ABOUT ADULT BEDWETTING
For many adults, it is hard to even talk about something that they often think of as a “kid thing," but the truth is that 5,000,000 Americans struggle with adult bedwetting, also known as enuresis. There's no shame in recognizing that you have a problem with adult bedwetting. In fact, accepting that your body is not functioning the way you'd like it to is the first step towards treatment - and you'll be happy to hear that real, effective treatments are available. Simply put, there's no reason why anyone shouldn't have a dry night - and that includes you.
It's worth noting 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.
Read on for more information, or click here to jump down the page, where you'll find free downloadable materials that can help you better understand the nature of your condition and provide you strategies to talk with your doctor and develop a treatment strategy that works for you.
There are several factors that can contribute to an adult experiencing nocturnal enuresis, or adult bedwetting.
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.
Overactive Bladder Muscles
If the muscles of the bladder, known as detrusor muscles, are overactive, nocturnal enuresis can occur. In fact, an overactive bladder muscle has been found in up to 70-80% of adult bedwetting patients.
Bladder irritants, such as alcohol and caffeine, can contribute to detrusor instability. Try tracking your diet and bladder activity in a bedwetting diary to see if you notice any correlations with what you eat and drink and wetting the bed.
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.
Other Health Issues
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 bedwetting 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
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.
Adult Bedwetting MANAGEMENT
Talk to Your Doctor
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. In addition to managing your condition with any of the ideas listed below, you should also visit a healthcare provider to discuss symptoms and receive proper treatment.
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.
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.
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.
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.
Connect With Others
It may surprise you that adult bedwetting is a very common occurrence. In fact, this page is the most visited page on the NAFC website. If you live with this condition, we encourage you to sign on to the NAFC Message Boards. Many people on our message boards live with adult bedwetting and it’s a safe, anonymous place to learn from others. Find out what has worked for them, hear their stories, and, once you’re ready, share your own.
FREE DOWNLOADABLE GUIDES
Click on any of the images below to download your free guide - you'll find valuable information about the causes of bedwetting in adults, the range of treatments that are available, strategies for management and suggestions to make the most out of your next doctor's visit.
Your Guide To Good Nights And Great Mornings - Strategies for Addressing and Treating Adult Bedwetting
This brochure will give you all the information you need about bedwetting, why it happens and how you can manage it. Click the image above for your free copy.
It's Time To Talk... Visiting Your Doctor to Talk About Bedwetting
It's never easy to talk to someone about something as personal as bedwetting, even a physician. If you're struggling with how to talk to your doctor about this sensitive topic, this is the brochure for you. Click the image above for your free copy.
The NAFC Guide To Home Hygiene - Skin Care, Laundry, Bedding and Odor Control
Bedwetting can bring on a whole host of concerns, including questions about how to keep things clean and sanitary. Click the image above for your free guide on how to keep your bed and your home smelling fresh.
Bedwetting Discussion Guide
This short and simple questionnaire can be invaluable when it comes to helping you and your doctor determine the causes of your bedwetting and develop an effective plan to help you stay dry. Click the image above for your fee copy.
One of the most useful things you can do to treat your bedwetting issues is to keep a careful record. This easy-to-use tool can be of great value to the program you and your doctor develop to manage your condition. Click the image above for your free copy.
This simple guide lists many of the most common foods and beverages that can contribute to incontinence. It's a great sheet to have handy so you can avoid those everyday items that might exacerbate your condition. Click the image above for your free copy.