Find out about adult enuresis, its causes, treatments and coping strategies to deal with this frequent medical problem in adulthood.

The adult enuresis, also known as night enuresis, is a condition in which a person urinates involuntarily while sleeping. Although it is frequent in children, adult enuresis is a less discussed problem that can be embarrassing and distressing for those affected. However, it is important to keep in mind that adult’s enuresis is not uncommon and affects a significant number of people worldwide.

Adult enuresis may be due to several causes, from underlying diseases to lifestyle related factors. A possible cause are urinary tract infections (ITU), which can cause an increase in urgency and frequency of urination, which can lead to enuresis. In addition, physical anomalies, such as the enlargement of the prostate in men or bladder in both sexes, can also contribute to this condition. Other factors such as hormonal imbalances, neurological disorders and sleep disorders can also influence adult enuresis.

Important information:

• Adult enuresis can be a sign of an underlying medical condition, so it is essential to consult a healthcare professional to obtain adequate diagnosis.
• The diagnosis of adult enuresis usually involves a detailed medical history, a physical examination and, possibly, specialized tests such as urine analysis or urodynamic studies.

The treatment of adult enuresis usually involves a multifaceted approach that combines changes in lifestyle, behavioral techniques and, in some cases, medical interventions. Simple measures such as reducing fluid intake before bedtime and emptying bladder just before sleeping can help minimize enuresis episodes. In addition, the application of a regular schedule to go to the bathroom and the use of bed protection products, such as waterproof sheets or absorbent pads, can reassure and minimize discomfort.

1. Liquid restriction before bedtime: Limiting fluid consumption for a few hours before sleeping can help reduce enuresis probabilities.
2. Schedule to go to the bathroom: establishing a regular routine to empty the bladder before sleeping can train the body to empty the bladder properly.
3. Medications: In some cases, a healthcare professional may prescribe certain medications, such as anticholinergic drugs or desmopressin, to help control adult enuresis.

Understanding Adult Bed Wetting: Causes, Symptoms, and Treatment Options

Causes of adult enuresis: Adult enuresis can be caused by several factors, such as underlying diseases, psychological problems, and lifestyle choices. A common cause is overactive bladder, which causes an uncontrollable urge to urinate. Other medical conditions, such as urinary tract infections, diabetes, and neurological disorders, can also contribute to adult enuresis. Additionally, excessive alcohol consumption and certain medications can increase the likelihood of bedwetting episodes.

Note: It is important to see a healthcare professional for a proper diagnosis if adult enuresis becomes a persistent problem, as it could be a symptom of an underlying medical condition.

Symptoms of adult enuresis: The most common symptom of adult enuresis is wetting the bed during sleep. This may occur occasionally or on a regular basis. Adult enuresis may also be accompanied by a feeling of urgency to urinate, frequent urination during the day or urinary incontinence. It is important to note that these symptoms can vary from person to person, and it is essential to evaluate the individual’s overall health and medical history to determine the underlying cause.

Treatment options for adult enuresis: There are several treatment options for adult enuresis, depending on the underlying cause. A healthcare professional may recommend lifestyle modifications, such as limiting fluid intake before bed, avoiding caffeine and alcohol, and using bladder training techniques. Medications, such as anticholinergics, may be prescribed to reduce bladder contractions and control the urge to urinate. In some cases, therapy or counseling may be beneficial to address any psychological factors contributing to adult enuresis.

1. Consult a healthcare professional to obtain adequate diagnosis.
2. Modify the lifestyle to control adult enuresis.
3. Explore medication or therapy/advice options if necessary.

Types of Adult Bed Wetting

1. Primary Night Enuresis:

This type of enuresis occurs when a person has never achieved constant nighttime from childhood. Individuals with primary night enuresis can have an excessively active bladder at night, which makes them free unconsciously. It is usually a consequence of a delay in development or a problem inherent in the urinary system. Primary nocturnal enuresis can significantly affect the quality of life and sel f-esteem of affected people.

Note: It is essential that people who experience primary nightly enuresis consult a healthcare professional to rule out any underlying medical condition.

2. Secondary nocturnal inure:

Secondary enuresis is characterized by the reappearance of enuresis after a period of dryness of at least six months or more. It may be due to various factors, such as physical, psychological or environmental triggers. The most common causes of secondary night enuresis in adults can be urinary tract infections, hormonal imbalances, stress, anxiety or certain medications. Identifying the specific cause is crucial to determine the most effective treatment approach for people with secondary night enuresis.

