A Guest Blog By Christine Pruneau BSN, RAC-CT
Enuresis, or bed-wetting, is commonly associated with children but night time incontinence also affects adults, both young and old. While this can be an embarrassing condition, it is one that can be treated. In many cases, adult bedwetting can be a symptom of another condition, so the first step is determining the root cause. From there, finding ways to manage nighttime leaks can help make you more comfortable as you undergo appropriate treatment.
There are many potential causes of bed-wetting in adults, both young and old:
Causes in younger adults:
- Diabetes – new or undiagnosed
- Medication side effects
- Sleep apnea, or not awakening to the sensation of a full bladder
- Manufacturing large amount of urine at night
- Underdeveloped bladder
- Urinary tract infection or kidney/bladder stones
- Chronic constipation
- Weak pelvic floor muscles (mostly females)
- Neurological disorder or injury
In older adults, causes might also include:
- Bladder cancer or tumor
- Prostate cancer or enlargement
- Overactive bladder
- Weak pelvic floor muscles
If you are experiencing adult bedwetting, you should speak with a doctor, who will usually start by performing a complete physical examination that includes lab analysis of urine and blood. A referral to a specialist might be needed where additional tests would be ordered such as an abdominal ultrasound, neurological exam and other urological procedures.
Treatment of bedwetting in adults centers on the root cause. Many times the incontinence is reversible once the underlying cause is identified. Determining the origin is often the biggest challenge but definitely worth pursuing. Until there is a diagnosis and treatment regimen, it is important to keep yourself dry and comfortable during the night.
There are several options for managing bedwetting:
Adult protective underwear works wonders in protecting skin, bedding and clothing from urine when the need is moderate. For the best performance of these products, make sure they are the correct size and worn comfortably snug. Protective underwear or briefs are comfortable to wear and are available at drug stores, medical equipment providers and online retailers. In addition, protective bedding, such as waterproof pads and mattress covers can help make cleanup easy in the event there is overnight leakage.
Pelvic floor strengthening has proven to help adults of all ages with urge incontinence and bedwetting. A stronger pelvic floor could reduce the number of bedwetting episodes and allow a person to get to the bathroom in time to void. A physical therapist trained in incontinence care can be very helpful with these exercises.
Here are some other ideas, but patients should speak to their doctor before trying:
Set an alarm to awaken during the night to toilet.
If the patient is wet before the time of the alarm, set the alarm to an earlier time until finding the ideal hour of the night to toilet.
Watch fluid intake.
Limiting after-dinner fluids will likely reduce urine production at night. But PLEASE NOTE: if someone is very physically active into the evening hours, or could become dehydrated for any reason, this would not be recommended.
Medications to control incontinence is directed at treating the underlying cause. In cases where there is urge incontinence, some medications may help to relax the detrusor muscle contractions of the bladder. This type of incontinence is more common in older adults, but can certainly effect younger and middle-age adults as well. For those suffering from a lack of vasopressin (a chemical that keeps the body from eliminating too much fluid), Desmopressin is a drug that replaces vasopressin in the body. This is often associated with diabetes insipidus, brain tumor or head injury. Careful assessment by a specialist would be in order in this case.
Night time incontinence may differ with younger and older adults but can be treated and managed in most cases. Perseverance and motivation on the part of both patients and providers are key to managing nighttime incontinence. Know that adult bedwetting is not your fault, and, while it should not be considered normal, it does occur in many people. The good news is that adult bedwetting is something that can be managed with the right tools, and speaking with a physician can help you find the underlying cause and proper treatment.
Christine Pruneau RN, BSN, RAC-CT has 25 years of experience in clinical education for a long term care and home health. She is a frequent speaker on the subject of continence management and has a special interest in restorative health in both adults and children. Christine is the Clinical Director for Home Care Division at First Quality Healthcare.