Sorry about your roommate Kizza, but you must know that for many adults, it is hard to even talk about something that is a “kid thing.”  It must be noted that bedwetting in adults is actually different than what children go through. And while that might not remove the embarrassment, you must know that nocturnal enuresis is involuntary and not your fault.

To fully understand the how and why a quick refresher anatomy refresher course could be helpful. Urine is produced by the kidneys and travels through the ureters to the bladder to be stored. The bladder is basically a muscular sac that holds urine until it is ready to be released into the urethra, the tube that connects the bladder to the outside of the body. At the same time the bladder contracts, the urinary sphincter relaxes. The relaxed sphincter acts like an open door, which allows the urine to pass and exit the body. When there is a physical impediment or neurological disconnect, urination can become problematic or mistimed.

CAUSES

There are several factors that can contribute to an adult experiencing nocturnal enuresis. Like with so many medical issues, the first place to check is family history. Evidence has shown that bedwetting is hereditary.  One study has shown that someone with two bedwetting parents has a 77% chance of becoming a bedwetter. When one parent wet the bed as a child, his son or daughter was found to have a 40% chance of becoming a bedwetter. These probabilities carry into adulthood as well.

Another factor may have to do with ADH, the antidiuretic hormone. Its main function is to signal the kidneys to decrease the amount of urine produced. Instinctively, the body normally produces more ADH to avoid nocturnal enuresis. However, some people do not produce the appropriate amount of this hormone at night, which leads to high urine production. In other cases, the body produces ADH, but the kidneys do not respond and continue to produce the same amount of urine. This excessive production of urine during sleep is defined as nocturnal polyuria. This abnormality can cause nocturnal enuresis in adults, but it is also a symptom related to type I diabetes. Consulting a healthcare professional is helpful especially if you feel that you may be experiencing diabetes or nocturnal enuresis.

Patients with a “smaller” bladder are often dealing with primary nocturnal enuresis. The physical size of the bladder isn’t actually smaller, rather, the functional bladder capacity (FBC) can hold a smaller volume of urine.

Related to FBC, if the muscles of the bladder, known as detrusor muscles, are overactive, nocturnal enuresis can occur. In fact, detrusor overactivity has been found in up to 70-80% of primary nocturnal enuresis patients.  Bladder irritants, such as alcohol and caffeine, can contribute to detrusor instability. Medications are also known to increase bedwetting in adults. Side effects from hypnotics, insomnia medications, and psychiatric medications such as thioridazine, clozapine, and risperidone can increase your risk. Be sure to talk to your healthcare provider about any medications prescribed and their side effects.

As for secondary nocturnal enuresis, there is plenty of research that suggests an underlying health issue is at the root of the bedwetting. Such problems can be associated with the prostate in men or pelvic organ prolapse in women.

Any of these medical issues can also cause bedwetting: diabetes, urinary tract infection, urinary tract stones, neurological disorders, anatomical abnormalities, urinary tract calculi, prostate cancer, prostate enlargement, bladder cancer, or obstructive sleep apnea.

TREATMENT OPTIONS

Before a treatment can be prescribed for your roommate, his physician will want to zero in on the cause of his nocturnal enuresis. A symptom diary is one of the most useful tools for a healthcare provider.

Take care to note when you void during the day and night:

• When accidents occur (time of day or night)
• Amount of urine voided
• Drinking patterns (does he drink a lot of fluids in the later afternoon/evening?)
• What your roommate drinks (sugary, caffeinated, artificially sweetened, carbonated, alcoholic drinks, etc.)
• Nature of the urinary stream (is the urinary stream strong and constant or is there difficulty initiating a void or continuous dribbling?)
• Any existing recurrent urinary tract infections
• The number of wet versus dry nights
• In addition, note any other symptoms associated with nocturnal enuresis such as night sweats

In addition to helping you find options to help cure bedwetting, it is also important to see a healthcare provider to rule out any other serious problems that may cause nocturnal enuresis as a side effect.