During a recent conversation, a friend told me about her cousin who still struggles with bedwetting at the age of 20.
I was told that despite every spiritual step taken, the situation persisted. However, my intuition suggested there is more to the situation than the insinuation it is a spiritual condition. Then I researched it, and “lo and behold” I found out it is a medical condition called Enuresis.
It then dawned on me that many people might be suffering from this condition, often misunderstanding it as a spiritual ailment rather than a medical one.
In view of this, we will examine all that should be known about Enuresis.
WHAT IS ENURESIS?
Enuresis, also known as Nocturnal Enuresis, is the loss of bladder control during the night. It is the accidental or involuntary release of pee while sleeping.
In children, it is a standard development stage. However, it can be a symptom of underlying illness or disease in adults. According to research, enuresis occurs in 1-2% of adults.
There are two main types of nocturnal enuresis
- Primary nocturnal enuresis is when a person has never achieved consistent nighttime dryness.
- Secondary nocturnal enuresis is when a person wets the bed again after not wetting the bed for six months or more. It is the type that develops after at least six months a person learns how to control his/her bladder. Secondary enuresis is usually the result of a medical or psychological condition.
WHAT CAUSES ENURESIS?
Physical and psychological conditions can lead to some people having enuresis. Potential causes of enuresis, particularly in adults include;
Enuresis can be generational. This means that if a person’s biological parents had nocturnal enuresis, their children are more likely to have the same condition.
- Hormonal imbalance
A hormone called vasopressin or antidiuretic hormone (ADH) limits the volume of pee that your body produces during the night by managing the amount of water in your body.
ADH works by causing water in pee to be reabsorbed by your bloodstream. This causes a smaller volume of pee to enter your bladder. So people whose bodies do not produce enough ADH may be more likely to wet the bed.
- Bladder problems
Enuresis can be caused by either small functional bladder capacity or overactive bladder muscles.
People with a small functional bladder capacity do not actually have a smaller physical size of bladders than others. Instead, it feels fuller at lower volumes, meaning it can hold a smaller volume of urine.
So they tend to urinate more often and this makes them more likely to wet the bed during the night.
If detrusor muscles, the muscles of the bladder, are overactive, nocturnal enuresis can happen.
Detrusor muscles relax when the bladder fills and contract when it’s time to empty. However, if these muscles contract at the wrong time, you may not be able to control urination. This may further lead to nocturnal enuresis.
According to the National Association For Continence, around 70–80% of adults who wet the bed have overactive bladder muscles.
Emotional and psychological stress can trigger enuresis.
Stressors such as major life changes, family issues, academic pressure, or social anxiety can create emotional turmoil.
This emotional stress can disrupt normal sleep patterns and may affect the body’s ability to regulate bladder function during sleep.
Psychological stressors which include family issues, social anxiety and academic pressure can also contribute to enuresis.
- Medical condition
Underlying medical conditions may be the cause of adult bedwetting, like sickle cell disease, neurological changes and kidney or bladder abnormalities.
If bedwetting recurs after you have had dry nights for six months or more, a medical condition may be causing it.
- Sleep disorder
Obstructive sleep apnea and sleepwalking can cause enuresis in adults.
These disorders can cause the body to produce atrial natriuretic peptides. This is a substance that increases the excretion of urine, which leads to more urine production.
One study found that 7 % of people with obstructive sleep apnea experience bed-wetting. Urinating during your sleep may become more frequent as the sleep apnea worsens.
- Urinary tract infection
Urinary tract infection (UTI) can cause frequent and unexpected urination.
UTI often causes inflammation and irritation of the bladder which can further worsen incontinence and bed-wetting at night
HOW CAN ENURESIS BE MANAGED OR TREATED?
Enuresis treatment varies based on its cause. However, treatment for enuresis can be divided into three main categories which include behavioral/lifestyle changes, medication and surgery.
These are the changes you need to make to your routine, particularly at night, don’t involve medication to manage enuresis. These include:
- Monitor fluid intake
Limit intake of fluids in the late afternoon and evening before bedtime in order to decrease the amount of urine produced at night.
- Cut down on bladder irritants.
Caffeine, alcohol, artificial sweeteners, and sugary drinks may irritate your bladder and lead to more frequent urination. So you need to reduce your intake of these irritants.
- Bladder Therapy
Bladder therapy is an approach aimed at gradually increasing your bladder’s functional capacity.
This therapy tends to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold.
Bladder therapy gradually teaches you to hold in urine for longer and longer periods to prevent emergencies and leaks.
- Alarm system
Multiple variations of the alarm exist to curb enuresis.
You can set an alarm for the middle of the night to help prevent bed-wetting. Getting up once or twice a night to urinate means you won’t have as much urine if an accident occurs.
There are also wet-detection devices that can be attached to the underwear or a pad on which the individual sleeps.
Even though there is no magic pill exists to totally eliminate enuresis, there are medications available that might provide relief.
However, these medications tend to work better when combined with behavioral changes. The medications include;
This medication mimics the vasopressin hormone and causes the kidneys to produce less pee.
This medication prevents enuresis by increasing brain signals to different parts of your body, like your bladder.
Imipramine has been proven to have a 40% success rate.
- Oxybutynin or tolterodine
This medication treats an overactive bladder by reducing bladder contractions.
- Trospium chloride
A medication that helps your bladder relax by blocking muscle cell receptors on your bladder wall. It prevents bladder over-activity.
To treat enuresis, surgical treatment is advised to only be used when other treatment options have proven futile.
- Sacral Nerve Stimulation
During this procedure, a small device that sends signals to the muscles in your bladder will be implanted to stop unnecessary contractions.
Fewer contractions of the bladder muscles will ultimately cause less frequent urination.
- Clam Cystoplasty
This is a surgical treatment where the bladder is cut open and a patch of intestinal muscle is inserted.
This extra muscle helps reduce bladder instability and increase bladder capacity.
- Detrusor Myectomy
This process also known as autoaugmentation involves removing some of the bladder muscles.
Detrusor myectomy helps decrease contractions.
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