Nocturnal Enuresis – Causes of bedwetting in adults

It is quite normal to wake during the night once or twice to pass urine. However, a person who suffers with nocturnal enuresis won’t wake up and therefore empty their bladder. This can also be referred to as bedwetting.  Nocturnal enuresis can often be cured with the right help.  The urge to urinate during the night usually wakes up the sleeping person so that they can go to the toilet and empty their bladder. However, some adults don’t wake up and end up wetting the bed, this is called enuresis nocturna.

 

What does nocturnal enuresis mean?

Nighttime incontinence, bedwetting in adults, bladder weakness at night – all terms used to describe nocturnal enuresis. Involuntary leakage of urine during the day – i.e. when awake – is called urinary incontinence according to the definition of the International Continence Society (ICS)1. If this involuntary urination occurs during sleep – i.e. mostly at night – experts referred to it as enuresis or nocturnal enuresis.

Bedwetting does not only occur in children and adolescents; many adult women and men have also experienced uncontrolled emptying of the bladder during sleep. However, if a person is bedwetting this does not mean they are necessarily incontinent. Occasional, uncontrolled urination during sleep is not a cause for concern. From a medical point of view, enuresis is only diagnosed in people over the age of 5 if nocturnal enuresis occurs twice a month for at least a period of three months2,3 – or regular urine leakage during sleep.

 

Nocturia – constant urge to urinate at night is not urinary incontinence

If you experience regular and frequent sleep interruptions due to an increased urge to urinate, this is called nocturia4. There is no involuntary loss of urine, so nocturia is not a form of incontinence. Nocturia is the most common cause of sleep disturbances. As previously mentioned, to wake once or twice to pass urine is normal but anything more than this can become tiresome and annoying. If you Have symptoms of nocturia, then it would be recommended you contact your GP.

 

What are the causes of enuresis?

Determining the exact causes of bedwetting as an adult can be extremely difficult, as enuresis is an indication of an underlying medical condition. The reasons range from genetic predisposition to medical conditions. Psychology, stress and anxiety can also play an important role in adult bedwetting.

Possible causes include:

  • The production of antidiuretic hormone (ADH) is inhibited – The hormone AHD is produced more at night and sends signals to the body to reduce urine production. If this does not happen, urine is produced just as quickly during the night as during the day. This can cause the bladder to overflow and also trigger uncontrolled voiding5.
  • Overactive bladder – An overactive bladder is characterised by an excessive urge to urinate, which is difficult to suppress. While many affected people can control this urge during the day, at night they are unable to control it consciously, resulting in involuntary urine leakage6.
  • Genetic predisposition – Genetic factors also play a role. Bedwetting often runs in families so if there is a family history of nocturnal enuresis such as a parent or close relative then there is an increased likelihood that a child will be affected7.
  • Sleep disorders – A person affected by nocturnal enuresis are often “deep sleepers”. And therefore have reduced awareness of the need to urinate which can lead to uncontrolled emptying of the bladder as they don’t wake up8.
  • Mental stress – Mental state also plays a major role. Increased stress, social difficulties, possible anxiety and trauma can cause symptoms9, 10.
  • Excessive alcohol consumption – Definitely one to avoid! Those who consume excessive amounts of alcohol, tend to go into a deep sleep, and will not be woken by a strong urge to urinate or by the leakage of urine. Alcohol should be avoided or have a reduced intake if a person is suffering from incontinence. Alcohol can irritate the bladder and behave like a diuretic.

Underlying conditions that can lead to enuresis include:

  • Urinary stones
  • Obstructive sleep apnoea
  • Prostate enlargement
  • Anatomical abnormalities
  • Type I and type II diabetes
  • Urinary tract infection (UTI)

 

Diagnosis and treatment of enuresis

Your GP should be consulted if you experience any symptoms of enuresis so that the cause can be found and then a treatment plan can be put into place.

The GP will investigate the causes, potentially using one or more of the following methods:

  • Medical history: discuss the medical history of the person affected. Screening for possible psychological causes are also undertaken.
  • Bladder diary: keeping a bladder diary. A bladder diary records what fluids you are drinking and how much fluid and when you go to the toilet. A bladder diary is really useful in identifying the bladders habits and patterns.
  • Basic examinations include physical examinations, urine samples and ultrasound examination.
  • Further examinations include urine flow measurement (uroflowmetry). This measures the amount of urine excreted per second. The amount of urine remaining in the bladder is subsequently checked (residual urine determination).

