Unspoken struggle of bedwetting as an adult

For most, the embarrassment of waking up to a wet bed is confined to childhood memories. But for 23-year-old Nelima*, this mortifying experience has followed her into adulthood, a cruel continuation of a battle with nocturnal enuresis -- the clinical term for bedwetting.

“It’s shameful and embarrassing that, at my age, I still wet the bed,” Nelima says.

What others overcame as kids has stubbornly trailed her, bringing relentless embarrassment, social isolation, and an erosion of self-confidence.

Dr Mercy Githumbi, a general paediatrician, explains that bedwetting beyond a certain age is considered a condition requiring attention.

“It’s defined as a child or adult who has reached an age where they should be dry, but still experiences accidental urination, whether into clothing or bedding,” she says.

While occasional incidents in young children may not raise major concerns, Dr Githumbi notes that when bedwetting persists into older age groups and adulthood, it becomes a significant problem with far-reaching consequences.

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“It can affect self-esteem, school or work performance, and even social interactions,” she explains during an interview on Spice FM’s The Situation Room show.

For Nelima, the impact has been profound. “I fear hanging out with friends because I am terrified, they’ll laugh at me,” she says.

“In school, classmates constantly teased that I smelled like urine, so this made me antisocial.”

Dr Githumbi acknowledges that bedwetting can start as an isolated monthly episode but can escalate into a distressing situation for the individual and their family.

“I diligently followed all the recommended tips -- avoiding fluids after 5pm, sleeping on my side through the night - but nothing could stop my involuntary ‘rain showers’,” Nelima recounts.

She would still wake up to soaked sheets, even after not going to bed until 5am.

”One afternoon, the realisation that I had wet the bed again despite my efforts hit me. No matter what I tried, the supposed solutions amounted to nothing for me,” she says.

“The shame was depressing and unbearable and I didn’t know how to stop it,” Nelima says.

The causes, Dr Githumbi says, can vary. Some experience bedwetting exclusively at night, while others may have accidents during the day as well.

“It could be physiological or a condition affecting the child’s ability to hold urine properly,” she says.

According to Dr Vic Albert, a urologist at German Medical Centre, the body produces an antidiuretic hormone at night called ADH, which slows the kidney’s production of urine while you sleep.

“In people with enuresis, this hormone is not produced in significant enough quantities to slow the production of urine, which often leads to bedwetting. This can be a symptom of both Type I and Type II Diabetes,” he says.

Adult bedwetting can occur after a particularly stressful episode, Dr Albert explains a urinary tract infection, as a side effect of medication or as a result of a medical condition including bladder cancer. Other factors include an overly active bladder and excessive alcohol, constipation, pelvic organ prolapse, and an enlarged prostate.

He further explains that while most people outgrow enuresis in childhood, there are rare cases where some people continue bed-wetting as adults. This he says is known as persistent primary nocturnal enuresis.

“This can affect between 0.5 per cent to 2 per cent of adults over 18 years of age,” he says.

For others, developing nocturnal enuresis later in their adult life is a cause of great concern, especially when nocturnal bedwetting begins after many years.

“However, bedwetting is multifactorial. Sleep-regulating hormones might be affected due to oversleeping, leading to brain signal mismanagement. External causes and psychological factors can also play a role,” he says.

Lucy Wambui, the founder of the enuresis initiative, battled bedwetting for 15 years, she started the organisation to raise awareness and support for a condition often shrouded in stigma and shame.

“I stopped bedwetting when I was 15 years old,” Wambui recounts. “Back in the 70s and 80s, there was hardly any forum to discuss this openly. We didn’t know it was a purely medical condition. It was often blamed on poor potty training by parents.”

Bedwetting, Wambui explains, can be hereditary, with a 75 per cent chance of a child becoming a bedwetter if both parents had the condition, and a 50 per cent chance if only one parent was affected.

“Our parents could have been bedwetters, though they never talked about it,” she says.

In some cases, bedwetting is not physiological but also can be caused by factors like a small bladder capacity or an overactive bladder (OAB).

“Some people are born with a bladder that can’t hold the volume of urine produced during sleep,” Wambui explains.

Trauma can also trigger bedwetting later in life.

“You can see a child who had stopped wetting the bed around 8 or 10 years old, but after experiencing a traumatic event, they start bedwetting again,” Wambui says.

“If left untreated, this can persist into adulthood, leaving some adults dependent on protective measures like mattress covers.”

According to Wambui, while there is no quick fix, bedwetting is treatable.

“It’s not like someone with diabetes or an enlarged prostate causing urinary incontinence. It’s a condition where the person is otherwise healthy, but they wet the bed during sleep.”

In treatment, Dr Albert explains, medications targeting bladder sensitivity or urine production can be employed. These drugs aim to reduce urine production and sensitivity, aiding in bedwetting management.

Certain medications play a crucial role in managing bedwetting. Desmopressin acetate, a synthetic analogue of antidiuretic hormone (ADH), is often the primary medication prescribed. Oxybutynin and Tolterodine work to reduce urinary bladder contractions and enhance bladder capacity, particularly during nighttime. Additionally, Imipramine, an antidepressant, aids in overnight urine storage by reducing bladder contractility.

“These medications are subject to regulation and should be prescribed only after a comprehensive assessment, with diligent monitoring and follow-up by a specialist. Dosages may need adjustment based on individual responses,” he emphasises. “Medication only deals with the symptoms rather than the underlying causes of bedwetting, so it’s recommended that you try behavioural treatments as well,” he says.

Behavioural treatments, he explains, encompass methods such as monitoring fluid intake, regulating bladder volume, utilizing bedwetting alarm systems, and setting nightly alarms before bedtime, which may aid in the prevention of bedwetting.

He adds, “The most common medications mimic the hormone ADH, slowing production of urine in the kidneys and lessening the instances of bedwetting.”

Nevertheless, the urologist advises that surgery should be a last resort, only pursued after exploring all non-invasive alternatives. These may include Sacral Nerve modulation, Bladder reconstruction, Prostate resection, and Urethral Sphincter reconstruction.

“Treatment of Diuretic Enuresis needs patience and psychosocial support because it might take a long time to be completely dry,” says the doctor.

One of the key coping mechanisms, Wambui says is fostering a supportive environment, which helps one know they are not alone.

“Don’t punish or ridicule those struggling with bedwetting, as it’s not something they can control,” she urges parents.

Wambui also emphasizes the importance of early potty training adding that she potty trained her son as early as six months old and was off diapers by a year.

“As soon as a child can sit unsupported, they are ready to be potty trained,” she says.

Nocturnal enuresis can affect your lifestyle by preventing you from enjoying a night away from home, taking holidays or business trips and even starting a new relationship.

On top of that, practical problems like the constant washing and drying of sheets and the cost of replacing bed linen only add to the frustration and exhaustion from a bad night’s sleep.