Bed-wetting, also known as sleep enuresis, is a fairly common condition in young children and is seen as a sign of an immature, developing bladder. However, when adults wet the bed it is not only a devastatingly embarrassing condition but also often an indication of an underlying illness or a symptom of other untreated medical conditions. Bed-wetting that starts in adulthood (secondary enuresis) is uncommon and requires medical evaluation.
According to Dr Albert Ndata, a general practitioner in Kigali, besides being an embarrassment, secondary enuresis can have long term effects on the social life of adults.
“It is a very distressful condition. It causes a lot of mental health issues for the affected person such as depression, anxiety, guilt and failing in relationships. This condition affects the social life of sufferers which can lead to harmful behaviour like alcoholism and drug addiction,” he says.
Dr Rachna Pande, a specialist in internal medicine, notes that the condition negatively impacts both physical and mental health.
“Bed-wetting becomes embarrassing and the affected person loses self-confidence. They avoid moving out and socialising. Bed-wetting increases chance of infection due to the back and buttocks being repeatedly contaminated by urine. In debilitated persons, this can lead to formation of bed sores. Recurrent or chronic urinary tract infection can lead to chronic kidney damage causing chronic renal failure,” she says.
What to look out for
According to Dr Ndata, one of the first places to look for causes of urinary incontinence is whether there is a family history as children with bed-wetting parents face a higher risk of having the same.
He, however, attributes this condition to other factors such as hormonal imbalances in some people.
People whose bodies don’t make sufficient levels of antidiuretic hormone may experience nocturnal enuresis because their bladders can’t hold higher volumes of urine, explains Dr Ndata.
“Hormonal imbalances can also lead to production of high quantities of urine during the night which the subject fails to hold. The kidneys may also have trouble responding to some of these hormones and so keep producing urine at night leading to the problem,” he adds.
Dr Ndata explains that the bodies of people with diabetes don’t process glucose properly and may produce larger amounts of urine. The increase in urine production can cause children and adults who normally stay dry overnight to wet the bed.
“Some people may have functionally small bladders which have difficulty holding urine for long hours at night. Some diabetic patients may also suffer from this condition. Bladder muscle hyperactivity can also be a cause for this which can be worsened by alcohol consumption,” he says.
Dr Pande also explains that bed-wetting in adults may occur due to multiple causes, the most common being infection of the urinary bladder. Medical conditions associated with it include neurological problems, prostate enlargement and anatomical abnormalities.
“In men it can be due to an enlarged prostate, while in women it can be due to prolapsed uterus. Worm infestations can also lead to bed-wetting. With advancing age, bladder sphincters tend to become weak causing urine to trickle out when bladder is full. During waking one can exert some voluntary control, but that is lost during sleep.
“Some drugs like diuretics used for hypertension and cardiac failure also cause increased urination and can cause bed wetting as well. Senile dementia, where with advancing age one starts losing control over cognitive functions also has bed wetting as one of the manifestations,” she explains.
Prevention and treatment
Dr Pande notes that although treatment consists of diagnosis of the underlying cause, the condition can still be prevented.
“Prevention lies in drinking much water which will flush the germs out of bladder. One should avoid drinking any fluids at least two hours before bed time to keep dry in night. If possible, one should wake up once about 2-3 hours after sleeping, with help of an alarm clock or a family member and try to pass urine. The bladder will then be trained to pass urine at that time and bed-wetting can be avoided. Also using an adult diaper before sleeping is also useful and would save the person from embarrassment of bed wetting,” she says.
Dr Ndata also suggests certain lifestyle changes that may help one end bed-wetting.
“The use of waterproof mattress and adult diapers can help as well as behavioural modification like cutting out caffeinated or alcoholic drinks in the evening can be helpful. Caffeine and alcohol are bladder irritants and diuretics. That means they will cause one to urinate more,” he advises.
Dr Ndata adds that some surgical procedures can help increase capacity and nerve stimulation which helps decrease muscle tone in the bladder.
“Some drugs are available which can act as hormone replacement and decrease the amount of urine produced at night. Some drugs can also help decrease muscle spasm of bladder causing bladder relaxation,” he says.