Depending on the findings, some of the following treatments may be offered by the GP:

  • Bladder and toilet training in order to better control nocturnal enuresis (urotherapy).
  • Pelvic floor training for strengthened pelvic floor muscles
  • Electrostimulation and biofeedback
  • Antibiotics if caused by UTI
  • Fluid & diet advice such as reducing or cutting out caffeine and alcohol.
  • Losing weight
  • Medication

 

Products to manage the problem at night

High-quality incontinence products should give you a peaceful and dry night’s sleep. It should be noted that there are several special features that an incontinence product has to contain fluids especially for the night:

 

Body position

During the day, we are mostly in an upright or sitting position, whereas in bed we sleep in a horizontal lying position. When lying down, the absorbent pad of the product is no longer supported by gravity, which makes it difficult to absorb urine when lying down. Therefore, incontinence products for the night should ensure that no urine leaks out at the sides. This is achieved by leakage protection and quick absorption. Ideally, the materials used should be made of soft materials; since those affected “are lying on the product” all night, rough materials can significantly impair wearing comfort.

 

Supportive clothing

Our daytime outfit is not the same as our nighttime garment. When going out to work or shop for groceries we may wear several “layers” of clothing. Incontinence pads, for example, are often held in place by an adhesive strip in the underwear. An additional pair of trousers offers supportive hold with their thicker, firm fabric. This “scaffolding” is not given when wearing pyjamas or underwear. The product used should ensure that it does not slip when turning and moving during sleep.

 

Wearing time

Another difference is the wearing time of the product. During the day, a person or carer can easily change the incontinence pad or disposable pull ups; However, at nighttime, it is important that the persons sleep is uninterrupted and therefore the product should not require changing. The product should be able to withstand one – or at best several – urinations without leaking or causing a feeling of wetness.

 

The right incontinence product for the night

MoliCare® Premium Mobile 10 drops Day & Night Protection are a pull up style product with a soft textile, elasticated material that contours to your body-shape and can be worn like regular underwear. They provide full protection both in the day and at nighttime and still allow you to go to the toilet easily. Molicare Premium Mobile 10D has a pH value of 5.5 and its advanced quick dry system with a triple-layer absorbent core ensures skin-friendliness. Up to 12 hours of leakage protection is secured based on high quality material and the two-part cuff system. Convenient removal by tear-open side seams.

Those caring for a person who is incontinent should be aware that the skin can become irritated. In cases where the skin does become irritated it would be recommended to speak to your GP so that a suitable barrier cream can be prescribed.

The various therapy methods and high-quality incontinence products can help you and your loved ones to get dry again at night so that nothing stands in the way of a good night’s sleep.

 


 

References

1 The standardisation of terminology in lower urinary tract function: report from the standardisation

sub-committee of the International Continence Society, Abrams et al., 2003:, page 39

https://www.goldjournal.net/article/S0090-4295(02)02243-4/fulltext

 

2 The wet child Becker T Journal of Urology and Urogynecology 2006; 13 (special issue 5) (issue

for Austria), page 7-10

https://www.kup.at/kup/pdf/6087.pdf

3 https://www.special-harninkontinenz.de/kinder/

 

4 Continence, Incontinence, Continence Promotion, Practical Manual for Nurses, Hayder, Kuno, Müller,

Huber Publishing House, page 55

 

5 J. P. Guignard et al: Endocrine theory of idiopathic nocturnal enuresis. In: Arch Pediatr. 1997, 4

Suppl 1, p. 3s-6s

https://pubmed.ncbi.nlm.nih.gov/9181001/

6 https://www.netdoktor.de/symptome/enuresis/

7 https://d-nb.info/977156338/34

 

8 Paul A. Palmisano, MD, Enuresis: Causes, Cures and Cautions, West J Med. 1976 Nov; 125(5): 347-.

349.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1237345/?page=2

9 https://www.nafc.org/adult-bedwetting

10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936340/

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