3. Night Polyuria:

Night polyuria refers to the production of abnormally large amounts of urine during the night. It is a common type of adult enuresis that can be caused by conditions such as diabetes, heart failure or excessive fluid intake before bedtime. People with nightly polyuria may experience an increase in urine production during the night, overflowing the bladder’s ability and causing enuresis episodes.

Tip: The monitoring of the intake patterns and elimination of fluids can be useful to diagnose and treat night polyuria.

1. Bladder dysfunction
2. Obstructive sleep apnea
3. Neurological disorders
4. Side effects of medication
5. Alcohol or substance abuse

Common Causes of Adult Bed Wetting

1. Urinary tract infections (ITU)

A common cause of enuresis in adults is urinary tract infections. UTIs can cause increased urinary frequency and urgency, making it difficult to control your bladder during sleep. If you suspect that a UTI is the underlying cause of enuresis, it is important to seek medical attention for proper diagnosis and treatment.

2. Bladder dysfunction

Bladder dysfunction refers to problems with the storage capacity and control of the bladder. It can manifest as involuntary contractions or an overactive bladder, which makes a person more likely to wet the bed. Bladder dysfunction can be caused by a variety of factors, including neurological conditions, hormonal imbalances, and certain medications.

• Neurological conditions, such as multiple sclerosis or spinal cord injuries, can disrupt communication between the bladder and the brain and cause bladder dysfunction.
• Fluctuations in hormonal levels, particularly antidiuretic hormone (ADH), can affect the body’s ability to adequately control urine production and concentration, contributing to enuresis.
• Certain medications, such as diuretics or sedatives, can interfere with bladder function and increase the likelihood of enuresis.

3. Sleep disorders

Adults who suffer from sleep disorders, such as sleep apnea or insomnia, may also experience enuresis. Sleep disorders can disrupt normal sleep patterns and decrease the brain’s ability to respond to signals from the bladder, leading to the involuntary release of urine during the night.

4. Psychological factors

Psychological factors, such as stress, anxiety or trauma, can contribute to adult enuresis. Emotional distress can disrupt the body’s normal physiological processes, including bladder control. Additionally, certain psychiatric conditions, such as depression or post-traumatic stress disorder (PTSD), may be associated with enuresis in adults.

Medical Conditions Associated with Adult Bed Wetting

1. Urinary tract infections (UTI):

Urinary infections are a common cause of enuresis in adults. These infections occur when bacteria enter the urethra and multiply in the urinary tract. UTIs can cause frequent and urgent urination, as well as a strong, persistent urge to urinate even when the bladder is empty. Infection and inflammation of the urinary tract can disrupt normal bladder function and cause enuresis in adults. It is important to seek medical attention for UTIs, as they can be effectively treated with antibiotics.

Key points:

• Urinary tract infections can contribute to adult enuresis.
• Urinary tract infections cause inflammation in the urinary tract, leading to disorders in bladder function.
• Timely treatment with antibiotics is essential to resolve UTIs and reduce episodes of enuresis.

2. 2. Diabetes mellitus:

Diabetes mellitus, particularly uncontrolled diabetes, may play a role in adult enuresis. High blood sugar levels can cause increased urine production, resulting in a greater likelihood of bedwetting episodes. Additionally, diabetes can cause nerve damage (diabetic neuropathy) that affects bladder control. This neuropathy can interfere with signals between the bladder and the brain, causing enuresis in adults with diabetes. Proper treatment of diabetes through lifestyle changes and medication can help relieve the symptoms of bedwetting.

Key points:

• Uncontrolled diabetes can contribute to enuresis in adults due to increased urine production.
• Diabetic neuropathy can affect bladder control and cause enuresis in adults with diabetes.
• Effective diabetes management can help reduce episodes of bedwetting.

3. 3. Obstructive sleep apnea (OSA):

Obstructive sleep apnea is a sleep disorder characterized by repetitive episodes of airflow blockage during sleep. These episodes can cause sudden awakening from sleep, resulting in enuresis. Disrupted sleep patterns and physiological changes associated with OSA can disrupt normal bladder function and lead to enuresis in adults. Treating OSA with continuous positive airway pressure (CPAP) or other interventions may help improve sleep quality and reduce the incidence of enuresis.

Key points:

• Obstructive sleep apnea may contribute to enuresis in adults due to disrupted sleep patterns.
• Episodes of airflow blockage during sleep can cause sudden awakening and subsequent enuresis.
• Effective treatment of obstructive sleep apnea can help control the symptoms of enuresis.

