Adult Night Urination

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Adult Night Urination is the involuntary passage of urine at night by adults, be it male or female. People do not talk about this a lot because they feel ashamed to. I had a personal experience with nocturnal enuresis (night urination), not as an adult but as a child. I am not sure if I stopped when others did. Guess that's what makes me special. ☺

Adult Nocturnal Enuresis is a medical condition that should be carefully examined and discussed.

Causes

Hormonal Cause
A deficiency in Anti-Diuretic Hormone (ADH) production can also cause adult night urination. 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.

Family Background
Family history appears to play a significant role with Adult Bedwetting. Patients with one or both parents who suffer from the problem have a significant chance of developing the problems themselves.


Metabolic Syndrome
Diabetes Mellitus is a metabolic syndrome that can also cause an increase in urine production leading to nocturnal polyuria or urination in the night.

Bladder Anatomy
Patients with anatomically small bladders have smaller functional bladder capacities and hence can also suffer from bedwetting.

Irritants
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 Bromazepam  hypnotic) used for treating sleep disorders and psychotropic drugs like Sertraline (a SSRI), used for treating anxiety and other mood disorders.

Causes of Secondary Night Urination 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, the attending Physician will want to determine the cause of night urination. Hence, it is important to document certain important issues:

Timing of normal urine passage during the day
Timing of accidental urine passage
Drinking patterns
Nature of beverage consumed
Nature of urinary stream (do you dribble?)
Any existing medical problems
Any accompanying symptoms (eg fevers etc)

The attending Physician will then take a full clinical history and go through the list of medications the patient is currently on to identify any drugs that might cause bedwetting as a side effect. Following which, a full physical examination will be performed and the Physician might request for a urine sample for lab analysis. Thereafter, the physician might order specific investigations like uroflowometry (a simple test that determines the flow and force of urine stream) or post void residual urine measurements via ultrasound to evaluate bladder function.

Management

Many simple changes in the bedroom setting can help alleviate adult bedwetting. 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 the condition.

Pharmaceutical Treatment

Drugs like Desmopressin mimic ADH, causing the kidney to produce less urine. Antimuscarinic medications like Benzhexol, Benzatropine, Atropine, etc. have also demonstrated some success with treating adult nocturnal enuresis but antimuscarinic drugs carry with them side effects that might affect patient compliance e.g dry mouth, blurred vision.

Thank You

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