As young children, there were many things that we considered normal and inevitably a part of growing up. Eventually, when we move away from our adolescent years, we expect to have outgrown these so-called ‘childish’ habits. But the truth is that as we age, our bodies change in ways that can’t be expected. When it comes to bedwetting, also referred to as enuresis, it’s a struggle that more than 5,000,000 Americans face.
Whether you’ve wet the bed regularly throughout your life, or you’ve just started as an adult, there is no denying that it is a difficult experience. Here’s the good news: waking up to wet sheets does not have to be normal.
What is nocturnal enuresis?
Nocturnal enuresis is the involuntary release of urine during sleep. Despite the similarity in childhood and adult bedwetting causes, it may be a surprise to learn that they are actually two different conditions.
- Persistent Primary Nocturnal Enuresis starts during childhood, where bladder control during the night has not been achieved for longer than six months. It is the most common type of enuresis, affecting about 2 – 3% of adults over 18.
- Adult Onset Secondary Enuresis is a condition that develops years after childhood when a person starts to lose control of their bladder.
This should not be confused with nocturia, which also occurs due to underlying urinary-tract related conditions. Nocturia is defined as waking up one or more times at night to empty your bladder. Wait, so why don’t people with enuresis get up to go to the toilet? Although there is some research that suggests psychological factors, that question still remains unanswered.
What are the main adult bedwetting causes?
Every night, you make it a point to drink fewer liquids before bed. You take more bathroom trips in preparation and even try not to fall into too deep of sleep so that you are able to get up easier during the night. Yet, when you wake up, you once again make your way to the laundry room with your wet sheets in hand. Why? Let’s take a look at the four most common adult bedwetting causes that you may be overlooking.
Hormonal imbalances can have a large impact on controlling bladder leakage. Every human body makes Antidiuretic Hormone (ADH), a hormone that sends signals to the kidneys to tell them to produce less urine during nighttime. However, if a person does not make sufficient ADH, this may result in larger volumes of urine that the bladder is unable to hold.
Small and Overactive Bladders
In order to control the flow of urine, it is vital that the bladder is functioning properly. To that end, small and overactive bladders are often the silent catalysts for the unexpected release of urine during the night. First off, you should know that a small bladder refers to a smaller functional capacity of the bladder. Simply put, they are just bladders that feel fuller faster and function as if their size was altered. On the other hand, an overactive bladder is pretty much exactly what it sounds like. It usually occurs when the bladder muscles squeeze too often or at wrong times causing urinary leaks.
There are two main types of diabetes that can contribute to bedwetting. The more commonly known type of diabetes, brought on by a resistance to insulin, causes the body to flush out excess glucose through a larger production of urine. While diabetes mellitus, translating to “sweetened with honey” references high blood sugar, a rarer form of diabetes insipidus develops an unnatural production of an antidiuretic hormone called vasopressin that results in a frequent urge to urinate.
For many adults, the onset of secondary enuresis is linked to periods of transition and anxiety. We have all experienced some form of stress, but the impact can look different for everyone. During the nighttime, as the body processes the prominent events of the day, the result may be wetting the bed. This fight or flight response takes a similar form to common reactions like chest pain, panic attacks, and headaches.
Are there any risk factors for nocturnal enuresis?
If you are among the 1 in 100 adults experiencing enuresis, you may relate to the prior adult bedwetting causes or the following risk factors:
- Enlarged prostate gland
- Neurological disorders
- Genetic variants
- Obstructive sleep apnea
- Urinary tract infection
- Excessive alcohol and caffeine consumption
- Kidney problems
How is adult bed-wetting diagnosed?
If you have experienced occasional or one-time bedwetting, you probably don’t have anything to worry about. But if those small accidents turn into nightly occurrences that are impacting your quality of life, it might be time to have a talk with your doctor. At your appointment, your doctor will begin with a physical exam and ask general questions about your health. For this reason, try to make a note of the following:
- Frequency and time of bedwetting
- Amount of urine leaked each night (a lot or a little)
- Consumption of liquids before sleep
- Any other symptoms during the day
In order to better diagnose the problem, your doctor may also run a few tests such as:
- Urinalysis: It uses a small sample of urine to check for any conditions involving the urinary tract – kidneys, ureters, bladder, and urethra.
