It is, however, a very real medical problem and should be looked into.
Causes
Adult Nocturnal Enuresis can be caused by a variety of factors.
Family history appears to play a significant role with Adult Nocturnal Enuresis. Patients with one or both parents who suffer from the problem have a significant chance of developing the problems themselves.
A deficiency in Anti-Diuretic Hormone (ADH) production can also cause adult nocturnal enuresis. ADH is a hormone produced by a portion of the brain called the hypothalamus and acts to decrease the amount of urine produced, A deficiency in ADH will hence result in an increase in urine production and trigger urination.
Diabetes Mellitus can also cause an increase in urine production leading to nocturnal polyuria or urination in the night.
Patients with anatomically small bladders with smaller functional bladder capacities also suffer Adult Nocturnal Enuresis simply because the functional bladder capacity is smaller.
In other cases, overactive bladder muscles can trigger Adult Nocturnal Enuresis. This can be secondary to use of bladder irritants like alcohol and caffeine, or use of certain medications like hypnotics and psychotropic drugs like Selective Serotonin Reuptake Inhibitors.
Causes of Secondary Nocturnal Enuresis include any other medical issues that irritate the genitourinary system. Eg Urinary Tract Infections, Prostate enlargement / cancer etc
Seeing your Doctor
Prior to initiating treatment, your attending doctor will want to determine the cause of your nocturnal enuresis. Hence, it is important to document certain important issues:
- Timing of normal voiding during the day
- Timing of accidents
- Drinking patterns
- Nature of beverage consumed
- Nature of urinary stream (do you dribble?)
- Any existing medical problems
- Any accompanying symptoms (eg fevers etc)
Your attending doctor will then take a full clinical history and go through the list of medications you are on to identify any drugs that might cause nocturnal enuresis as a side effect. Following which, a full physical examination will be performed and your doctor might request for a urine sample for lab analysis. Thereafter, your doctor might order specific investigations like uroflowometry or post void residual urine measurements via ultrasound to evaluate bladder function.
Management
Many simple changes in the bedroom setting can help alleviate adult nocturnal enuresis. Use of waterproof mattress covers or sheet protectors makes nursing care easier. Wearing adult diapers or absorbent briefs help prevent leakage of urine. Skin care products like barrier creams help prevent skin irritation due to prolonged exposure to urine. Behavioural modifications like limiting fluid intake during late afternoon or in the evenings will reduce the amount of urine produced at night.
In situations where nocturnal enuresis are a symptom of an underlying condition, then treatment of the underlying condition remains paramount in managing nocturnal enuresis.
Surgical Treatment
Surgical treatment for adult nocturnal enuresis is limited and you should discuss this thoroughly with your healthcare provider before making a decision to undergo surgery for the condition.
Options include:
- Sacral Nerve Stimulation: This causes the bladder to become less active and hence result in fewer episodes of micturition.
- Cystoplasty: This is a surgical procedure to increase bladder capacity and reduce bladder instability.
- Detrusor Myectomy: This is also a surgical procedure which aims at strengthening bladder contractions while reducing the frequency of bladder activity.
Pharmaceutical Treatment
Drugs like Desmopressin mimic ADH, causing the kidney to produce less urine. Anti-cholinergic medications have also demonstrated some success with treating adult nocturnal enuresis but anti-cholinergic drugs carry with them side effects that might affect patient compliance.
Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.
While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.
Over the years, he has developed a strong passion to maintain and enhance the quality of life for patients under his care. A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.
