Night-time Problems

• Needing To Go Too Often - 'Nocturia'
• Bedwetting - 'Enuresis'

Needing To Go Too Often- 'Nocturia'

Nocturia refers to being woken at night by the need to pass urine. This is uncommon under the age of 60 but after that age it becomes more usual: a normal pattern would be once a night in your sixties, twice a night in your seventies, three times in your eighties and so on.

The causes may include:

1. excessive fluid intake before retiring:  Cut down on any drinks in the last two hours before you go to bed - especially cut out any alcohol, coffee or tea as these stimulate urine production.
2. reduced bladder capacity:  Bladder retraining can help - but improvement at night will only come when any daytime problem has been dealt with. There is a tendency for bladder capacity to be reduced as you get older.
3. (in elderly men) an enlarged prostate obstructing the bladder outlet. This can cause nocturia - usually along with a diminished rate of flow, delay in starting, dribbling and/or incomplete emptying.
4. fluid redistribution:  The symptoms of this are ankles, legs, thighs and fingers swollen with excess fluid. At night, when you lie down, the fluid is reabsorbed into the blood stream and the kidneys then offset this dilution of the blood by producing more urine. Try cutting down your salt intake to see if this helps. Put your feet up when you have the chance during the day. If these methods do not work, consult your doctor so that he can rule out any more serious problem. He may suggest a diuretic pill, to stimulate urine production during the day, but it is not a good idea to take these for any long period of time.
5. failure of the bladder to concentrate urine at night:  Normally a young adult produces two-thirds of total daily urine in the day and one-third at night, when the kidneys concentrate it so as to produce less volume - the result of a hormone effect on the kidneys. The result is that the first urine you pass in the morning will be darker than usual. In later life, though, the kidneys are less able to concentrate urine overnight, so that this effect will be less noticeable. An artificial hormone - desmopressin - can sometimes be used to suppress urine production at night (but not in people with high blood pressure or heart problems). The natural side effect of this is of course that you will produce more urine during the day.

Bedwetting - ‘Nocturnal Enuresis’

Wetting the bed at night is surprisingly common, although very few people talk about it. It affects about 1 person in 100 throughout adult life. Some people have wet the bed all their lives. Others become dry as a child (typically rather later than their friends) but then start wetting the bed again as young adults.

Bedwetting, though often known as "nocturnal enuresis", can happen at any time you are asleep - for example, if you doze off during a train journey. It affects different people in different ways. The practical problems of coping with wet bedding, even at home, can be considerable, especially if you do not have good washing and drying facilities. You may find that you worry about staying away for the night, going on holiday or business trips, going to college or moving away from home. You may find that you don’t want to get into a relationship in case your new partner finds out. It may cost you a lot of money to wash and dry bedding or buy disposable products.

However, in most cases, with the right advice and support, something can be done to improve the situation, sometimes even cure it.

Even if you tried everything when you were a child, it is always worth trying again. New methods and treatments are always becoming available.

What causes bedwetting?

For most people who wet the bed, nobody knows the cause, and none can be found. Many have an overactive bladder and this can cause daytime problems as well, such as passing urine very often (frequency), having to rush to the toilet (urgency) and accidentally leaking urine on the way (urge incontinence). The cause of this unstable bladder is usually unknown.

Occasionally, an infection in the urine or other bladder problems may cause bedwetting. Stress or anxiety may sometimes start the problem, with the wet nights continuing long after the stress is over.

Most people produce most of their urine during the day and very little at night. A few people who wet the bed produce urine at a constant rate throughout the day and night, and this may explain why the bladder needs emptying at night (although not why you don’t wake up to do so).

It is not true that most people who wet the bed sleep more deeply than other people. Most often you will never know why. If you have had the problem all your life, it may be that your brain has never learned to control your bladder (just as some people never learn to ride a bike, swim or play the piano).

What help is available?

The first step is to talk to your family doctor or local continence nurse specialist. Some people feel too embarrassed to talk about bedwetting. Try not to be: these are health professionals who deal with problems such as this every day.

