Bedwetting refers to the involuntary passage of urine during sleep, referred to as nocturnal enuresis. On its own, ‘enuresis’ is the clinical term for wetting, regardless of whether the wetting occurs in the clothing during the day or in bed at night. An alternative term for enuresis is urinary incontinence.
For infants and young children, urination is involuntary and wetting is therefore quite normal for them. Some degree of bladder control is generally achieved by children between the ages of 4 to 6 years. While bed-wetting is something that is considered by many to be a problem that only affects kids, the reality is it can affect adults too.
Adults may feel embarrassed on waking up to wet sheets, but this is not owing to any fault of their own. Bed-wetting in adults could be due to a medical condition, certain medicines, or a problem with the bladder.
Causes of bedwetting
There are two types of bedwetting: primary and secondary bedwetting.
- Primary bedwetting is bedwetting that has been ongoing since early childhood without a break.
- Secondary bedwetting refers to bedwetting that resumes after a child has been dry at night for a significant period of time (at least six months), or bedwetting in adults, which can be a sign of an underlying medical or psychological problem.
Children
For children, the age at which bladder control is fully achieved differs considerably. Factors that affect this include the child’s gender (bedwetting is more common in boys), developmental and mental state, overall physical and psychological health.
Adults
The kidneys produce too much urine. ADH is a hormone that conveys signals to your kidneys to produce less urine. Normally, ADH-hormone levels drop significantly at night. Adults, who have bed-wetting issues, may not make enough of this hormone or the kidneys might not respond well to it.
Structural or anatomical abnormality. An abnormality or legion in the organs, muscles, or nerves that are involved in the process of urination can cause urinary incontinence or other urinary problems.
Neurological problems. An abnormality in the nervous system, or injury or disease of the nervous system, can cause neurological control for urination to become unbalanced.
Overactive bladder (OAB). Normally, your bladder muscles contract when you're ready to urinate. In the case of OAB, these muscles can contract too often or at the wrong times.
Medicine. Certain pharmaceutical drugs can irritate your bladder. These can include sleeping pills or antipsychotics.
Diabetes. Diabetes causes abnormally high levels of sugar (glucose) in the blood. Consequently, the body increases urine output. Having to urinate frequently is a common symptom of diabetes and is called Polyuria. Passing more than 3 liters of urine daily is considered polyuria and can in turn lead to dehydration and can affect kidney function. A form of diabetes known as diabetes insipidus is also known to affect ADH-hormone levels, causing an increase in the production urine. Adult bed-wetting may also be caused by other conditions that disturb your body's ability to collect and retain urine.
Some examples of these conditions include bladder or prostate cancers and diseases of the brain and spine, such as a seizure disorder, multiple sclerosis, or Parkinson's disease.
These, along with other conditions may cause adult bedwetting, such as:
- Blocked urethra
- Constipation
- Obstructive sleep apnea
- Pelvic organ prolapse
- Problem with the structure of the bladder and/or other urinary organs
- Enlarged prostate
- Urinary tract stones or infection
What can help
Consult a doctor.The first step towards dealing with bedwetting, whether in adults or in children of advanced age or who are presenting secondary bedwetting, is to consult a doctor about the problem. The doctor should first diagnose bedwetting and then establish a cause for the condition. It is important that any underlying medical issues are identified, eliminated or treated accordingly. Attempting to treat bedwetting without establishing the cause could be harmful, as it could be a symptom of more serious conditions.
Kegel Exercises. Childbirth, age, surgeries or injuries may cause the pelvic floor to become weakened. A weakened pelvic floor may lead to urinary incontinence which may in turn present as adult bedwetting. Kegel exercises strengthen the pelvic floor muscles that are responsible for supporting the uterus, bladder, small intestine and rectum. Kegel exercises, also known as pelvic floor muscle training can be done just about anytime and anywhere.
Relax. Although anxiety itself doesn’t cause nocturnal enuresis, overly apprehensive behavior could be a causative factor. Nocturnal enuresis has been linked to emotional problems and the toll they take on the body. Establishing good relaxation techniques such as yoga or tai chi may help.
Parasites. Such as worms can also be a contributer to night time enuresis.
Constipation. An astonishing new study suggests that for many children with nocturnal enuresis, the root may be with their bowels and not even their bladders.
According to the study, constipation was a frequent contributor to bed-wetting.
After treatment with laxatives or enemas, most of these children stopped wetting the bed within a matter of a few months. Researcher Steve J. Hodges, MD, says that stool left in the lower intestine, or rectum, can push against the bladder and reduce its capacity to hold urine.
Prevent constipation by increasing fruit, vegetable, wholegrains, fibres such as psyllium husks and water in the diet. Adding in a probiotic can also help.
Honey. Ayurveda medicine recommends honey for enuresis. Honey contains trace amounts of vitamins B2, B4, B5, B6, B11 and vitamin C, minerals like calcium, iron, zinc, potassium, phosphorous, magnesium, selenium, chromium and manganese. Antioxidants are also found honey such as flavonoids, of which, pinocembrin is unique to honey and bee propolis. The darker the honey the greater antioxidant properties. For bed-wetting, give children 5ml of old bee’s honey daily just before going to bed and up to 10ml can be taken for adults.
It is important to give support for adults and children with nocturnal enuresis.
References
- http://www.uofmhealth.org/health-library/hw211532
- https://www.ncbi.nlm.nih.gov/pubmed/7752378
- http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283
- Urinary incontinence in women. National Institute of Diabetes and Digestive and Kidney Diseases. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-incontinence-women/Pages/facts.aspx. Accessed July 29, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3611628/
- http://www.nytimes.com/health/guides/disease/kidney-stones/prevention.html
- Koo, P., McCool, F. D., Hale, L., Stone, K., & Eaton, C. B. (2016). Association of Obstructive Sleep Apnea Risk Factors with Nocturnal Enuresis in Postmenopausal Women. Menopause (New York, N.Y.), 23(2), 175–182.
- Sinha, R., & Raut, S. (2016). Management of nocturnal enuresis - myths and facts. World Journal of Nephrology, 5(4), 328–338. http://doi.org/10.5527/wjn.v5.i4.328 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177368/
- http://www.anxietycentre.com/FAQ/anxiety-and-nocturnal-enuresis.shtml
- http://www.webmd.com/children/news/20120130/study-constipation-may-cause-bedwetting#1
- http://www.umm.edu/health/medical/altmed/supplement/psyllium
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