Chijioke Iremeka
Involuntary release of urine during sleep, also known as bedwetting by adults could be a sign of a serious medical condition such as bladder and prostate cancer, or side effects of certain medications that require urgent medical intervention, physicians say.
According to them, though bedwetting, medically known as nocturnal enuresis, is uncommon in adults, they advised anyone experiencing such to seek medical attention to diagnose the root cause and nip it in the bud before it becomes life-threatening.
An online medical portal, Mayo Clinic, described nocturnal enuresis as passing urine without intending to while asleep, after the age when staying dry at night can be reasonably expected.
Speaking exclusively with PUNCH Healthwise in different interviews, the experts said bedwetting may also be due to conditions that affect the body’s ability to store and hold urine, saying that bladder and prostate cancers can lead to such a condition.
Other conditions they listed that could lead to bedwetting in adulthood are diseases of the brain and spine, such as a seizure disorder, multiple sclerosis, or Parkinson’s disease among others.
A Consultant Family Physician at the Anambra State Ministry of Health, Awka, Anambra State, Dr Chidumeje Okafor said bedwetting in adulthood can be traumatic and may lead to low self-esteem.
He noted that enuresis in adults is divided into secondary and functional, explaining that in secondary; the patient has had enuresis during childhood and stopped, but started again in adulthood.
He added, “Enuresis can be functional, which means having involuntary passing of urine in adulthood when the person should have stopped in the presence of no obvious deformity.”
Speaking on the causes, he said, “Let me start from the head and that is the brain. The brain produces a hormone called anti-diuretic hormone which is responsible for the reabsorption of water in the body.
“Antidiuretic hormone helps regulate the amount of water in your body. It works to control the amount of water your kidneys reabsorb as they filter out waste from the blood.
“That means that in any water you drink, the body through the hormone ensures everything is not urinated. So, the hormone reduces your urine.
“So, if there is any damage to the brain that leads to the reduction of this hormone that controls water and its reabsorption, there will be excessive urine production, meaning that you will be urinating even on the bed as an adult.”
According to him, when a person has bed-wetting issues, the body may not be making enough of this hormone or the kidneys might not be responding well to it.
He also said diabetes insipidus also affects ADH levels, causing a person to produce more urine.
Okafor noted that since the bladder cannot hold enough urine and there is no enough room in the bladder, urine can leak.
He said people with overactive bladders, especially women, usually have their bladder muscles squeezed when they are not ready to urinate.
“In an overactive bladder, these muscles squeeze too often or at the wrong times and make you urinate. Also, some drugs you take can irritate your bladder, such as sleeping pills or antipsychotic drugs. These will also make you wet the bed.”
On the way forward, he advised anyone experiencing the medical condition to see a physician for evaluation to ascertain the actual cause of the secondary enuresis.
“Counselling in the form of motivational therapy is needed because the thought of bedwetting as an adult is devastating and it might proceed to psychological trauma and depression.
“Also, alarm therapy can help. That is setting an alarm for the person to wake up regularly to urinate. However, where these failed, the use of drugs to act as Anti-diuretic substitutes to regulate the water in the body and reduce frequent urination will be required,” Okafor added.
On the treatment and management of the condition, an Australia-based Nigerian Urologist, Dr Michael Ogah said, “Bedwetting may also be due to conditions that affect the body’s ability to store and hold urine. For instance, bladder cancer and prostate cancer can cause it.
He noted that diseases of the brain and spine, such as a seizure disorder, multiple sclerosis, or Parkinson’s disease can cause bet-wetting.
On the solution, he said, “Changes to your daily and nightly routines will help. Avoid drinking before going to bed. This will reduce the volume of urine made by your body. Avoid caffeine and alcohol, which can stimulate the bladder.
“Set an alarm clock to wake you up at regular intervals during the night. Medicine like desmopressin reduces the amount of urine your kidneys make.
“OnabotulinumtoxinA can be injected into the bladder to relax the muscles. There might be a detrusor myectomy, which is a major operation that treats an overactive bladder, where your surgeon removes part or all of the muscles around your bladder to stop them from contracting at the wrong times.”
In a study by Hamed Akhavizadegan et al, published in the National Library of Medicine, titled, ‘A comprehensive review of adult enuresis, the authors said gaining the ability to hold urine through the night is one of the developmental neuro-motor skills of a functioning bladder.
The authors said regardless of underlying pathology, patients with NE experience discordance between bladder compliance, sphincter efficiency, and urine production overnight and often lack awareness of a sensation to avoid.
The study affirms that many adults afflicted with NE are affected psychologically, saying that NE is a symptom of urinary tract disorder or systemic disease.
“It requires a standard evaluation consisting of history and physical examination, urinalysis, and when indicated, urinary ultrasonography, urine flow rate, frequency volume chart, urodynamic study, and cystoscopy.
“It is recommended that general practitioners refer adults with NE to urologists due to its complexity. However, many patients benefit from long-term desmopressin. Anticholinergics can add benefit even in the absence of overactive bladder symptoms.”
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