ADULT BEDWETTING | CAUSES AND TREATMENTS
Learn about the factors that contribute to adult bedwetting, or nocturnal enuresis, and the many treatments available to those suffering from nighttime leaks.
For many adults, it is hard to even talk about something that is a “kid thing.” It must be noted that bedwetting in adults is actually different than what children go through. And while that might not remove the embarrassment, you must know that nocturnal enuresis is involuntary and not your fault.
To fully understand the how and why you may be experiencing adult bedwetting, a quick anatomy refresher course could be helpful. Urine is produced by the kidneys and travels through the ureters to the bladder to be stored. The bladder is basically a muscular sac that holds urine until it is ready to be released into the urethra, the tube that connects the bladder to the outside of the body. At the same time the bladder contracts, the urinary sphincter relaxes. The relaxed sphincter acts like an open door, which allows the urine to pass and exit the body. When there is a physical impediment or neurological disconnect, urination can become problematic or mistimed.
There are several factors that can contribute to an adult experiencing nocturnal enuresis. Like with so many medical issues, the first place to check is family history. Evidence has shown that adult bedwetting is hereditary. One study has shown that someone with two bedwetting parents has a 77% chance of becoming a bedwetter. When one parent wet the bed as a child, his son or daughter was found to have a 40% chance of becoming a bedwetter. These probabilities carry into adulthood as well.
Another factor may have to do with ADH, the antidiuretic hormone. Its main function is to signal the kidneys to decrease the amount of urine produced. Instinctively, the body normally produces more ADH to avoid nocturnal enuresis. However, some people do not produce the appropriate amount of this hormone at night, which leads to high urine production. In other cases, the body produces ADH, but the kidneys do not respond and continue to produce the same amount of urine. This excessive production of urine during sleep is defined as nocturnal polyuria. This abnormality can cause nocturnal enuresis in adults, but it is also a symptom related to type I diabetes. Consulting a healthcare professional is helpful especially if you feel that you may be experiencing diabetes or nocturnal enuresis.
Patients with a “smaller” bladder are often dealing with primary nocturnal enuresis. The physical size of the bladder isn’t actually smaller, rather, the functional bladder capacity (FBC) can hold a smaller volume of urine.
Related to FBC, if the muscles of the bladder, known as detrusor muscles, are overactive, nocturnal enuresis can occur. In fact, detrusor overactivity has been found in up to 70-80% of primary nocturnal enuresis patients. Bladder irritants, such as alcohol and caffeine, can contribute to detrusor instability. Medications are also known to increase bedwetting in adults. Side effects from hypnotics, insomnia medications, and psychiatric medications such as thioridazine, clozapine, and risperidone can increase your risk. Be sure to talk to your healthcare provider about any medications prescribed and their side effects.
As for secondary nocturnal enuresis, there is plenty of research that suggests an underlying health issue is at the root of the bedwetting. Such problems can be associated with the prostate in men or pelvic organ prolapse in women.
Any of these medical issues can also cause bedwetting in adults: diabetes, urinary tract infection, urinary tract stones, neurological disorders, anatomical abnormalities, urinary tract calculi, prostate cancer, prostate enlargement, bladder cancer, or obstructive sleep apnea.
Before a treatment can be prescribed, your physician will want to zero in on the cause of your nocturnal enuresis. A symptom diary is one of the most useful tools for a healthcare provider.
Take care to note when you void during the day and night:
- When accidents occur (time of day or night)
- Amount of urine voided
- Drinking patterns (do you drink a lot of fluids in the later afternoon/evening?)
- What you drink (sugary, caffeinated, artificially sweetened, carbonated, alcoholic drinks, etc.)
- Nature of the urinary stream (is the urinary stream strong and constant or is there difficulty initiating a void or continuous dribbling?)
- Any existing recurrent urinary tract infections
- The number of wet versus dry nights
- In addition, note any other symptoms associated with nocturnal enuresis such as night sweats
In addition to helping you find options to help cure bedwetting, it is also important to see a healthcare provider to rule out any other serious problems that may cause nocturnal enuresis as a side effect.
At the appointment you can expect:
- A physical examination
- Neurological evaluation
- Urinalysis and urine culture. The urinalysis and urine culture are different tests that determine the contents of the urine
Further tests may include:
- Uroflowometry. This involves urinating into a specialized funnel that measures the flow rate, amount of urine, and time required for urination
- Post-void residual urine measurements. This test requires an ultrasound and are non-invasive procedures that determine the volume of urine left in the bladder after voiding
For those suffering from persistent primary nocturnal enuresis, many treatments can be used at any age.
While there are a slew of reasons you may be wetting the bed, there are a handful of management techniques that can make all the difference when the goal is waking up dry. One of the biggest mistakes adults make is not using the correct products for protection - look for products specifically designed for overnight use, as these are more absorbent and can hold greater amounts of urine. Fit is also a big factor, so pay attention to the guides provided and don't get anything too big or too small, as it can result in leaking during the night.
