Miss Chen, a 20-year-old college student, is currently enjoying the period of her youth on campus.
However, an embarrassing issue quietly troubles her during the night.
She occasionally wakes up in the middle of the night to find her mattress damp, causing her to feel embarrassed and anxious.
This situation not only affects her sleep quality but also creates disturbances in her daily life.
Consequently, she not only has to discreetly avoid friends and family while changing sheets but also refrains from participating in overnight camp activities, fearing something might be wrong with her body.
Fortunately, after receiving outpatient treatment, she can now enjoy a peaceful night's sleep and regain her confidence, allowing her to participate in her favorite camp activities without worry.
According to the International Continence Society (ICS), any unintended voiding during nighttime sleep is defined as Nocturnal Enuresis (NE).
While it's considered a normal phenomenon in young children due to incomplete development, it can significantly impact the quality of life, interpersonal relationships, and mental health of adults experiencing it.
Dr. Huang aims to explore issues related to adult nocturnal enuresis, providing more understanding for the public and helping patients facing this condition feel more at ease.
Mechanism:
The ability of a normal person to maintain urinary control during the night involves factors such as normal bladder compliance, a closed bladder outlet (sphincter), decreased nocturnal urine production, and awakening due to the full bladder.
Therefore, if nocturnal enuresis occurs, it is likely that one or more of these functions are compromised.
However, it is not clear whether adult nocturnal enuresis depends on the severity of bedwetting during childhood or if it is caused by entirely new physiological mechanisms.
Prevalence:
The prevalence of adult nocturnal enuresis is approximately 2-3%, increasing to 23% in women with voiding dysfunction and reaching 39% in patients in nursing homes.
Approximately 17.2% of individuals with Down syndrome experience nocturnal enuresis.
Risk Factors:
Risk factors for nocturnal enuresis (NE)
• Neurologic disease
• Psychiatric medications
• Sleep apnea syndrome
Risk factors for NE in women
• Smoking
• Obesity
• decreased physical activity
• hypertension
Risk factors for NE in men
• BPH and outlet obstruction
Additionally, research suggests that childhood bedwetting does not increase the risk of adult nocturnal enuresis.
Psychosocial Considerations:
Compared to the general population, adults with nocturnal enuresis have a significantly higher occurrence of anxiety, depression, chronic fatigue, and low self-esteem.
Western countries, the Middle East, and Southeast Asian nations have recognized its significant impact on social and psychological health.
Etiology:
1.detrusor disorder
a. detrusor overactivity — neurogenic bladder、Idiopathic detrusor overactivity
b. detrusor hypocompliance — scarred bladder、chronic infection
2.Outlet issues
a.Outlet obstruction— neurogenic bladder、BPH、Urethral stricture
b.Outlet incompetence — neurogenic bladder、Iatrogenic sphincter apparatus injury、Antipsychotics
3.Nocturnal diuresis
a. Renal disorder — Chronic renal disorder)、Renal medullary concentration disorder (hemolytic disorders)、diuretics)、Nephrogenic diabetes insipidus
b. Central disorder — Obstructive sleep apnea syndrome (OSA)、Chronic liver disease、Elderly、Central diabetes insipidus
4.Sleep arousal threshold disorder
a.Sleep disorder — Primary sleep disorder、Elderly、Alcohol、sedatives、antipsychotics
b.Reduced bladder sensation — Diabetes neuropathy
Nocturnal enuresis in adults can have multiple causes, making clinical diagnosis complex. Psychiatric medications like olanzapine, clozapine, quetiapine, and risperidone can cause enuresis through various mechanisms.
Treatment:
First-line treatment options include lifestyle modifications (avoiding caffeine, sedatives, and alcohol, maintaining a healthy weight, and regular physical activity), behavioral therapy (timed voiding training, adapted dry behavioral therapy), and medical therapy (desmopressin and anticholinergic drugs).
Second-line modalities include surgical intervention, neuromodulation, and botulinum toxin injection to the bladder.
Conclusion:
Adult nocturnal enuresis, or bedwetting, is a health issue that significantly impacts quality of life but is often overlooked.
It can cause discomfort in social situations, reluctance to go out, and concerns about overall well-being.
Understanding potential causes and effective treatments is crucial for patients.
This discussion aims to provide basic information for healthcare providers and patients, encouraging those with similar issues to seek professional medical assistance.
References:
A comprehensive review of adult enuresis
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30273117/