Your doctor or nurse will want to know about your bladder habits. You may find it useful to keep a diary for about a week before your appointment showing how often you pass urine, how much you drink and when you are wet.There is a sample chart for this purpose on this website.) A sample of your urine may be tested for infection. Sometimes a doctor will recommend that you attend the hospital outpatient department for a bladder test ("urodynamics").

Medicine:  Your doctor may prescribe drugs to try to control your bedwetting. There are two basic types. One type (e.g. desmopressin) stops your body producing so much urine at night: you then produce more the next morning. The other type works by relaxing the bladder, allowing it to hold more urine and by stopping any over-activity (examples include tolterodine and oxybutynin).  Medication does not often cure bedwetting, but it can often control it and give you a break. This can be especially useful if you are away from home.

Enuresis alarms:  These are designed to wake you up when you start to wet, either by sounding a buzzer or by vibrating, which may be preferable if you are sharing a bedroom. Gradually your body learns to hold the urine, or to wake so that you can empty the bladder. Nobody knows why this works, but it often does. Modern alarms are small and discreet, and can be worn close to the body.

An alarm is most successful if used with professional supervision (e.g. from your continence advisor). Continence Foundation Helpline has a list of companies which supply alarms.  There are more details about alarms in our Products Section.

Complementary therapies:  While there is limited scientific research and no proof of their effectiveness, some people believe that homeopathic medicines, hypnosis or acupuncture can be beneficial. Be sure you seek advice from a trained practitioner.

How can I help myself?

Drinks:  You need to drink at least 2½-3½ pints (1½-2 litres) of fluid every 24 hours - preferably a bit more. If you don’t drink enough, your body may not be able to get rid of its waste products efficiently. It does not matter when you drink, but you may find it sensible to drink mostly in the morning, with less fluids in the evening.

Drinks with caffeine (such as coffee, tea and cola and some other fizzy drinks) can irritate the bladder. Try cutting down on these, especially in the evening.

Alcoholic drinks make bedwetting worse for some people. This may be the effect of the alcohol itself, or the extra fluid, especially in beers and other long drinks. It is worth experimenting with different drinks to see if they all have the same effect. Low alcohol drinks may be better - but are not to everyone’s taste!

Waking:  You should, of course, be careful to empty your bladder before you go to sleep. Some people find that waking to empty the bladder, by setting an alarm clock for a couple of hours after going to bed, can save a wet bed, although of course it does not "cure" the problem. If you do this, vary the time you set the clock for, otherwise your bladder may get into a habit of emptying at the same time, whether you are awake or not.

Bladder training:  If you have a daytime problem of frequency and/or urgency, or pass urine very often at night, it may help to increase the amount of urine that your bladder can hold. A ‘normal’ bladder should hold about half a litre (¾ to 1 pint) when it is full. If yours doesn’t hold this much, practise "holding on" and going to the toilet less frequently during the day. This takes a lot of willpower. It may help to keep a record or chart.

Practical management:  It is often said that a problem shared is a problem halved, and this can be true of bedwetting. Talking about it can be a tremendous relief, especially when you realise that most people will be sympathetic and supportive.

Bedwetting can seem like a real barrier if you want to start a new relationship. Talking openly and honestly, before the situation arises, can sometimes bring you closer to a partner - you have shown enough trust to share your problem.

As our products section shows, there are now many ways of Protecting Beds and Chairs.  This does not mean you have to sleep wrapped in plastic! Newer ‘breathable’ waterproof fabrics are a lot more comfortable and less hot. Avoid nylon bedclothes and nightwear, which tend not to absorb sweat and smell. Washable absorbent undersheets come with cotton or ‘stay-dry’ facings and some are available in double-bed size. Disposable sheets and underpads may be useful away from home. Some hotels will provide bed protection if you ask in advance.

Fresh urine should not smell, and as long as you have a good wash each day and keep wet sheets in an airtight container until washed, odour should not cause a problem.

Above all, be prepared and be positive. If all efforts to help your problem have failed, ask your doctor to refer you to a hospital specialist who is an expert in bedwetting.