What Causes Incontinence in the Elderly at Night?

The International Continence Society defines Nocturnal Enuresis as “two or more nighttime voids”.

It is estimated that at least two percent of adults in the UK lack control over their bladders while sleeping. Whilst nocturnal enuresis in seniors is a subject that is under researched and often avoided, it is something that can have an extreme impact on a senior’s life.

The amount of urine in our bodies decreases and becomes more concentrated at night, so we are able to sleep throughout the night without having to visit the bathroom more than once. However, for those with Nocturnal Enuresis, they may need to urinate several times a night, which interrupts their sleep cycle. Bedwetting in older individuals causes numerous problems for everyday life, such as the embarrassing need to change sheets frequently. Experiencing night time incontinence can cause an extreme fear of staying away overnight and travelling with incontinence. Ultimately, having incontinence at night can have a negative impact on sleep patterns, causing constant exhaustion. It has been estimated that up to a third of adults who wake up to go to the bathroom do so at least twice a night.

Some seniors experience incontinence randomly, whereas others will have been incontinent throughout their life. Here are the two types of Nocturnal Enuresis:

• Adult Onset Secondary Enuresis–this is when an individual is continent for many years but then nighttime wetting suddenly begins when they are older.  
• Persistent Primary Nocturnal Enuresis– 2 – 3% of adults have this condition. Adults with primary nocturnal enuresis will not have experienced dryness for longer than six months.

Seniors are much more likely to develop any type of incontinence. This is due to the high prevalence of incontinence relating  diseases such as Multiple Sclerosis, Parkinson’s Disease, Dementia and other related conditions. Neurological conditions can affect the relationship between the brain and the bladder, causing accidents and delayed communication. Seniors are also likely to suffer from strokes and related conditions. It is estimated that between 6 and 30 percent of hospitalised people aged 65 and over are dehydrated. When someone is already in a fragile state, dehydration in seniors can cause a huge toll on the body. It is therefore very common for seniors with dehydration to suffer from an irritated bladder.

The following conditions are also known to be prevalent in seniors with incontinence:

• Urinary Tract Stones
• Prostate Cancer
• Prostate Enlargement
• Bladder Cancer

In addition to these known causes, a number of studies have collected different findings over the years. Heredity as a causative factor of primary nocturnal enuresis has been confirmed by the identification of a gene marker. Alanna Levine, spokesperson for the American Academy of Pediatrics states, “bedwetting causes include a small bladder capacity and genetics”. Studies have shown that there is a dominant gene located on chromosome 13 and another gene on chromosome 12 that is prevalent with the condition. Another recent UK study showed an individual with two bedwetting parents has a 77% chance of bedwetting later in life. Interestingly, the results also showed that when one parent wet the bed as a child, his son or daughter was found to have a 40% chance of becoming a bedwetter. Another factor contributing towards night incontinence is often thought to be a lack of ADH, the antidiuretic hormone in the body. The main function of ADH is to signal the kidneys to decrease the amount of urine produced.

General functional bladder capacity can also play a role in a senior’s ability to maintain continence at night. Seniors with a “small” bladder are much more likely to have to deal with frequent trips to the bathroom during the night. The phrase “small” bladder does not refer to the literal size of the bladder. Rather, it means that the bladder can hold a much smaller volume of urine. Although these reasons are greatly significant, there are a large number of additional health conditions that have been linked to bedwetting. These conditions include urinary tract infections, kidney disease, an enlarged prostate gland and even side effects from medications.

Watch your Liquid Intake

To prevent leakages, try not to drink any liquids after around 5 p.m. to 6 p.m. Drinking you’re your bedtime can cause the need to urinate at night. Ensure you avoid alcohol and sweet beverages, as they are common culprits for an irritated bladder.

Be proactive and invest in protective products

There are a variety of pads and pants in the market that you can choose to manage your incontinence, no matter how heavy. However, when in need of a reliable night time product for heavy leaks, it is ideal to look for a product that has the highest absorbency and will be comfortable to lay in for a large amount of time. You can look for an absorbent All-In-One product for more reliable protection. These are ideal for people with heavier incontinence and those with lower levels of mobility. They are designed to be worn in replacement of your ordinary underwear.

Keep A Diary

Monitoring your urine output allows you to keep track of this data in a private document. In your diary, you can record the type and amount of fluid you consume and your leakage. It is useful to keep track of your bladder function for at least 72 hours.

Ensure you keep track of the times which you consume a large amount of liquid.

Always Talk to a Professional

 It can be hard for seniors with nighttime incontinence to talk about something that we often associate with children. However, if you are suffering from night time incontinence, you should not shrug it off as a simple phase or something to keep to yourself due to embarrassment. Dr Lisa Rosenberg, MD of Pittsburgh University states, “incontinence is a common part of aging but is never normal”.  A healthcare professional or continence specialist can assess your symptoms, identify the cause and discuss what form of treatment is the most suitable for you. The specialist nurse, also referred to as a continence advisor, can provide you with a recommended diet and lifestyle plan. To find your local service, ask at your GP practice or call the Bladder and Bowel Foundation. Alternatively, you may be able to refer yourself directly to your local NHS continence service for an assessment and to discuss your treatment options.

Bedwetting can be a frustrating condition to live with, however bear in mind there are always ways to manage it!