Nocturnal Enuresis in the Adult

Structured Abstract

Purpose of Review

The goal of this paper is to describe the pathophysiology of adult nocturnal enuresis and develop a generalized approach for evaluation and treatment.

Recent Findings

Although nocturnal enuresis (NE) impacts a significant proportion of the adult population, research on this topic remains lacking. In the few existing studies, the management strategy is extrapolated from research on pediatric nocturnal enuresis. Furthermore, treatment approaches highlight the importance of identifying risk factors and contributing pathologies. The modern urologist should understand the complexity of this problem and the variety of techniques to evaluate and treat the adult patient with NE.


Adult nocturnal enuresis is multifactorial and may have multiple underlying pathologies. A comprehensive workup requires an understanding of the patient’s history and symptomatology and the pathophysiologic processes that can occur. Treatment should first target identifiable etiologies, although a generalized algorithm can then be utilized with behavioral and lifestyle modifications, followed by medical therapy. Future studies will provide a better framework for treating this problem.

This is a preview of subscription content, log in to check access.

Fig. 1.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Sakamoto K, Blaivas JG. Adult onset nocturnal enuresis. J Urol. 2001;165(6 Pt 1):1914–7.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Yeung CK, Sihoe JD, Sit FK, Bower W, Sreedhar B, Lau J. Characteristics of primary nocturnal enuresis in adults: an epidemiological study. BJU Int. 2004;93(3):341–5.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    • Lee D, Dillon BE, Lemack GE. Adult Onset Nocturnal Enuresis: Identifying Causes, Cofactors and Impact on Quality of Life. Low Urin Tract Symptoms. 2018;10(3):292–6. patients were evaluated to determine risk factors and adverse effects of adult NE.

    Article  PubMed  Google Scholar 

  4. 4.

    Pahwa AK, Andy UU, Newman DK, Stambakio H, Schmitz KH, Arya LA. Noctural enuresis as a risk factor for falls in older community dwelling women with urinary incontinence. J Urol. 2016;195(5):1512–6.

    Article  PubMed  Google Scholar 

  5. 5.

    Hillary CJ, Chapple CR. The evaluation and treatment of adult nocturnal enuresis. Curr Bladd Dysfunct Rep. 2014;9:84–9.

    Article  Google Scholar 

  6. 6.

    Yeung CK, Sihoe JD, Sit FK, Diao M, Yew SY. Urodynamic findings in adults with primary nocturnal enuresis. J Urol. 2004;171(6 Pt 2):2595–8.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Weiss JP, Blaivas JG. Nocturnal polyuria versus overactive bladder in nocturia. Urology. 2002;60(5 Suppl 1):28–32; discussion.

    Article  PubMed  Google Scholar 

  8. 8.

    Lukacz ES, Sampselle C, Gray M, Macdiarmid S, Rosenberg M, Ellsworth P, et al. A healthy bladder: a consensus statement. Int J Clin Pract. 2011;65(10):1026–36.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    •• Akhavizadegan H, Locke JA, Stothers L, Kavanagh A. A comprehensive review of adult enuresis. Can Urol Assoc J. 2018:282–7. is the most comprehensive review to date on adult nocturnal enuresis.

  10. 10.

    Lose G, Mattiasson A, Walter S, Lalos O, van Kerrebroeck P, Abrams P, et al. Clinical experiences with desmopressin for long-term treatment of nocturia. J Urol. 2004;172(3):1021–5.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Zahariou A, Karagiannis G, Papaioannou P, Stathi K, Michail X. The use of desmopressin in the management of nocturnal enuresis in patients with spinal cord injury. Eura Medicophys. 2007;43(3):333–8.

    CAS  PubMed  Google Scholar 

  12. 12.

    Chung E. Desmopressin and nocturnal voiding dysfunction: clinical evidence and safety profile in the treatment of nocturia. Expert Opin Pharmacother. 2018;19(3):291–8.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Koo P, McCool FD, Hale L, Stone K, Eaton CB. Association of obstructive sleep apnea risk factors with nocturnal enuresis in postmenopausal women. Menopause. 2016;23(2):175–82.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Ninivaggio C, Riese H, Dunivan GC, Jeppson PC, Komesu YM, Murata A, et al. One and the same? Nocturnal enuresis and overactive bladder in the female veteran population: evaluation of a large National Database. Female Pelvic Med Reconstr Surg. 2018;24(4):307–11.

    Article  PubMed  Google Scholar 

  15. 15.

    Madhu CK, Hashim H, Enki D, Drake MJ. Risk factors and functional abnormalities associated with adult onset secondary nocturnal enuresis in women. Neurourol Urodyn. 2017;36(1):188–91.

    Article  PubMed  Google Scholar 

  16. 16.

    Ekinci O, Celik T, Unal S, Oktay G, Toros F, Ozer C. Nocturnal enuresis in sickle cell disease and thalassemia major: associated factors in a clinical sample. Int J Hematol. 2013;98(4):430–6.

