What is enuresis incontinence?

Enuresis, or bedwetting as it is commonly known, is primarily a type of urinary incontinence occurring in young children. However, in rare cases Secondary Adult Onset Enuresis (Nocturnal Enuresis) can appear in adults. Nocturnal Enuresis can occur after a particularly stressful episode, a urinary tract infection, as a side effect of medication or as a result of a medical condition including cancer. Other factors include an overly active bladder, a smaller than usual bladder, and excessive alcohol.

Most people outgrow Enuresis in childhood but there are rare cases where some people continue to wet the bed their whole lives. Known as Persistent Primary Nocturnal Enuresis, it can affect between 0.5% - 2% of adults over 18 years of age. For others, developing Nocturnal Enuresis later in their adult life is a cause of great concern, especially when nocturnal bedwetting begins after many years.

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 only add to the frustration and exhaustion from a bad night’s sleep.

The fact is, many people wet the bed at night, although most never seek help because they are too embarrassed. However, 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, even though there are many causes, 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.

Other suggested causes 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 recent 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 such as sleep apnoea. If you think this is the case, see your doctor as soon as possible.

Nocturnal enuresis treatments

Perhaps the first sensible thing to do is to talk to your family doctor. Don’t worry about feeling too embarrassed to talk about bedwetting. They’ve heard it all before and you’ll find that they will 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 episodes of Nocturnal Enuresis.

Be prepared to give a sample of your urine so it can be tested for infection. Your doctor may even recommend that you attend the hospital outpatient department for a urodynamic study (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 by sounding a buzzer or by vibrating, your body eventually learns to hold the urine, or to wake 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 head down this path.

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 (i.e. water, tea, coffee, milo, soup, etc) every day. Keep to drinking mostly during the day with less fluid in the evening. Try cutting down on drinks with caffeine (coffee, tea, cola and some other fizzy drinks) especially in the evening. 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. Some people have found that waking to empty their bladder by setting an alarm clock for a couple of hours can save them the embarrassment of a wet 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 amount of 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 someone 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 both men and women specifically designed to absorb large amounts of urine and to give you the confidence of a good night’s sleep.