Living Better With Incontinence

Nocturia and Bedwetting

For those who live with urinary incontinence, getting through a given day can be a struggle. When conditions like nocturia or nocturnal enuresis (bedwetting – for our purposes, adult bedwetting) exist, sufferers can only dream of making it through the night dry. Nocturia is defined as the need to get up twice or more during the night to pass urine, causing unwelcome disturbances in a sufferer’s sleep cycle. One-third of adults over age 30 are reported to wake up at least twice a night to use the toilet. Nocturnal enuresis, in which urine is involuntarily voided during sleep, is shown to affect 2% of adults. There are two types of adult bedwetting. Persistent primary nocturnal enuresis begins in childhood and carries into adulthood, nighttime continence having never been achieved for longer than a six month period. Adult onset secondary enuresis is bedwetting that begins at a later age, usually among individuals nearer to 60 years old.

Causes

The biggest contributor to nocturia and adult bedwetting is simply aging, whereby our bodies tend to produce more urine (nocturnal polyuria) and our bladder muscles become weakened. For women, pregnancy, childbirth and menstruation can play a role in nighttime urination, as can an enlarged prostate for men. Urinary tract or bladder infection, diuretic (urination-encouraging) medications, and excessive fluid consumption before bed are all causes. Overactive bladder can also often result in cases of nocturia or nighttime enuresis. They can also be symptoms of a greater underlying condition such as diabetes, high blood pressure, heart or vascular disease, or a sleep disorder.

Symptoms

Nighttime urination is characterized by the normal sleep cycle (six to eight hours) being disrupted by the need to get and relieve oneself. Severe cases of nocturia may include getting up five to six times during the night. As you would expect, several negative effects can occur with this kind of sleep deprivation and/or insomnia: mood swings, exhaustion and impaired cognitive ability are a few examples.

Nocturnal enuresis occurs when one cannot contain one’s urine during sleep, thus ‘wetting the bed.’ In sufferers the hormone ADH, the antidiuretic hormone produced during sleep which slows urine production, is not made in significant enough quantity. People with nocturnal enuresis may also have a limited functional bladder capacity (FBC), whereby the amount of urine they can hold is more diminished than average. Bedwetting can occur when overactive bladder or other factors of urinary incontinence are present. Persistent or chronic adult bedwetting may necessitate the use of waterproof bed pads or sheet protectors.

Treatment

Though nocturia and nocturnal enuresis are two different phenomenon and should not be confused with one another, treatment and management options tend to interlace between the two. This is generally the case with urinary incontinence as a whole. The first step in confronting these nighttime urinary occurrences is monitoring fluid intake and limiting its consumption before going to bed. This is especially the case with caffeinated or alcoholic drinks – both diuretics.
In cases of nocturia, it is recommended that you start a diary of the number of times and circumstances regarding your nighttime visits to the toilet. This information can greatly help your medical practitioner diagnose the nature of your nocturia. In order to reduce and redistribute fluids in your body, afternoon naps, elevating your legs and compression stockings are all behavioral techniques used to counteract the occurrence of nocturia. Additionally, there are a number of medications that address the symptoms of nocturia, most of them targeting abnormal detrusor muscle activity in the bladder.
Behavioral approaches to adult bedwetting can include retraining the bladder during the day with large amounts of fluid and engaging moisture-detecting alarms at night when nocturnal enuresis occurs, conditioning the body to wake before urination happens. Also, sufferers have found relief in setting random alarms at night to get up and urinate. Again, there are medication options available that address this condition. Unlike those prescribed for nocturia, most of these medications act like the ADH hormone and slow urine production in the kidneys. Furthermore, as a very last resort after trying behavioral and pharmaceutical approaches, some sufferers are recommended invasive surgical options much like those used for overactive bladder or urge incontinence.