    Article  PubMed  Google Scholar 

  17. 17.

    Bower WF, Sit FK, Yeung CK. Nocturnal enuresis in adolescents and adults is associated with childhood elimination symptoms. J Urol. 2006;176(4 Pt 2):1771–5.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Campbell P, Li W, Money-Taylor J, Davies J, Gray T, Radley S. Nocturnal enuresis: prevalence and associated LUTS in adult women attending a urogynaecology clinic. Int Urogynecol J. 2017;28(2):315–20.

    Article  PubMed  Google Scholar 

  19. 19.

    El-Bahnasawy MS, Shaaban H, Gomha MA, Nabeeh A. Clinical and urodynamic efficacy of oxybutynin and verapamil in the treatment of nocturnal enuresis after formation of orthotopic ileal neobladders. A prospective, randomized, crossover study. Scand J Urol Nephrol. 2008;42(4):344–51.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Weiss JP, Everaert K. Management of nocturia and nocturnal polyuria. Urology. 2019;133S:24–33. comprehensive review of the evaluation and managament of adult nocturia.

    Article  PubMed  Google Scholar 

  21. 21.

    Ouslander JG, Ai-Samarrai N, Schnelle JF. Prompted voiding for nighttime incontinence in nursing homes: is it effective? J Am Geriatr Soc. 2001;49(6):706–9.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Hofmeester I, Kollen BJ, Steffens MG, van Capelle JW, Mulder Z, Feitz WF, et al. Predictors for a positive outcome of adapted clinical dry bed training in adolescents and adults with enuresis. Neurourol Urodyn. 2016;35(8):1006–10.

    Article  PubMed  Google Scholar 

  23. 23.

    Sinha R, Raut S. Management of nocturnal enuresis - myths and facts. World J Nephrol. 2016;5(4):328–38.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Tani M, Hirayama A, Torimoto K, Matsushita C, Yamada A, Fujimoto K. Guidance on water intake effectively improves urinary frequency in patients with nocturia. Int J Urol. 2014;21(6):595–600.

    Article  PubMed  Google Scholar 

  25. 25.

    Hashim H, Al MR. Management of fluid intake in patients with overactive bladder. Curr Urol Rep. 2009;10(6):428–33.

    Article  PubMed  Google Scholar 

  26. 26.

    Yucel S, Kutlu O, Kukul E, Baykara M. Impact of urodynamics in treatment of primary nocturnal enuresis persisting into adulthood. Urology. 2004;64(5):1020–5; discussion 5.

    Article  PubMed  Google Scholar 

  27. 27.

    Vandersteen DR, Husmann DA. Treatment of primary nocturnal enuresis persisting into adulthood. J Urol. 1999;161(1):90–2.

    CAS  Article  Google Scholar 

  28. 28.

    Burgu B, Gokce MI, Gucuk A, Soygur T. Prospective evaluation of factors affecting the response and relapse rates to desmopressin therapy in male monosymptomatic enuretic adults. Urology. 2009;74(4):915–9.

    Article  PubMed  Google Scholar 

  29. 29.

    Hajdinjak T, Leskovar J. Comparison of nocturia response to desmopressin treatment between patients with normal and high nocturnal bladder capacity index. ScientificWorldJournal. 2013;2013:878564–7.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Han J, Jung JH, Bakker CJ, Ebell MH, Dahm P. Desmopressin for treating nocturia in men. BJU Int. 2018;122(4):549–59.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    •• Ebell MH, Radke T, Gardner J. A systematic review of the efficacy and safety of desmopressin for nocturia in adults. J Urol. 2014;192(3):829–35. article supports the utility of desmopressin in adults and offers a generalized approach for the clinician.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Goldberg H, Baniel J, Mano R, Gillon G, Kedar D, Yossepowitch O. Low-dose oral desmopressin for treatment of nocturia and nocturnal enuresis in patients after radical cystectomy and orthotopic urinary diversion. BJU Int. 2014;114(5):727–32.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Neveus T. Nocturnal enuresis-theoretic background and practical guidelines. Pediatr Nephrol. 2011;26(8):1207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Chancellor MB, Rivas DA, Staas WE Jr. DDAVP in the urological management of the difficult neurogenic bladder in spinal cord injury: preliminary report. J Am Paraplegia Soc. 1994;17(4):165–7.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Hunsballe JM, Rittig S, Pedersen EB, Olesen OV, Djurhuus JC. Single dose imipramine reduces nocturnal urine output in patients with nocturnal enuresis and nocturnal polyuria. J Urol. 1997;158(3 Pt 1):830–6.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Lara S. MacLachlan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent and Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Female Urology

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Katz, E.G., MacLachlan, L.S. Nocturnal Enuresis in the Adult. Curr Urol Rep 21, 31 (2020).

Download citation


  • Nocturnal enuresis
  • Nocturnal polyuria
  • Nocturia
  • Desmopressin
  • Urinary incontinence