Why Adult Women May Experience Bed-Wetting and How Pelvic Floor Therapy Can Help

By Dr. Christine Martirez PT, DPT on 11/8/2024

Bed-wetting, also known as nocturnal enuresis, is often thought of as a childhood issue. However, many adult women silently struggle with bed-wetting as well. It can be an embarrassing and frustrating condition, but understanding its causes can pave the way for effective treatment. Often, the issue isn't just about the bladder itself; it involves the pelvic floor, neurological control, and daily bladder habits. In this post, we'll explore why adult women may experience bed-wetting, the role of pelvic floor muscles, and how pelvic floor therapy can help.

The Anatomy of the Pelvic Floor and Its Relationship to the Bladder

The pelvic floor is a group of muscles that form a supportive hammock at the base of the pelvis. These muscles support the pelvic organs, including the bladder, uterus, and rectum. They also play a crucial role in bladder control by coordinating the opening and closing of the urethra (the tube that allows urine to exit the bladder).The bladder itself is a hollow organ that stores urine until it's ready to be expelled. When the bladder fills, it sends signals to the brain indicating that it's time to urinate. The pelvic floor muscles respond by either relaxing to allow urine to pass or contracting to hold it in.

How Daytime Bladder Habits Can Impact Nighttime Control

Daytime bladder habits can greatly influence what happens at night. For instance, if someone frequently experiences urinary urgency and frequency during the day, those habits can carry over into nighttime. Here’s how this might happen:

• Frequent trips to the bathroom during the day

  can train the bladder to become more sensitive to even small amounts of urine. This can lead to a reduced bladder capacity over time, making it harder to hold urine at night.

• Holding urine for extended periods during the day

  can weaken the communication between the bladder and the pelvic floor muscles, potentially leading to less control at night.

• Fluid intake patterns

  also matter; drinking large amounts of fluid close to bedtime can contribute to nighttime bladder issues.

All these behaviors can train the bladder to become more reactive, increasing the likelihood of bed-wetting.

The Neurological Control of the Bladder and Its Impact on Bed-Wetting

The bladder's function is governed by complex neurological pathways, including a series of "loops" that connect the bladder, spinal cord, and brain. Here’s how this system works:

1. Filling Stage

   As the bladder fills, it sends signals via the pelvic nerves to the brain to indicate that it’s reaching capacity.

2. Storage Phase

   The brain responds by sending inhibitory signals to the bladder, encouraging it to continue storing urine until it’s an appropriate time to void.

3. Voiding Phase

   When you consciously decide to urinate, the brain relaxes the pelvic floor muscles and the bladder contracts to release urine.

However, when these neurological loops become disrupted—due to factors like stress, pelvic floor dysfunction, or an overactive bladder—the bladder can send incorrect signals to the brain, triggering urgency and even involuntary urination at night.

How Pelvic Floor Dysfunction Can Contribute to Bed-Wetting

Weak or overly tight pelvic floor muscles can contribute to urinary incontinence and bed-wetting. Here’s how:

• Pelvic floor muscle weakness

  can make it harder for the muscles to stay contracted during sleep, especially when the bladder fills to capacity.

• Overly tight pelvic floor muscles

  may be unable to relax properly, leading to poor coordination and sudden urges. Paradoxically, tight muscles can also cause leakage because they may fatigue more easily, especially at night.

• Muscle imbalances

  or scar tissue (such as from childbirth or surgery) can disrupt the communication between the bladder and pelvic floor muscles.

How Pelvic Floor Therapy Can Help Adult Women with Bed-Wetting

Pelvic floor physical therapy offers a comprehensive approach to managing bed-wetting and other forms of urinary incontinence. Here’s how therapy can help:

1.

Pelvic Floor Muscle Training

A pelvic floor therapist will assess the strength, flexibility, and coordination of your pelvic floor muscles. Through exercises, biofeedback, and other techniques, therapists can help you gain better control over these muscles to improve bladder control.

2.

Neuromuscular Re-education

Therapists use biofeedback to retrain the bladder-pelvic floor communication pathways. This helps improve the timing and coordination of muscle contractions, reducing nighttime leakage.

3.

Bladder Retraining

Bladder retraining involves gradually increasing the time between bathroom visits during the day to help increase bladder capacity and reduce urgency. By retraining your bladder habits, you can minimize the frequency of nighttime urges.

4.

Breathwork and Relaxation Techniques

Since stress and anxiety can exacerbate urinary urgency, therapists may include breathwork and relaxation exercises to help calm the nervous system and reduce overactive bladder symptoms.

5.

Manual Therapy

Manual therapy techniques can release tension in the pelvic floor, abdomen, and surrounding muscles to enhance muscle function and improve bladder control.

Bed-wetting in adult women is more common than most people think, but it doesn’t have to be a lifelong struggle. Understanding the root causes—whether they’re related to the pelvic floor muscles, neurological control, or daily habits—can help guide effective treatment. Pelvic floor therapy offers a holistic approach that addresses the underlying causes of bed-wetting, empowering you to regain control and improve your quality of life. If you’re experiencing bed-wetting or other forms of urinary incontinence, consider seeking out a pelvic floor physical therapist who can provide individualized support tailored to your needs.

Struggling with urinary urgency, frequency, or night time bed wetting? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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