Psychological Factors Contributing to Adult Bed Wetting

One of the main psychological factors that contribute to enuresis in adults is stress. Stressful events or situations can trigger episodes of enuresis in adults, even those who previously did not wet the bed at night. Common sources of stress include relationship problems, work pressure, financial difficulties, and emotional trauma. The body’s response to stress involves the release of cortisol, a stress hormone that can interfere with the functioning of the urinary system. This alteration can cause nocturnal enuresis.

In addition to stress, anxiety and unresolved emotional problems can also contribute to adult enuresis.

Anxiety can cause a person to experience increased arousal during sleep, causing increased tension in the muscles responsible for bladder control. This muscle tension can cause the involuntary emission of urine during the night. Additionally, unresolved emotional problems, such as past traumas or unresolved conflicts, can manifest as enuresis in adults. Enuresis can serve as a subconscious outlet for emotional distress, providing temporary relief or a sense of control. Addressing these underlying psychological factors is essential to effectively manage and treat enuresis in adults.

• Stressful events or situations can trigger episodes of adult enuresis.
• Anxiety during sleep can cause muscle tension and involuntary urination.
• Unresolved emotional problems can manifest as enuresis

Table 1 summarizes the main psychological factors that contribute to adult enuresis:

Diagnosis and Assessment of Adult Bed Wetting

Diagnosis:

When evaluating adult enuresis, health care professionals use a comprehensive approach that includes evaluation of the medical history, physical examination, and diagnostic tests. Evaluating the medical history involves a detailed discussion with the patient to gather information about their symptoms, the duration of the condition, and any potential factors that may contribute to nocturnal enuresis. It is important to rule out any underlying medical conditions, such as urinary tract infections or bladder abnormalities, that could be causing the enuresis.

The physical examination may include checking for signs of neurological disorders, urological abnormalities, or other physical conditions that could be contributing to adult enuresis. A complete examination of the abdomen, genitals, and nervous system may be performed to identify any abnormalities or signs of possible causes.

Assessment:

Evaluation of adult enuresis requires taking into account various factors that can contribute to this condition. A bladder newspaper is often used to record the frequency and amount of urine expelled during the hours of vigil and at night. This helps identify patterns or triggers of enuresis episodes. In addition, a night polygraphy test can be performed, which consists of monitoring various physiological parameters during sleep, to evaluate the activity of the bladder, sleep patterns and respiratory anomalies.

1. The evaluation also implies analyzing the lifestyle and behavioral factors that can contribute to adult enuresis. This includes assessing fluid intake, alcohol or caffeine consumption and emotional or psychological stress factors.
2. Table 1: possible causes and risk factors of adult enuresis:

When performing a diagnosis and exhaustive evaluation process, health professionals can determine the most appropriate treatment options for adult enuresis, ranging from behavior and lifestyle modifications to medical interventions and therapeutic approaches.

Treatment Options for Adult Bed Wetting: Medications, Therapy, and Lifestyle Changes

Medication: medications can play a fundamental role in the treatment of adult enuresis, since they attack the main cause of the condition. One of the most prescribed medications is demopressin, which helps reduce urine production during the night. This medicine is available in tablets, nasal or molten oral spray. Another option is anticholinergic drugs, which relax the bladder muscles and increase their capacity. It is important to keep in mind that medications should only be used under the orientation and prescription of a healthcare professional.

• Despressin: Reduces urine production at night
• Anticholinergic drugs: they relax the bladder muscles and increase their capacity.

Note: Medications should only be used under the orientation and prescription of a healthcare professional.

Therapy: various therapeutic approaches can be beneficial to treat adult enuresis. Behavioral therapies, such as bladder training and positive reinforcement, can help people recover control of bladder function. In addition, pelvic soil exercises, also known as Kegel exercises, can strengthen the muscles responsible for bladder control. These exercises consist of contracting and relaxing the pelvic soil muscles and can be performed discreetly throughout the day. It is essential to consult a healthcare professional or a physiotherapist to receive adequate guidance on the correct realization of these exercises.

1. Behavioral therapies: bladder training and positive reinforcement
2. Pelvic floor exercises (Kegel exercises): strengthen pelvic floor muscles

Changes in lifestyle: Making certain modifications in lifestyle can greatly contribute to control the adult enuresis. Limiting fluid intake before bedtime, especially drinks with caffeine and alcohol, can help reduce the probability of night enuresis. In addition, establishing a regular routine to go to the bathroom, which includes emptying the bladder before sleeping, can help reduce the frequency of enuresis. The use of enuresis alarms, which are designed to awaken people to the first sign of moisture, can also be an effective strategy to train the body to recognize the need to urinate during sleep.

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Author of the article

Dr.Greenblatt M.

Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont