makes you more prone to recurrent infections.
– Weakened immune system – Conditions like HIV, cancer treatment, steroid use, and organ transplant can impair immune defenses and raise UTI risk.
– Spinal cord injuries – Nervous system disruption from spinal injuries can cause bladder control problems.
– Advanced age – Bladder control tends to decline with age making leakage more likely.
When to see a doctor
You should contact your doctor if you experience any urinary leakage while sleeping. It could signal an underlying UTI or other medical issue requiring treatment. Seek prompt medical attention if you have any of the following:
– Fever over 101°F – This may indicate a kidney infection.
– Back or side pain – Pain could result from kidney infection or obstruction.
– Nausea and vomiting – Kidney infection or blockage can cause nausea.
– Blood in urine – Hematuria indicates bladder or kidney damage.
– Weak urine stream – Could result from obstruction like enlarged prostate in men or bladder prolapse in women.
– Foul-smelling urine – Suggests infection.
– Uncontrolled leakage – Seek help for heavy leakage or complete loss of bladder control.
– Recurrent UTIs – More than two in six months merits evaluation to check for obstructions or other abnormalities.
– Leakage without UTI symptoms – This warrants assessment for other potential causes like overactive bladder or pelvic floor dysfunction.
When urinary leakage at night is normal
Occasional, minor urine leakage during sleep may not require immediate medical care if you have typical UTI symptoms like:
– Burning with urination
– Frequent and urgent need to urinate
– Pelvic discomfort
– Cloudy or strong-smelling urine
In this case, make an appointment with your doctor within a few days to get evaluated and treated for the likely UTI. Be sure to mention your nighttime leakage. Starting a short course of antibiotics should resolve the infection and associated urinary symptoms.
However, if you don’t have typical UTI symptoms along with the nighttime urinary issues, see your doctor promptly to check for other potential causes.
Diagnosing the cause
To diagnose the reason for urinary leakage during sleep, the doctor will typically:
– Take a medical history – They will ask about your symptoms, UTIs, medications, bowel and bladder habits, mobility issues, and other medical conditions.
– Conduct a physical exam – They will assess your abdomen, back, pelvic area, rectum, and neurological function.
– Obtain a urine sample – This will be tested for signs of infection like bacteria, white blood cells, and nitrites.
– Analyze urine culture – A lab culture can identify the specific bacteria causing a UTI.
– Order imaging tests – Ultrasounds or CT scans check for obstructions like stones or tumors.
– Perform cystoscopy – A small tube with a camera is inserted to directly visualize the urethra and bladder.
– Conduct urodynamic testing – This assesses bladder function during filling and emptying.
– Prescribe bladder diary – You track when and how much you urinate and drink over a few days.
Your doctor will review the results to pinpoint if a UTI, overactive bladder, weak pelvic floor, obstruction, or other problem is causing you to leak urine during sleep.
Treatments for urine leakage with UTI
Treating the UTI is the first step in resolving leakage during sleep. Additional treatments may include:
– Antibiotics – Oral antibiotics specifically treat the bacteria causing the UTI based on urine culture results.
– Increased hydration – Drinking adequate water and fluids helps flush out bacteria.
– Urinate regularly – Emptying your bladder regularly prevents excessive filling.
– Bladder training – This trains your bladder to hold more urine by resisting urgency.
– Pelvic floor therapy – Strengthening exercises can improve pelvic floor muscle tone.
– Biofeedback – This uses electrical stimulation to help gain bladder control.
– Anticholinergics – These medications calm bladder muscle contractions for urgency.
– Desmopressin – This synthetic hormone reduces nighttime urine production.
– Catheterization – Using a tube to empty the bladder may help in some cases.
– Surgery – Removing obstructions, diverticula, bladder stones or tumors can reduce leakage.
Lifestyle and home remedies
You can also take some self-care steps at home to help manage urinary leakage during sleep from a UTI:
– Urinate before bed – Empty your bladder right before going to sleep.
– Limit fluids before bed – Cut off intake 1-2 hours before bedtime.
– Take antibiotics as prescribed – Completing the full UTI antibiotic course is essential.
– Stay hydrated during the day – Drink plenty of water during the daytime.
– Urinate after intercourse – Flush out bacteria introduced during sex.
– Wipe front to back – Prevent bacteria being transferred from rectum to urethra.
– Take cranberry products – Cranberries contain compounds that may help prevent UTIs.
– Consider probiotics – Probiotics support healthy vaginal and urinary tract bacteria.
– Practice pelvic floor exercises – Strengthening pelvic muscles promotes bladder control.
– Maintain a healthy weight – Excess weight can put pressure on the bladder.
– Avoid constipation – Hard stools can obstruct urine flow and raise UTI risk.
– Use protective pads or bedding – Absorbent pads or sheets safeguard mattresses
When urinary leakage requires medical treatment
While minor leakage due to UTI may resolve with infection treatment and self-care, frequent or heavy nighttime incontinence usually merits medical management. See your doctor if you have:
– Leakage more than 2-3 times per week
– Heavy leakage flooding your clothes or bedding
– No UTI symptoms along with leakage
– Recurrent UTIs with leakage between infections
– Leakage accompanied by back pain, nausea, fever, or other concerns
– Leakage persisting after UTI treatment
Your doctor can evaluate your specific symptoms, diagnose any underlying cause, and provide appropriate therapies to treat your nighttime incontinence. Leaving bladder control problems unchecked can worsen over time, so seek help to regain comfortable sleep and hygiene.
Coping with nighttime urinary leakage
Until you can resolve the cause of your nighttime urinary leakage, take steps to make coping easier:
– Use incontinence pads – Disposable absorbent pads worn at night contain leaks.
– Wear adult diapers – Diapers with greater absorbency provide nighttime protection.
– Place pads under sheets – Absorbent pads protect the mattress.
– Set alarms to wake and urinate – Alarms remind you to wake up and urinate.
– Limit sleep aids and sedatives – These drugs inhibit your ability to wake up to urinate.
– Review medications – Diuretics or medications with frequent urination as a side effect may contribute.
– Use a bedside commode or urinal – These allow urinating immediately when you wake with urgency.
– See a counselor – A counselor can help you handle emotional aspects like shame or embarrassment.
– Join a support group – Connecting with other people experiencing urinary incontinence provides support.
Preventing recurrent UTIs and leakage
After treating an acute UTI, take proactive steps to avoid recurrent infections and associated nighttime leakage:
– Wipe front to back after using toilet
– Urinate before and after intercourse
– Drink cranberry juice or take cranberry supplements
– Take probiotics to support urinary tract bacteria
– Stay hydrated with adequate water intake
– Don’t use irritating feminine hygiene sprays
– Avoid prolonged use of diaphragm contraceptives
– Don’t delay urinating when urge hits
– Urinate as soon as possible after intercourse
– Avoid hot tubs and bubble baths
– Consider daily preventive antibiotics if you get frequent UTIs
– Establish consistent toilet habits
– Practice pelvic floor strengthening exercises
– Maintain good toilet and genital hygiene
– Wear cotton underwear and avoid overly tight clothing
Recurring UTIs warrant medical investigation to check for underlying abnormalities or obstructions that may require treatment beyond antibiotics alone.
Conclusion
Urinary leakage or wetting the bed during sleep can occur as a symptom of an underlying UTI, especially in women prone to recurrent bladder infections. While inconvenient, minor nighttime incontinence associated with typical UTI symptoms often resolves after proper antibiotic treatment and self-care. However, frequent or persistent leakage, leakage without UTI symptoms, or other concerns merit prompt medical evaluation to diagnose and treat the underlying cause. Work with your doctor to find the right therapies and lifestyle changes to manage urinary control issues and sleep comfortably through the night.
