Managing Incontinence at Night

Why night-time is different

• Higher night urine production. In many older adults the body makes more urine at night than in the day. Causes include fluid pooled in the legs by day that returns to the circulation when lying down (swollen ankles), heart failure, kidney conditions, diabetes, sleep apnoea, reduced hormone levels that normally concentrate urine at night, and drinks, caffeine, alcohol or diuretics taken late.
• Overactive bladder and an enlarged prostate can cause frequent waking.
• Poor sleep: a person who sleeps lightly wakes and then feels the need to pass urine; pain, anxiety, restless legs and noise all contribute; see insomnia in older adults.
• Deep sleep with sedatives can make a person miss the signal and wet the bed.
• Mobility, vision and distance from the toilet.
• Dementia, where the person may not recognise the urge, the toilet or the dark room.
• Cold, damp nights and heavy bedding that make getting up hard.
• Constipation pressing on the bladder.
• Urinary infection; see urinary tract infections in older adults: atypical signs.

Start with the doctor

Many causes of night-time urine are treatable, and changing them may reduce wetting more than any product. Ask the doctor to look at:

• Medicines and their timing. Water tablets (diuretics) taken late in the day can cause night urine; sleeping tablets and sedatives can cause wetting and falls; some other medicines affect the bladder. Never change the timing or dose of any medicine yourself; ask the doctor whether a timing change is appropriate.
• Heart, kidney, thyroid and blood sugar, and swelling of legs; see swollen legs in older adults and diabetes after 60: a home care guide.
• Prostate or bladder emptying problems; see prostate problems and urinary symptoms in older men.
• Sleep apnoea, which raises night urine; see sleep apnoea in older adults: signs and next steps.
• Infection and constipation.
• A bladder and night diary, to count night visits and volumes.

See incontinence in older adults: causes and types and when to see a doctor about bladder or bowel changes.

Evening habits that help

• Spread drinks through the day, and reduce them gradually in the two to three hours before bed, if the doctor agrees and the person is not at risk of dehydration. Do not cut fluids overall; see hydration for older adults.
• Limit caffeine and alcohol, especially after mid-afternoon: tea, coffee, cola and alcohol irritate the bladder and increase urine.
• Be careful with evening soups, fruit and watery foods if they trigger night trips.
• Reduce salt in the evening meal, since salty food can raise night urine in some people. Ask the doctor or dietician.
• Elevate the legs for an hour in the late afternoon if the legs swell, as the doctor advises, so that fluid returns to circulation and is passed before bed.
• Encourage movement during the day, which improves sleep and circulation; see chair exercises for seniors.
• Offer a last toilet visit just before bed, sitting and emptying fully, and consider a second attempt after a minute or two ("double voiding") if advised.
• Avoid heavy late meals.
• Keep a calm bedtime routine.
• Treat constipation; see constipation in older adults.

Overnight products

• Choose high-absorbency overnight products that fit well; see pull-ups or briefs: choosing the right product and how to measure for adult diapers and pull-ups. A product that is too thin or the wrong size leaks.
• Use briefs with tabs for bedridden people, and overnight pull-ups for mobile ones.
• Add an underpad on the bed as a backup; see underpads: disposable and washable options.
• Use a waterproof mattress protector, breathable and fitted; see mattress protectors for incontinence.
• Avoid doubling pads inside the brief, which can cause leaks.
• Skin first: apply a thin barrier cream if advised; see barrier creams and skin care under pads.
• Change if the person wakes wet or after a bowel movement; do not leave a person wet to preserve sleep, but minimise disturbance with low light, a warm room and a calm voice. Many people can stay in a well-fitted overnight product through the night if the skin is healthy, but change on waking or at the first chance.
• Check skin each morning; see incontinence-associated skin damage: prevention and care.

Making the toilet close and safe

• Bedside commode near the bed, with a firm seat, arms and locked wheels or stable legs; see commode chair guide and bedside commode and urinal routines.
• Urinal within reach, for men or women; see urinals for men and women: bedside use.
• Clear, short, well-lit route to the bathroom, without rugs, cords or clutter; see flooring, rugs and trip hazards.
• Night lights that come on with movement, low and warm, along the path and in the bathroom; see motion night lights for seniors.
• A bed at the right height, so that the person can sit and stand with feet flat; bed rails only if advised, since they can be a risk; see bedroom setup for night safety.
• Sit before standing: teach the person to sit on the edge of the bed for a minute before standing, to avoid dizziness; see dizziness when standing: postural hypotension in older adults.
• A phone, a bell or an alert within reach; see night safety for a parent alone and panic pendant buying guide.
• Non-slip footwear or socks with grip, and a warm robe.
• Grab bars in the bathroom; see bathroom safety checklist for seniors.
• Walking aid at the bedside if used; see night-time toilet trips and falls.

Timed or prompted night toileting

For some people, especially with dementia or heavy sleep, waking once at a set time, such as around midnight or in the early hours, to offer the toilet can prevent wetting. This must be balanced against the value of uninterrupted sleep for both the person and the carer. A diary shows the typical time of wetting, and a visit about an hour earlier may help. Ask the doctor or nurse; see bladder training and timed toileting.

Dementia and night

People with dementia may wake confused, not recognise the room, wander, hide wet clothes or resist change; see incontinence and dementia: routines and reassurance, dementia sundowning and night-time caregiving routines. A consistent bedtime routine, an easily recognised toilet door and commode, soft light, and gentle voices help. Avoid arguments in the night.

Protecting sleep: for both of you

• Plan changes to be quick and quiet: have supplies ready at the bedside (wipes, pad, gloves, bag, spare nightwear), with a small lamp; see how to change an adult diaper in bed.
• Share night duties among family members or a trained attendant; see hiring a home attendant checklist.
• Use a monitor or a bell instead of checking repeatedly.
• Look after the carer: rest during the day, and ask for help; see caregiver burnout: signs and prevention.
• Keep the room comfortable, with good ventilation and a cool temperature in summer; see temperature and ventilation at home.

Red flags

Call the doctor promptly for:

• Sudden new night wetting or frequency.
• Burning, pain, blood in urine, fever or new confusion.
• A swollen lower abdomen, inability to empty or a weak stream.
• Very large amounts of urine at night with thirst and weight loss (possible diabetes).
• Breathlessness lying flat, swelling and weight gain (possible heart failure); see heart failure at home: daily checks and warning signs.
• Falls on the way to the toilet.

Call 112 for inability to pass urine with severe pain, fever with confusion, severe breathlessness, chest pain or a serious fall.

When to ask a professional

Ask the doctor for a review of the causes of night-time urine, medicines and timing, and for tests. Ask a continence nurse for products and routines. Ask an occupational therapist for a home safety check, including the bedroom and bathroom. Ask a pharmacist about sedatives and other medicines. Seek urgent help for the red-flag signs above.