Bed Wetting in the Elderly
By Marlo Sollitto
Nocturnal enuresis (NE) is the involuntary voiding of urine during sleep. This condition is more commonly known as bed wetting.
Causes could include: diabetes, urinary tract infection, urinary tract stones, neurological disorders, anatomical abnormalities, urinary tract calculi, prostate cancer, prostate enlargement, bladder cancer, and obstructive sleep apnea. In very rare cases, acute anxiety or emotional disorder may cause adult bed wetting.
Tracking Adult Bed Wetting
One of the most useful tools for a healthcare provider is to have a great deal of information about your parent's symptoms and general habits. Consider keeping a symptom diary of daily habits and routines for at least two days prior to a medical appointment. These details will assist your healthcare provider when determining the cause and severity.
- Note when and how many times your parents urinates during the day and night
- When accidents occur (time of day or night)
- Amount of urine voided
- Drinking patterns (does your parent drink a lot of fluids in the later afternoon/evening?)
- What they drink (sugary, caffeinated, artificially sweetened, carbonated, alcoholic drinks, etc.)
- Nature of the urinary stream (is the urinary stream strong and constant or is there difficulty initiating a void or continuous dribbling?)
- Any existing recurrent urinary tract infections
- The number of wet versus dry nights
- In addition, note any other symptoms associated with nocturnal enuresis such as night sweats. This information can help a healthcare provider determine the cause of the problem and the appropriate treatment.
Make a Doctor's Appointment
Be prepared to supply such information and details related to personal and family medical history as well as medication usage. In addition to helping you find options to help cure bed wetting, it is also important to see a healthcare provider to rule out any other serious problems that may cause nocturnal enuresis as a side effect.
At the appointment you can expect:
- A physical examination;
- Neurological evaluation; and
- Urinalysis and urine culture to determine the contents of the urine.
Further assessments include:
- Uroflowometry: A test that involves urinating into a specialized funnel that measures the flow rate, amount of urine, and time required for urination.
- Post-void residual urine measurements: This test requires an ultrasound and are non-invasive procedures that determine the volume of urine left in the bladder after voiding.
If other problems are suspected, you can expect further tests for diagnosis.
Treatments for Bed Wetting
If your parent suffers from persistent primary nocturnal enuresis, you may first see a primary care professional, such as a family practice physician or nurse practitioner. However, individuals with adult onset nocturnal enuresis usually need to be referred to a specialist, such as an urologist or sleep disorder specialist. While you may be embarrassed to address the issue with others, a medical professional is able to give you options to help treat bed wetting. In many cases, bed wetting can be cured.
Monitoring Fluid Intake
Limiting intake of fluids in the late afternoon and evening before bedtime causes a decreased amount of urine produced at night. This could be a helpful first step to reduce wet nights. Also, decreasing the amount of caffeinated and alcoholic beverages may help. However, this does not mean that you should reduce your overall fluid intake. Only change the time of fluid intake, as drinking adequate fluids is important for general health. Be sure to drink plenty of water.
Bladder Volume Training
This technique is an effort to increase bladder capacity in those who have a small FBC. The training involves drinking large amounts of fluid during the daytime and refraining from voiding as long as possible, up to 2-3 hours. Through training, the functional bladder capacity is increased, making voids more infrequent. This method may be especially helpful to those with diagnosed detrusor overactivity, a condition in which the muscles of the bladder contract frequently and involuntarily. For men experiencing symptoms of enlarged prostate, consult a healthcare provider for behavioral therapy options, as bladder volume training can result in distending, or stretching, the bladder.
Bed Wetting Alarm System
A bed wetting alarm is a device that awakens an individual from sleep as soon as the accident begins. Multiple variations of the alarm exist, ranging from vibrating to sounding alarms and wet-detection devices that can be attached to the underwear or a pad on which the individual sleeps. Once awoken, the individual is able to stop the flow of urine, finish voiding in the bathroom, and return to bed. Eventually the body is conditioned to wake up with the urge to urinate before wetting the bed. This treatment option takes some weeks to work, requiring motivation and commitment. It is not as effective if the alarm goes off multiple times per night due to more than one bed wetting episode from decreased functional bladder capacity. Although, in many cases of bed wetting, this device helps the user overcome the condition.
While this option does not treat the problem, it may be helpful in preventing a wet bed. It involves setting an alarm during the night at a random time in order to urinate. It is important to set the alarm at a random time so that your bladder does not grow accustomed to emptying at a scheduled time during the night regardless of whether or not you are awake.
Different medicinal options exist to treat nocturnal enuresis. These may be used alone or combined with some of the behavioral treatments listed above, which generally has proven to be more effective.
Many studies have shown, however, that while pharmacological treatment may be initially effective in lowering the number of wet nights, the medicine is often effective only as long as it is taken. In other words, relapse rates are high once treatment has stopped, as only symptoms are addressed by the medication rather than the underlying condition or causal factors. The professional medical advice of a healthcare provider should be sought before starting any of these treatments.
The involvement of surgery when attempting to treat severe detrusor overactivity is limited and should only be considered when all other less invasive treatment options have proven to be unsuccessful. All of the procedures mentioned below have associated risks that must be considered and discussed with a healthcare professional.
Sacral Nerve Stimulation
Sacral nerve roots are stimulated by neuromodulation, a process where neurotransmitters control various neuron groups. This increases the external sphincter tone causing the detrusor muscle neurons to stop activity. When detrusor muscle neurons have a decreased activity level the muscle will not contract constantly, which ultimately causes less frequent urination episodes. SNS is recommended for people with moderate to severe urge incontinence and for whom other treatments have not been helpful or for whom prescriptions are contraindicated.
This is a surgical treatment where the bladder is cut open and a patch of intestine is placed in between the two halves. The goal of this procedure is to reduce bladder instability and increase bladder capacity.
This process is also known as auto augmentation that involves removing a portion or all of the exterior muscle surrounding the bladder. It intends to strengthen bladder contractions and reduce the number of them.