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Thursday, August 21, 2014
I Am Still Wetting My Bed at 34
Dear Doctor, I am a 34 female. I suffered from this issue ever since I was child; unfortunately there was no progress in my condition. I have fair knowledge about what the problem could be (from internet/wikipedia). So I try to sum it up. Firstly it worth to mention that I was through a medical check up for my bladder 3 years ago and it seemed to be working fine according to the doctors. Tablets been prescribed for me which werent of any good for me. Even worse they affected slightly my eye sight. I am not sure if my problem is genetic because I remember younger brother has the same problem, but that only till age of 12. Also, not sure if it is something to do with the "hormone" that tells the brain that the bladder is full because at seasons (not always) I keep rush to toilet and then find out that my bladder wasnt even half full (only small amount of urine). Some other note could be helpful that in the first 2 nights of my period it is like 70% sure that I am going to wet my bed those nights. Finally might it be sleeping disorder or a combination of all these things? I really hope that you have some recommendations for me. Thank you.
I agree that it is very distressing to suffer from this condition into adulthood. Bedwetting is very common in children and usually resolves in the first decade of life. There are several factors that contribute to bedwetting, also known as enuresis, in children. These include difficulty arousing from deeper stages of sleep in younger children along with slow development of urination reflexes. For the most part, these factors resolve with normal development of the child by age 10-12 years.
Bedwetting or nocturnal enuresis can be exacerbated by several sleep disorders that result in interruption of sleep or sleep rebound with subsequent deep sleep. These disorders include sleep apnea and a group of sleep disorders known as movement disorders of sleep. Bedwetting may recur in adulthood if a sleep disorder develops in adolescence. It is possible for a patient with sleep apnea or abnormal movement disorder during sleep to report a recurrence of their bedwetting that had resolved in their childhood.
In many cases, bedwetting may be the result of medical problems other than sleep disorders, such as congestive heart failure, diabetes, nighttime seizures, depression, severe psychological stress, and dementia. Problems or disorders of the urinary tract system that can result in enuresis include urinary tract infections, an overactive bladder muscle or loss of control of the bladder sphincter. Medications that affect sleep stages and arousability from sleep may also result in bedwetting. Of course, the excessive intake of fluids or substances that promote urination (i.e. diuretic medications, caffeine, and alcohol) can lead nighttime bedwetting. Individuals who consume large amounts of alcohol before bedtime may have confusion hallucination or difficulty awakening from sleep to urinate. They also may have seizures during their sleep from alcohol withdrawal.
Now, I will assume that you are not on any medications, have no diagnosis of seizures and do not consume alcohol excessively or before bedtime. You describe bedwetting that persisted throughout your adult years and never had a period of resolution as an adolescent. Your bedwetting is also associated with daytime symptoms including urinary urgency and frequency. This further suggests that the bedwetting at night, as distressing as it is, is a part of a problem that occurs in the daytime as well. Therefore, the problem is much less likely to be caused by failure of your sleep architecture or arousal mechanism. It is also less likely to be caused solely by a sleep disorder. A sleep disorder may aggravate the problem at night but would not explain your daytime urinary symptoms. The urgency and urinary residual you describe is very consistent with the so called “hyperactive bladder.” This could also be consistent with underdeveloped bladder reflexes or size.
You may want to two effective behavioral interventions. These are decreasing or ceasing your fluid intake for the 4-5 hours before bedtime and setting an alarm to awaken you within 3-4 hours from your bedtime so you can get up and use the bathroom at night. Once you have implemented these interventions for some time it becomes ‘second nature” to awaken after 3-4 hours to urinate.
I also recommend you be evaluated for medical and sleep disorders that may cause bedwetting. This can be achieved by history and exam, but some blood or urine tests may be needed. A sleep disorder can be ruled out with a history and a sleep study if needed. A review of your medications by your primary physician would also be reasonable. You may require additional urological evaluation, which should be done under the supervision of a Urologist.
Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University