Nocturnal Enuresis

Nocturnal Enuresis means wetting the bed. Many people wet the bed at night, although few people talk about it. In fact, one person in every 100 may be affected throughout adult life. Most people think that no one else has this problem. Many people never seek help because they are too embarrassed.

Some people wet the bed regularly all their lives. Others grow out of this during childhood but start again later in life. It can even happen if you doze off on a long coach or train journey. The right advice and support can help people who have this problem. Bed wetting can often be cured. It is always worth seeking help even if you feel you have already tried everything.

Bed wetting causes many practical problems, such as constantly having to change wet sheets and bedding. Bed wetting can affect staying away overnight, going on holiday or business trips. Bed wetting can affect sleep patterns and often it causes frustration and exhaustion.

Bedwetting can also affect self-esteem which can put a strain on personal relationships.

Types of nocturnal enuresis

Persistent Primary Nocturnal Enuresis is a condition which starts during childhood, where night time dryness has not been achieved for longer than six months. About 2 – 3% of adults over 18 years of age have this type of nocturnal enuresis. Adult Onset Secondary Enuresis is defined as nocturnal enuresis in which night time dryness has been achieved at some point in life. Dryness may have occurred for many years but then night time wetting suddenly begins at an older age.

What causes bedwetting (nocturnal enuresis)?

There are many causes of bedwetting and others remain unclear. Usually people produce less urine when they are sleeping. However, some people produce larger amounts of urine during the night, which may explain why the bladder needs emptying then.

So why don’t you wake up when you need to go to the toilet? Unfortunately, there is no clear cut answer to this question.

Research has shown that nocturnal enuresis can occur due to a genetic link. Though this is not true for everyone, evidence has shown that bedwetting is hereditary. One study showed that someone with two bedwetting parents has a 77% chance of also becoming a bedwetter. When one parent wet the bed as a child, then their child was found to have a 40% chance of becoming a bedwetter.

Another cause put forward for primary nocturnal enuresis is a smaller than average bladder. This does not mean that the actual size of the bladder is smaller in nocturnal enuresis patients, rather that their functional bladder capacity (FBC) is a smaller volume. The FBC is the amount of urine the bladder holds before sending a signal to the brain to indicate the need to void. The overactivity of the detrusor muscle (bladder) indicate that the muscle is never fully relaxed during the filling phase and therefore the bladder capacity is not as large.

Some people have an ‘overactive’ or ‘unstable’ bladder (OAB) which causes problems at night as well as during the day. Several studies have found a high incidence of detrusor instability (OAB) with nocturnal enuresis. Detrusor overactivity has been found in up to 70 – 80% of primary nocturnal enuresis patients.

The amount and type of drinks that you have is important. We all need fluids to stay healthy, but some drinks can irritate the bladder or make the body produce urine more quickly than usual. Alcohol, and drinks that contain caffeine (such as tea, coffee, hot chocolate and cola), can affect you in these ways.

Some medicines prescribed for completely unrelated problems can change the way your urinary system works and can cause you to have less control than normal. These medications include common drugs used for heart and blood pressure problems, or for mental illness and anxiety.

An infection in the urine (urinary tract infection, “UTI”) can sometimes cause bed wetting. Stress or anxiety can also cause the problem, which might last long after the stress has gone.

If you start bed wetting again as an adult and this persists, it could be the result of a more serious underlying problem. If this is the case, you need to go to the doctor immediately for further investigation.

What help is available?

If you are concerned about your problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.

It would be a good idea to keep a record of your bladder activity for a few days before your appointment with your doctor or nurse. You would need to keep a record for at least 3 days and filling in a bladder diary is a simple way of doing this. Please visit our Bladder Diary/Retraining page for more information.

A urine dipstick test may be done to rule out a urinary tract infection. The doctor may also arrange for you to go to a hospital for special tests on your bladder, these tests are called Urodynamics.