Enuresis in Adults

What is enuresis in adults?

Enuresis is the medical term for bedwetting, which is an issue most often seen in young children. However, certain adults also face this problem. In adults, it often becomes harder to talk about something, which is considered as a childhood problem. However, it is important to note that bedwetting in adults is different than what most children experience. 

Urine is produced by the kidneys and travels toward the bladder, where it gets stored. The bladder is basically a muscular sac, which is known to hold the urine until it becomes ready to be released into the urethra. The urethra is a tube that connects the bladder to the outside of the body.

At the almost similar time, the bladder would contract, thereby relaxing the urinary sphincter. This relaxed sphincter would then act as an open door, allowing the urine to pass and exit the body. When the body undergoes any kind of neurological disconnect or physical impairment, then an individual would have a difficulty in passing urine or mistiming in the passing of urine, which can lead to bedwetting. 

Causes

There are multiple factors, which can lead to enuresis in adults. As with most medical conditions, the first thing to look at is the individual's family history. It has been shown through evidence that enuresis in adults is hereditary. According to one study, a person with two parents who have a history of bedwetting has a 77 percent chance of experiencing bedwetting. If a person only has one parent who has a history of bedwetting as a child, he or she would have a 40 percent chance of experiencing the same. These probabilities would also be carried during the adult life of the individual.

Another cause of bedwetting is the decreased secretion of the antidiuretic hormone (ADH). The main function of this hormone is to signal the kidneys to reduce the amount of urine being produced. Normally, the body produces more of this hormone to avoid bedwetting at night. However, there are some individuals who cannot produce more ADH, which often leads to a high production of urine at night. In few other cases, there is no problem in ADH production, but in the faulty response of the kidneys, wherein there is a continuous production of the same volume of urine. Nocturnal polyuria is the term used when there is an excessive urine production during sleep. This condition can cause bedwetting in adults, especially at night. Nocturnal polyuria can also be a symptom of type 2 diabetes. Therefore, it is important to consult a healthcare provider if you are experiencing frequent bedwetting at night. 

Individuals who have a small bladder may also have to deal with primary enuresis. In such cases, the actual physical size of the bladder would not be smaller, but the functioning capacity or functional bladder capacity (FBC) may be holding a small amount of urine as in other normal cases. Moreover, when the detrusor muscles (bladder muscles) are overactive, bedwetting at night can also occur. Such muscle overactivity is found in 70-80 percent of patients with primary nocturnal enuresis. Detrusor instability can be enhanced by certain bladder irritants, such as caffeine and alcohol. There are also certain medications that can increase the occurrence of adult bedwetting. They include medications for insomnia and psychoactive drugs, such as risperidone, clozapine, and thioridazine. Make sure that you ask your doctor about the potential side effects of any prescribed medications. 

There are certain conditions, which can affect the ability of the body to store or hold urine. Some of those medical conditions may include prostate cancer, bladder cancer, and diseases related to the spine or brain, such as Parkinson's disease, seizure attacks, or multiple sclerosis. Apart from these conditions, few of the other possible causes of enuresis in adults are diabetes, pelvic organ prolapse, an enlarged prostate, obstructive sleep apnea, constipation, and problems with the structure of the urinary organs.

Diagnosis

When you reach out to the doctor mentioning about this issue, the doctor would first want to narrow down on the exact cause of your condition. Thus, it would be best to maintain a diary of symptoms and take note of any food or medications that have triggered the issue. You should also take note of the following:

• The exact time when bedwetting happens (night or day)
• Volume of urine passed
• Pattern of fluid intake whether at night or late in the afternoon
• Types of drinks you usually consume (alcoholic, caffeinated, carbonated, artificially sweetened, or sugary)
• Any recurrent or recent urinary tract infection
• The number of dry vs. wet nights
• Any difficulty when passing urine
• Night sweats

The doctor would also carry out a thorough physical examination, a routine urinalysis, and a urine culture. A neurological evaluation may also be carried out if needed. Other tests, which may be needed are:

• Post-Void Residual Urine Test: This test would need an ultrasound to be carried out and also certain non-invasive tests, which can help in determining the volume of the urine that has been left in the bladder after voiding.

• Uroflowmetry: This test would basically involve the individual to urinate into a specialized funnel that would help in measuring the flow rate of the urine, the amount of urine expelled, and the time required for urination.

Management 

The doctor may suggest the following changes in your daily and nighttime routine:

• Avoid drinking before going to bed: Try to avoid drinking any fluid at least two to three hours before hitting the bed. By doing so, the body would not produce more urine in the body. Try to avoid the intake of alcoholic, caffeinated, and carbonated drinks, which can lead to bladder stimulation.

• Try to retrain your bladder: It is always better to train your body in such a manner that it would help you to avoid certain conditions. Try to go to the bathroom by using a schedule during the day as well as during the night. You can gradually increase the amount of time taken between bathroom visits. One example would be making visits 15 minutes at a time. By carrying out this habit, it would help train your bladder on how to hold the fluid and avoid bedwetting instances.

• Use an alarm clock: Try to set an alarm clock at night, wherein you would wake up to urinate. This kind of timely interruption during sleep would in some way help in conditioning the brain to control the bladder and prevent bedwetting accidents. 

• Take medications: If none of the above options work, then the doctor would mostly prescribe the use of certain medications, even though there are few possibilities of having certain side effects. In such cases, desmopressin (DDAVP) is known to reduce the amount of urine produced by the kidneys. Other medications may calm down overactive bladder muscles, and they include tolterodine, darifenacin, solifenacin, imipramine, trospium chloride, oxybutynin, fesoterodine fumarate.

If the use of medications or any other procedures still does not work, then the doctor can suggest any of the following procedures:

• Detrusor myectomy: This procedure is one of the major operations for the treatment of an overactive bladder. In this particular procedure, the surgeon removes part or all of the muscles present in the bladder to stop them from contracting at wrong times.

• Bladder augmentation: This particular procedure or operation helps in making the bladder larger to hold more urine.

• Sacral nerve stimulation: It is a stimulation therapy that can help control an overactive bladder. The doctor would insert a small device into the body of an individual. The device would send a signal to the nerves present in the lower back to help control the flow of urine.

Other small measures to manage the condition:

• Wear absorbent pads or underwear while asleep.
• Place waterproof covers or pads all over the mattress or sheets to keep them dry.
• Make use of special skin-cleansing cloths as well as lotions to prevent the skin from getting irritated.