It was difficult for Prathima (name changed) a 68-year-old teacher from Chennai, to comprehend what her 88-year-old mother, Saraswati (name changed) was experiencing. Her mother was constantly wetting the bed, especially at night. “She never woke me up to ask me to take her to the bathroom. It felt as if she didn’t know she had wet herself,” recalls Prathima, adding that using adult diapers was inevitable in their situation.
Urinary incontinence, where a person cannot control urine due to an over-reactive bladder, is common among the elderly, say doctors.
Adult diapers, a need for some
When Saraswati suffered from continuous bedwetting for several nights, she was taken to the doctor for consultation. She says, “The doctor said it was due to the onset of dementia that she wasn’t able to communicate with us and suggested she use adult diapers.”
“Nocturnal enuresis – bedwetting at night – when it happens to the elderly, should be considered a warning sign of an underlying condition that needs to be examined,” says Dr Sanjay Garg, consultant urology, Manipal hospitals, Ghaziabad.
What causes bedwetting?
Dr Nanganath Narasimhan Prem, a geriatrician at Jaslok Hospital, lists the possible medical conditions that can cause nocturnal enuresis:
- Urinary tract infection
- Cardiovascular diseases
- Injuries or trauma
- Neurological disorders
- Side-effects of medication
Dr Prem emphasises that nocturnal enuresis occurs in elderly men and women for different reasons.
“For men, an enlarged or benign prostate can sometimes make it difficult for the bladder to hold the urine, resulting in bedwetting,” he says. He adds that it can increase the need to urinate, the urgency and frequency.
According to Dr Prem, bedwetting in women can occur because of the prolapse of genital organs. Since the anal, vaginal and urethral regions are close together, pelvic prolapse is common. “Atrophic vaginitis (drying for the vagina due to low estrogen) can also lead to uncontrollable urination. Coughing, sneezing and being overweight can all cause uncontrollable peeing.”
Dr Garg points out that incontinence occurs particularly at night because the metabolic rate and other bodily functions work rapidly at that time. “Consequently, the bladders also become full,” he says.
Treatment for nocturnal enuresis
According to Dr Garg, a complete medical assessment is necessary to diagnose the underlying medical condition causing bedwetting. Before treating the actual condition, people are provided symptomatic relief through therapy designed to ease the symptoms of the disease. “If it’s because of diabetes, hypertension, neurological, cardiovascular diseases or any serious condition, those must be resolved first. This will gradually stop the incontinence,” says Dr Garg.
How to tackle nocturnal enuresis
According to Dr Prem, older adults sometimes find it extremely difficult to express their need and urgency to pee because of the shame attached to it. “Their caretakers must understand that it not only affects them physically but also mentally,” he says.
Dr Prem lists some tips that caretakers can keep in mind when incontinence occurs:
- Get routine health check-ups to understand the reasons for incontinence.
- Ensure the washroom is accessible to the person.
- Keep a diary to track the urination patterns and the amount of urine passed.
- Do not let them drink too much water after 6 pm. Beverages like alcohol must be avoided especially at night.
- Invest in adult diapers if they are unable to control their bladder.
- Nocturnal enuresis is a condition in which older adults involuntarily void (pass urine) in their sleep because their bladder cannot retain urine.
- Nocturnal enuresis is common in young children; however, it should be considered a warning sign for older adults because it could indicate an underlying condition.
- Nocturnal enuresis can be treated by curing the underlying disease and by making lifestyle modifications such as avoiding drinking too much water before bedtime.