- NAFC's Dry Night Solution Kit. The NAFC Dry Night Solution Kit is a great way to test out several products without breaking the bank. Sign up for the kit, and you'll receive educational brochures, sample absorbent products specifically designed for overnight use, bedding protection, and coupons to save you money on bedwetting supplies. Best of all, you will speak with a qualified professional about your bedwetting , who will set you up with a properly fitting product and suggest tools and products to best fit your needs. And, it's all delivered straight to your own home, so you don't need to worry about navigating the unknown in the middle of a large retail store.
- Mattress Covers. A variety of products exist to protect the bed including vinyl, waterproof, and absorbing mattress covers or even sheet protectors, which can make cleanup easier.
- Absorbent Briefs. These products are a form of modified underwear designed to absorb liquid, therefore preventing leakage. Both reusable and disposable products are available.
- Skincare Products. Many products exist to protect the skin from irritation and soreness that occur when a person experiences nocturnal enuresis. A range of soaps, lotions, and cleansing cloths exist for various skin types.
Nocturnal Enuresis may be the symptom of an underlying condition. If this is the case, successful treatment of the condition can result in achieving nighttime dryness. Please contact NAFC by going to www.nafc.org or call 1-800-BLADDER for more information. In addition to contacting NAFC, you should visit a healthcare provider to discuss symptoms and receive proper treatment.
- Monitoring Fluid Intake. Limiting intake of fluids in the late afternoon and evening before bedtime causes a decreased amount of urine produced at night.
- Bedwetting Alarm System. Multiple variations of the alarm exist, ranging from vibrating to sounding alarms and wet-detection devices that can be attached to the underwear or a pad on which the individual sleeps.
- Waking. This involves randomly setting an alarm to go off in the night in order to wake one for urination. The randomness keeps from training the bladder to need to empty at a set time.
The involvement of surgery when attempting to treat severe detrusor overactivity is limited and should only be considered when all other less invasive treatment options have proven to be unsuccessful. All of the procedures mentioned below have associated risks that must be considered and discussed with a healthcare professional.
- Sacral Nerve Stimulation. Sacral nerve roots are stimulated by neuromodulation, a process where neurotransmitters control various neuron groups. This increases the external sphincter tone causing the detrusor muscle neurons to stop activity. When detrusor muscle neurons have a decreased activity level the muscle will not contract constantly, which ultimately causes less frequent urination episodes. SNS is recommended for people with moderate to severe urge incontinence and for whom other treatments have not been helpful or for whom prescriptions are contraindicated.
- Clam Cystoplasty. This is a surgical treatment where the bladder is cut open and a patch of intestine is placed in between the two halves. The goal of this procedure is to reduce bladder instability and increase bladder capacity.
- Detrusor Myectomy. This process is also known as autoaugmentation that involves removing a portion or all of the exterior muscle surrounding the bladder. It intends to strengthen bladder contractions while reducing the number of them.
While no magic pill exists to totally eliminate nocturnal enuresis, there are medications available that might provide relief. When used in conjunction with behavioral modifications the positive effects of medication are more effective.
- Desmopressin. By mimicking ADH or vasopressin, the kidney produces less urine.
- Imipramine. Boasts a 40% success rate but also has a fine line between an effective dose and toxic dose.
Anticholinergic Medications. These prescription medications are effective for treating enuresis with detrusor overactivity, demonstrating success in 5-40% of cases. The main side effects with anticholinergic medications are dry mouth, dizziness, and blurred vision.
- Darifenacin. This medication relieves bladder spasms and treats overactive bladder.
- Oxybutynin. Relaxes the detrusor muscle of the bladder.
- Tolterodine. This medication is an antimuscarinic and functions much like oxybutynin.
- Trospium Chloride. Treats an unstable bladder by blocking cholinergic receptors that are found on muscle cells in the wall of the bladder. Once the receptors are blocked, the bladder then can relax so overactivity does not occur.
- Solifenacin. This is a recently introduced anticholinergic that is a more selective antimuscarinic agent with fewer anticholinergic side-effects.
TREATMENTS UNDERGOING TESTING
- Botulinum Toxin A. This form of treatment is an injectable bulking agent given through a flexible cystoscope, a thin medical instrument used to examine the interior of the bladder, in different areas of the detrusor muscle wall. This outpatient procedure lasts between 6-9 months with few reported adverse side effects. This “off label” use is still undergoing testing in clinical trials.
- Laser Acupuncture. This newer branch of acupuncture uses a laser to target specific areas of the body to treat a variety of medical problems. One study found that laser acupuncture had a success rate equal to that of desmopressin therapy after 3 months.