Nocturnal enuresis (NE) is the involuntary voiding of urine during sleep. This condition is more commonly known as bed wetting. While nighttime loss of bladder control is often associated with young children, seniors may also suffer from involuntary urination for a number of reasons.
Causes of nighttime incontinence in the elderly include diabetes, urinary tract infection (UTI), medication side effects, neurological disorders, anatomical abnormalities, overactive bladder, prostate enlargement or prostate cancer, bladder cancer, and obstructive sleep apnea. In very rare cases, acute anxiety or an emotional disorder may cause adult bed wetting.
Urinary incontinence episodes are messy and can be embarrassing. Fortunately, there are treatments available and techniques that seniors and their caregivers can use to minimize the likelihood of elderly bed wetting.
Tracking Elderly Bed Wetting
A detailed record of a senior’s symptoms and bathroom habits can help a health care provider determine possible causes and treatments for nighttime incontinence. Keeping a diary over several days should provide enough data to assist a doctor in making a diagnosis, ordering any additional tests and developing a plan of care.
Don’t be embarrassed by sharing this personal information. As with any health concern, providing a complete picture of the issue will help improve the accuracy and speed of diagnosis and treatment. Be sure to include the following details in such a journal:
- Urination times throughout the day and night
- Timing of any incontinence accidents during the day and night
- Estimated amount of urine voided each time
- Detailed information on fluid intake (timing, amounts and type of beverages consumed)
- Nature of the urinary stream (Is the urine stream strong and consistent? Is there difficulty initiating a void? Continuous dribbling?)
- Indication of an existing or recurrent urinary tract infection (UTI)
- Note any other symptoms associated with urination and nocturnal enuresis, such as night sweats
Make a Doctor’s Appointment
A senior (or their caregiver) should be prepared to supply information and details related to personal and family medical history as well as medication usage. In addition to narrowing down treatment options for bed wetting, it is important to see a healthcare provider to rule out any other serious health problems that may cause nocturnal enuresis.
After gathering this information, the doctor will typically perform a physical exam, conduct a neurological evaluation, and collect a urine sample to be sent to the lab for urinalysis and urine culture.
Additional tests may be required to gather more information on what may be causing nighttime incontinence. Uroflowometry is one such test that involves urinating into a specialized funnel that measures flow rate, amount of urine and time required for complete urination. Another non-invasive procedure checks for incomplete bladder emptying and uses an ultrasound machine to measure any post-void residual urine in the bladder.
If a more serious underlying problem is suspected, the doctor may recommend further tests.
Treatments for Nighttime Bed Wetting
Seniors who experience persistent nocturnal enuresis typically make an appointment with their primary care physician or family doctor to address the issue. However, some cases may require a referral to a specialist, such as a urologist or a sleep disorder specialist. It can be uncomfortable to discuss bodily functions with another person, but a medical professional will be able to provide options for treating bed wetting. In many cases, nighttime incontinence can be minimized or completely cured.
Monitoring Fluid Intake
Limiting intake of fluids in the late afternoon and evening before bedtime results in decreased urine production at night. This could be a simple first step to reduce wet nights. Avoiding caffeine and alcohol, which can irritate the bladder, can be helpful as well. Hydration is still important, though, as drinking adequate fluids is crucial for general health. Rather than changing the daily amount of fluid intake, be more cognizant of what a senior is drinking and when. Water is always the best choice for proper hydration.
Bladder Volume Training
This technique helps to increase bladder control and volume in those who have a small functional bladder capacity (FBC). The training involves drinking large amounts of fluid during the daytime and refraining from voiding for as long as possible—up to two to three hours. Through training, one’s functional bladder capacity increases, making voids more infrequent. This method may be especially helpful for those with diagnosed overactive bladder, a condition in which the muscles of the bladder contract frequently and involuntarily. Men experiencing symptoms of enlarged prostate should consult a healthcare provider for alternative behavioral therapy options, since bladder volume training can result in distending or stretching the bladder.
Bed Wetting Alarm Systems
A bed wetting alarm is a device that awakens a senior from sleep as soon as an accident begins. Multiple variations of these alarms exist, which may include vibrating or sounding alarms and even wet-detection devices that can be attached to the underwear or a pad on which the individual sleeps. Once awoken, a senior can 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. Like bladder volume training, 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 multiple bed wetting episodes from decreased FBC. Although, in many cases of bed wetting, a bed wetting alarm device helps the user overcome the condition.
Scheduled Nighttime Voiding
While this option does not treat the underlying problem, it may be helpful in preventing soiled linens. This technique involves setting an alarm during the night at a random time to wake up and urinate. It is important to set the alarm at random times so that the bladder does not grow accustomed to emptying at a scheduled time during the night.
Pharmacological Therapy
Different medications are available for the treatment of nocturnal enuresis. These may be used alone or in conjunction with some of the behavioral treatments listed above, although the latter approach has proven to be more effective.
Many studies have shown that, while pharmacological treatment alone may be effective in lowering the number of wet nights a person experiences, the medicine is often effective only as long as it is taken. Relapse rates are high once treatment has stopped because the medication only manages symptoms. It does not target the underlying condition or causal factors of bed wetting.
Sacral Nerve Stimulation (SNS)
If less invasive approaches to treating nocturnal enuresis have been unsuccessful, surgical procedures like SNS may be recommended. The sacral nerves located in the lower back are responsible for sensory and motor impulses throughout the lower body. Sacral nerve stimulation for overactive bladder involves using electricity to stimulate specific nerves that control muscles involved in bladder function. 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.
Clam Cystoplasty
This is a surgical procedure that is performed to reduce bladder instability and increase bladder capacity. The bladder is partially cut open and a small patch made of the senior’s intestine is attached between the two halves to increase the volume of the organ.
Detrusor Myectomy
This surgical procedure involves removing a portion or all of the exterior muscle layer from the wall of the bladder. The goal is to reduce the strength and frequency of bladder contractions and therefore alleviate urinary symptoms of overactive bladder like urge and urgency.