Embarrasing Health Issues - Bed-wetting in teenagers and adults (Series 4)

Wetting the bed at night (the medical term is enuresis) is more common in adults than you might think. It affects about one person in every hundred, mainly men. While others may never have experienced a dry night. Many feel so embarrassed that they hide it from their families and can find it a barrier to forming close relationships. It can be especially difficult when staying away from home. 

Causes of Bed Wetting

Adults who wet the bed at night often have problems in the daytime as well, such as having to rush to the lavatory (urgency). It is not really known why this occurs. It may be a mixture of reasons. If you have always suffered from bed-wetting, you may:

• lack the necessary muscle and nerve control
• produce a lot of urine at night

If you have only recently started to wet the bed, it could be caused by:

• urine infection
• alcohol, coffee or diuretic medicines
• sleeping tablets
• diabetes
• stress and anxiety
• other conditions

Lack of necessary muscle and nerve control. Your bladder may not have developed the necessary nerve and muscle control, so the bladder muscle contracts and empties the bladder when it is only half full of urine. If you are a teenager, your bladder may soon learn – it is just being a bit slow.

Producing a lot of urine at night. You may be producing a lot of urine, because the mechanisms that reduce urine production at night have not developed. Again, if you are a teenager, the problem may resolve itself in time.

 

Urine infection. A urine infection can irritate the bladder, and make it more difficult to hold urine.

 

Alcohol, coffee or diuretic medicines. Diuretics are medications that are used to treat high blood pressure and some heart problems. They encourage the kidney to make more urine. It is best not to take a diuretic at bedtime, because you will need to pass urine in the night and, if your bladder control is poor, this could cause bed-wetting. Alcohol and coffee have a similar effect, so avoid them within 3 hours of bedtime.

 

Sleeping tablets can make you sleep so soundly that you do not wake up when your bladder is full. If you take sleeping tablets, discuss with your doctor whether you really need them, or try reducing the dose.

 

Diabetes is a disease in which the blood sugar is too high. The kidneys try to lower the sugar by making lots of sugary urine, so you pass more urine in the day and during the night (you are also thirsty). If your bladder control is poor, this could cause bed-wetting. The problem goes away when the diabetes is treated.

 

Stress and anxiety can cause bed-wetting.

What You Can Do

• Do not blame yourself. Remind yourself that it is not your fault. There is no need to feel guilty or dirty. And remember that no one can tell just by looking at you that you have this problem.
• Cut down on alcohol. Trial and error will show you if this helps. Similarly, try cutting down on coffee in the evening.
• Use an alarm clock to wake you a couple of hours or so after going to bed, and a couple of hours before your usual waking time. Vary the time every few days, to avoid getting into the habit of emptying the bladder at the same time each night.
• Try sleeping in a different bed, or moving to a different room or even just moving your bed into a different position – some people find this helps.
• Visit your doctor if you have not already done so. You may be so embarrassed that you feel this is impossible for you – and in fact 1 in every 6 adults and teenagers who wet the bed never seek help. Decide to be one of the brave people who gets it sorted. Your doctor will not be surprised or embarrassed, and will be pleased to help. But you must explain clearly that your problem is wetting the bed. Do not pretend you have cystitis or some other urine problem, hoping the doctor will guess what is wrong, because he or she probably will not. For 2–3 weeks before you see the doctor, keep a diary detailing when you wet the bed.

What Your Doctor Can Do

Check that there is nothing seriously wrong. Your doctor will ask you questions, especially about whether you have wet the bed since childhood, or whether it is a new problem. He or she will do simple urine tests for infection and for diabetes. Your doctor will also check that there is nothing physically wrong with the bladder system. This may require a hospital referral to a consultant urologist and/or a bladder X-ray or ultrasound scan.

Bedwetting alarms (enuresis alarms) are used for children who wet the bed, but they can also work for teenagers and sometimes for adults. Modern types are worn between two pairs of pants, so they are small and discreet. If you have a partner, they will obviously have to be understanding and as motivated as you are. If the alarm has not produced any improvement after 3 months, talk to your doctor about combining it with desmopressin (see below).

 

Medications are available on prescription from your family doctor.

 

Desmopressin is the best medication and is taken as a tablet, a nose spray or a sublingual wafer ('melt'). It works by concentrating your urine so that there is not such a large volume to cope with. It is especially useful if you stay away from home, or if you have a bed partner. Although it stops bed-wetting completely only in less than one-third of people, most find it reduces the number of wet nights. It does not cure the problem – when you stop taking it, the bed-wetting often recurs – but it is safe to take it over a long period.

 

Imipramine is a medication that somehow helps the bladder to hold more urine. It used to be popular, but is now used only if desmopressin has not helped. It has some side effects and is dangerous if too much is taken.

 

Tolterodine and oxybutynin calm overactive bladder muscle. They may be helpful if you have daytime wetting) as well as bed-wetting, and have to rush to get to the toilet (urgency). They can cause side effects, such as dry mouth and constipation, but these can be minimized by taking the medication at night. If desmopressin has not worked, they may be useful in combination with imipramine