Enuresis, or bedwetting as it’s commonly known, is primarily associated with children. However, in rare cases, adults can suffer secondary adult onset enuresis (nocturnal enuresis). Nocturnal enuresis can occur if you’ve had a urinary tract infection, it could be a side effect of medication or it can happen as a result of a medical condition including cancer or other particularly stressful episode. Other factors include an overly active bladder, a smaller than usual bladder, and drinking too much alcohol.
About enuresis incontinence
Most people outgrow enuresis in childhood but some people continue to wet the bed their whole lives. Known as persistent primary nocturnal enuresis, it can affect between 2 - 3% of adults over 18 years of age. But if you develop nocturnal enuresis later in life it can be embarrassing and it’s something you should see your doctor about.
Having nocturnal enuresis can affect your lifestyle by preventing you from enjoying a night away from home, taking holidays or business trips and even from starting a new relationship. On top of that, practical problems like the constant washing and drying of sheets and the cost of replacing bed linen or a mattress only add to your frustration and exhaustion from a bad night’s sleep.
Many people who do wet the bed at night almost never seek help. But with the right advice and support, nocturnal enuresis can be improved and sometimes even cured.
What causes nocturnal enuresis?
The simple question everyone with nocturnal enuresis asks is “why don't I wake up when I need to go to the toilet?” Unfortunately, there is no clear answer. Ordinarily, you produce less urine when you sleep. Some people produce larger amounts of urine during the night, which explains why the bladder needs emptying.
Suggested causes for bed-wetting include:
- Genetics — although not the case for everyone, some research suggests that nocturnal enuresis is hereditary. One such study determined that someone with both parents wetting the bed has a likelihood of 77% of also becoming a bedwetter. With only one parent wetting the bed as a child, the likelihood dropped to 40%.
- Smaller than average bladder — nocturnal enuresis patients may have a smaller functional bladder capacity (FBC). The FBC is the volume of urine the bladder can hold before sending a signal to the brain to indicate the need to void. Sometimes over activity of the bladder muscle means it is never fully relaxed during the filling phase. Consequently, the bladder capacity is not as large.
- ‘Overactive' or 'unstable' bladder (OAB) — Many studies have shown a high incidence of OAB (around 70 - 80%) in nocturnal enuresis patients.
- Fluids intake — Even though we all need to keep our fluid levels up, there are some drinks that can irritate the bladder or make the body produce urine more quickly than normal. These include alcohol and caffeine drinks like tea, coffee, hot chocolate and cola.
- Unrelated Medications — medication for heart and blood pressure problems or for mental illness and anxiety can alter the way your urinary system works, which in turn, can cause you to have less control over your bladder than normal.
- Urinary tract infection (UTI) — an infection in the urinary tract can sometimes cause nocturnal enuresis.
- Stress or anxiety — nocturnal enuresis may also be brought on by stress or anxiety, and may continue long after the problem has gone.
It’s also important to remember that nocturnal enuresis in adult life could be the result of a more serious underlying problem. If you think this is the case, see your doctor as soon as possible.
Nocturnal enuresis treatments
If you start wetting the bed, the first thing to do is to talk to your family doctor. Don’t worry about feeling embarrassed, they’ve heard it all before. Together you’ll be able to put your mind at ease and plan a few strategies to help you combat nocturnal enuresis.
A good idea before chatting with your doctor is to keep a diary for about a week before your appointment showing how often you pass urine, how much you drink and how often you wet the bed.
Be prepared to give a sample of your urine so it can be tested for infection. Your doctor may even recommend that you have a bladder test.
Some other strategies they may discuss with you include:
- Medications — various medications can often control nocturnal enuresis and could provide a long-term solution to the problem.
- Enuresis alarm — designed to wake you up when you start to wet the bed by sounding a buzzer or by vibrating. Eventually your body learns to hold the urine until you wake up so you can go to the toilet. Enuresis alarms are small and discreet and can be worn close to the body.
- Complementary therapies — some people find alternative medicines, hypnosis or acupuncture can be beneficial. Be sure to get advice from a trained practitioner before you try these.
Other helpful tips that may reduce the incidence of nocturnal enuresis include:
- Fluid intake — ideally you should drink at least 6-8 glasses of fluid a day. It’s best to drink in the daytime and cut down in the evening. Try not to drink coffee, tea, cola and other fizzy drinks as these can make you want to go to the toilet. Also note that alcoholic drinks make bedwetting worse. It may be the effect of the alcohol itself, or the extra fluid, especially in beer and other long drinks.
- Waking at night — make sure you empty your bladder before you go to sleep at night. And if you set an alarm clock to wake you up to go to the toilet, it’ll save you from wetting the bed. Vary the times you set the alarm so your bladder doesn’t fall into a habit of emptying at the same time, regardless of whether you are awake or not.
- Bladder training — this involves scheduling the time between trips to the toilet. Initially you start by going every couple of hours. However, if you feel the urge to go between trips, you should stand or sit still, contract your pelvic muscles and concentrate on making the urge to urinate go away. You should slowly increase intervals until you are able to go three to four hours without using the bathroom.
- Discussing the problem — Talking about nocturnal enuresis with your partner, a friend or doctor can be a tremendous relief, especially when you realise that most people will be sympathetic and supportive.
- Incontinence aids — Depend® has a range of overnight incontinence aids for men and women specifically designed to absorb large amounts of urine and to give you the confidence of a good night’s sleep.
Other types of incontinence