- Urine culture: In order to diagnose a urinary tract infection, urine is tested to find germs (bacteria) that can cause an infection.
- Uroflowmetry: This involves urinating into a specialized funnel that measures the production of urine and the rate of flow over time.
What can I do to prevent enuresis?
Like urge incontinence, adult bedwetting may not be a topic of conversation that many people would want to open up about. But with treatment options that range from small changes to large-scale operations, there is hope to have dry and relaxed mornings. Here are a few lifestyle and behavioral strategies that can reduce the chances of having to change the wet sheets in the morning.
- Bladder volume control helps to increase functional bladder capacity. Training takes the form of gradually building the time between voiding the bladder and consuming more liquids.
- Bedwetting alarms can be found in underwear or mattresses and offer fast intervention. With a simple sound or vibration, you are notified of any wetness and are able to stop the flow of urine and finish in the restroom.
- Waking up to clear your bladder might be helpful to reduce the amount of urine that leaks on the bed by setting an alarm to use the bathroom. Make sure to not set the same time each night so that your body does not become routine to empty at that time no matter where you are.
- Pelvic floor therapy can help strengthen the urinary sphincter and pelvic floor muscles which work to control urination. Kegel exercises are often the first line of treatment because they build a support system for the bladder, allowing better control over urinary leakage. There are a few ways to help train these muscles.
- Biofeedback helps master Kegel exercises through a vaginally inserted probe which allows you to know if you are using the correct muscles.
- Electric stimulation (e-stim) contracts the pelvic floor muscles, essentially doing Kegels for you. ELITONE is an FDA-cleared pelvic floor exerciser that delivers external therapeutic stimulation, allowing for comfortable movement during treatment. ELITONE sends signals for both muscle exercise and calming of overactive bladders.
- Dietary changes like cutting down on bladder irritants may also be helpful to reduce frequent urination. While it may be hard to give up caffeine, sugar, and alcohol, the benefit of removing these foods might outweigh their absence.
- Medications can help treat nocturnal enuresis. Research shows that desmopressin boosts the level of ADH so that your kidneys will reduce the production of urine at night. Other drugs can attack the risk factors of bedwetting, like antibiotics for urinary tract infections, anticholinergic drugs that calm overactive bladders, and 5-alpha reductase inhibitors which shrink an enlarged prostate.
If medications and treatment are not effectively helping your adult bedwetting causes, your doctor might recommend surgery as a last resort. These are a few options:
- Sacral nerve stimulation delivers signals to the muscles in your bladder to stop unnecessary contractions. This is done through an implant near the upper buttocks, that transmits signals with a thin wire near the sacral nerve, similar to a pacemaker.
- Clam cystoplasty (bladder augmentation) is a much more invasive procedure that involves surgically increasing bladder capacity. During the operation, your doctors will insert a patch of intestinal muscle into the bladder wall. This extra muscle helps reduce bladder instability and maximize control.
- Detrusor myectomy is a similar major operation that removes the detrusor muscles which control the contractions in your bladder. This procedure is intended for overactive bladder and urge incontinence by targeting the strength and frequency of contractions.
How can I manage bedwetting before I am able to control my bladder leakage?
Depending on your condition, it may take some time to find out which treatments may or may not work for you. In the meantime, if you are looking for ways to manage bedwetting, there are a few things that you can do to make your life easier in the mornings. By wearing absorbent pads or protective underwear, you can keep your skin from getting irritated. Try to find ones that are comfortable and fitting for the best results. Also, consider placing a waterproof mattress pad or cover over the bed to help them remain dry throughout the night.
If you are struggling with bedwetting, there are multiple non-invasive treatments and solutions available to help. The most important part is taking that step to talk to your doctor and getting guidance. Nocturnal enuresis is a very real problem that millions of adults face every day, but waking up to dry sheets might be closer than you think.