Nocturnal Enuresis (Adult Bedwetting)

Bedwetting is often a term that is associated with infants and young children, however a grown adult can also suffer from bedwetting! Read on to learn about what causes adult bedwetting and how to cure it.


What is Nocturnal Enuresis?

'Nocturnal Enuresis' is the medical term for bedwetting. This involves the involuntary release of urination at night. Throughout adult life, 1 in 100 people may be affected by nocturnal enuresis. This can lead to an array of social and psychological problems. You may not feel that you can attend social opportunities, such as business meetings and holidays, therefore compromising your lifestyle quality. It can also cause you stress and affect your self-esteem, possibly negatively impacting on relationships.


What are the Types of Nocturnal Enuresis?

There are two types of nocturnal enuresis:

  • Primary Nocturnal Enuresis - The involuntary release of urine during the night that develops in childhood. Enuresis is considered as primary when bladder control has never been achieved.
  • Secondary Nocturnal Enuresis - Enuresis is considered as secondary when incontinence reoccurs after at least six months of continence.

What Causes Nocturnal Enuresis?

There are a variety of physical and psychological conditions that can lead to the development of nocturnal enuresis in adults. Common causes include:

  • Hormone imbalance - The antidiuretic hormone (ADH) has the main function of signalling the kidneys to decrease the amount of urine produced. Usually, the body produces more of this hormone at night to avoid nocturnal enuresis. However, some people are unable to produce the appropriate amount of this hormone at night which can lead to a high urine production. In other cases, the hormone is not acted upon by the kidneys, allowing them to continue to produce the same amount of urine.
  • A small bladder - This if often the cause in patients who suffer from primary nocturnal enuresis. A common misconception is to believe that the bladder is smaller in size, this is not true. Instead, the physical size of the bladder is not small, rather it can only hold a smaller volume of urine. If the muscles of the bladder are overactive, primary nocturnal enuresis can occur; this is the case with 70%-80% of patients.
  • Obstructive sleep apnoea - This occurs when the walls of the throat relax and narrow whilst you sleep. This can lead to your sleep becoming interrupted on a regular basis.
  • Neurological disorders - Damage to the nervous system can cause problems that affect the bladder, the urethra, and the muscles that control the release of urine. People with neurological disorders can have problems with any of these.
  • Prostate problems - Nocturnal enuresis can be a symptom of Benign Prostatic Hyperplasia.
  • Bladder irritants - Caffeine and alcohol can contribute to bladder muscles instability. This is why some people find they've involuntary urinated during the night after consuming alcohol.
  • Diabetes - People with diabetes can develop secondary nocturnal enuresis because diabetes can cause excessive amounts of urine, as well as excessive thirst.
  • Bladder cancer - Harmful cells can invade the bladder and destroy healthy cells, causing the bladder to not function correctly.

Is Nocturnal Enuresis Genetic?

Wetting the bed as an adult can be a result of a hereditary issue. If both of your parents suffered from nocturnal enuresis, then you have a 77% chance of becoming a bedwetter too. You have a 40% chance of suffering from nocturnal enuresis if just one of your parents were a bedwetter. These probabilities continue from childhood into adulthood.


What is the Treatment for Nocturnal Enuresis?

Nocturnal enuresis can often be cured in most cases, and if not, a treatment can normally be found to improve the condition.

Many people are embarrassed to seek help for nocturnal enuresis, which will not improve the symptoms at all. Before your GP arranges a treatment, they will first want to diagnose the cause of your nocturnal enuresis. A bladder diary may be given to you where you can note:

  • When accidents occur (day or night)
  • The amount of urine voided
  • Your drinking patterns (do you have an influx of fluid in the late afternoon or evening?)
  • What you drink (sugary, caffeinated, artificially sweetened, carbonated, alcoholic drinks etc. can all impact on your condition
  • The nature of your urinary stream (is it strong and constant, difficult to initiate, or continuously dribble?)
  • Any existing recurrent urinary tract infections
  • The number of wet versus dry nights
  • Any other symptoms

Further investigation may be required for your condition, such as a physical examination. Your urine may also be analysed to determine a cause.

Short-term Management of Nocturnal Enuresis Includes Purchasing:

  • Absorbent pads
  • Absorbent underwear
  • Mattress covers or protectors

Long-term Management of Nocturnal Enuresis Includes:

  • Kegel exercises - Pelvic floor exercises are often the recommended treatment to prevent and treat nocturnal enuresis in adults. You can increase your bladder control by strengthening your pelvic floor; this can prevent bedwetting episodes and allow you to reach the bathroom in time. Try an electronic pelvic toner if you find it hard to perform manual Kegel exercises; an electronic toner can stimulate 90% of pelvic floor muscles, compared to 40% stimulate through manual Kegel exercises alone. To learn more about the benefits of a strong pelvic floor, click here.
  • Monitoring your fluid intake - You can decrease the amount of urine that you produce at nighttime by limiting your fluid intake in the late afternoon and evening.
  • Waking - Nocturnal enuresis can be treated by waking yourself up during the night to urinate. This can be done by randomly setting an alarm; keeping the time random ensures that your bladder is not trained to empty at a certain time.
  • Medication - There are no pills that can totally eliminate nocturnal enuresis but your GP may prescribe you with medication to help provide relief.
  • Surgical treatment - This is only considered when all other, less invasive treatments have been unsuccessful.


Sources

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Cleveland Clinic (2016) Adults + Booze = Bedwetting? Here's Why It Happens to You [online]. Cleveland Clinic [viewed 05/09/2018]. Available from https://health.clevelandclinic.org/adults-booze-bedwetting-heres-happens/

Continence NZ (2015) Adults and Bedwetting [online]. Continence New Zealand [viewed 03/09/2018]. Available from https://www.continence.org.nz/pages/Adults-and-Bedwetting/52/

Feldman, M. (2005) Management of Primary Nocturnal Enuresis. Paediatrics & Child Health. 10(10), pp. 611-614.

Mayo Clinic (2017) Bed-Wetting [online]. Mayo Clinic [viewed 03/09/2018]. Available from https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685

MedBroadcast (2018) Cancer of the Bladder [online]. MediResource [viewed 05/09/2018]. Available from https://medbroadcast.com/condition/getcondition/cancer-of-the-bladder

NAFC (2018) Adult Bedwetting [online]. National Association for Continence [viewed 03/09/2018]. Available from https://www.nafc.org/adult-bedwetting/

National Kidney Foundation (2015) Secondary Nocturnal Enuresis [online]. National Kidney Foundation [viewed 05/09/2018]. Available from https://www.kidney.org/patients/bw/BWbedwetSecondary

NICE (2012) Urinary Incontinence in Neurological Disease: Assessment and Management [online]. National Institute for Health and Care Excellence [viewed 05/09/2018]. Available from https://www.nice.org.uk/guidance/cg148/ifp/chapter/urinary-incontinence-related-to-a-neurological-condition

NHS (2016) Obstructive Sleep Apnoea [online]. NHS [viewed 05/09/2018]. Available from https://www.nhs.uk/conditions/obstructive-sleep-apnoea/

Pruneau, C. (2016) Causes of Adult Bedwetting and How to Manage it [online]. National Association for Continence [viewed 03/09/2018]. Available from https://www.nafc.org/bhealth-blog/causes-of-adult-bedwetting-and-how-to-manage-it

Sinha, R. et al. (2016). Management of Nocturnal Enuresis. World Journal of Nephrology. 5(4), pp. 328-338.