Why is this happening
Normally, the kidneys produce less urine at night, the bladder calmly holds it until the morning, and when full, a signal wakes the person up. Incontinence occurs if any of these links are disrupted. The bladder may contract involuntarily when the volume is low, nighttime urine production may remain daytime due to a lack of antidiuretic hormone, and the awakening threshold may be too high, for example, during deep sleep and apnea. Often several mechanisms operate at once, so treatment is selected after examination, and not based on symptoms alone.
- Involuntary contractions of the bladder
- Increased urine production at night
- Too deep sleep and high awakening threshold
- Obstruction of urine flow and bladder overflow
- Combination of several mechanisms
Possible reasons
In men over fifty years of age, an enlarged prostate is a common cause: the bladder does not empty completely, and excess urine is released at night. In women, weakness of the pelvic floor muscles after childbirth and during menopause is important. Common causes for all are an overactive bladder, urinary tract infections, stones, chronic constipation, obesity. A separate group includes general diseases: diabetes mellitus and diabetes insipidus, sleep apnea, heart failure. Neurological diseases, spinal cord injuries and multiple sclerosis impair urinary control. Alcohol, caffeine, sleeping pills and diuretics also have an effect.
- Overactive Bladder
- Prostate adenoma in men
- Weakness of the pelvic floor muscles in women
- Urinary tract infections and stones
- Diabetes mellitus, sleep apnea, heart failure
- Neurological diseases and spinal cord injuries
- Alcohol, caffeine, sleeping pills and diuretics
What to pay attention to
It is important whether enuresis has been present since childhood or appeared for the first time in adulthood: new incontinence always requires examination. Note how many times the episode occurs during the night, whether there are daytime symptoms - frequent urge, leakage when coughing, sluggish stream, feeling of incomplete emptying. Pay attention to snoring with pauses in breathing and daytime sleepiness, to thirst and the amount of fluid you drink, to taking medications and alcohol in the evening. It’s better to write all this down: the doctor bases the diagnosis primarily on these data.
- Enuresis since childhood or for the first time in an adult
- Frequency of episodes per night and per week
- Daytime symptoms: urge, leakage, sluggish flow
- Snoring with pauses in breathing
- Thirst and fluid volume in the evening
- Medicines and alcohol taken
Survey
The basis of diagnosis is a urination diary, which is kept for two to three days: the time and volume of drinks and excretion, and episodes of incontinence are recorded. Tests include a general urine test and culture if infection is suspected, blood glucose, and creatinine. Ultrasound examination of the kidneys and bladder is performed with mandatory measurement of residual urine after urination. For men, the prostate is assessed, for women, the condition of the pelvic floor is assessed. Uroflowmetry shows the nature of the jet. If there are neurological signs and sleep apnea is suspected, a neurologist and a sleep study are connected.
- Urination diary for 2–3 days
- Urinalysis and culture
- Blood glucose and creatinine
- Ultrasound of the kidneys and bladder with residual urine
- Uroflowmetry
- Prostate assessment in men
- Consultation with a neurologist, sleep study for snoring
Treatment
They start with simple measures: limit fluids, caffeine and alcohol three to four hours before bedtime, be sure to empty your bladder before bed, treat constipation, and lose weight. Bladder training with gradually increasing intervals and exercises for the pelvic floor muscles help. Next, the identified cause is treated: infection, prostate adenoma, diabetes, sleep apnea - in many cases this is enough. Drugs that reduce bladder contractions or nighttime urine production are prescribed only by a doctor, taking into account age and concomitant diseases. Additionally, alarm clocks and absorbents are used for the treatment period.
- Limit fluids, caffeine, and alcohol in the evening
- Urinating just before bed
- Bladder training and pelvic floor exercises
- Treatment of constipation and weight loss
- Treatment of infection, prostate adenoma, diabetes, sleep apnea
- Medicines strictly as prescribed by the doctor
- Alarm clock and absorbents during treatment
