Nocturnal enuresis
Nocturnal enuresis (NE) refers to bedwetting in adults, often associated with various medical conditions and medications. It can lead to psychological distress. Treatment options include addressing underlying medical issues, lifestyle changes (avoiding certain substances, weight management, regular exercise), behavioral therapy (timed voiding, alarm systems, adapted dry behavioral therapy), and medications like desmopressin or imipramine. For resistant cases, neuromodulation or botulinum toxin injections may be considered after other modalities have failed.
2024-01-01 00:25:35 - Editor
Overview of Nocturnal Enuresis (NE) in Adults
Nocturnal enuresis (NE) is considered a physiological finding in children less than five years of age, but is considered abnormal in adults. NE has been defined as wetting the bed at least twice per week for the past 6 months. NE is related to various conditions including detrusor overactivity, neurogenic bladder, chronic bladder infection, outlet obstruction, benign prostatic hypertrophy (BPH), urethral stricture, the use of certain antipsychotic agents (olanzapine, clozapine, quetiapine), obstructive sleep apnea syndrome, diabetes mellitus, diabetes insipidus, and the use of diuretics. NE can lead to anxiety, sleep disturbance, depression, or psychosis. (1, 2, 3)
Treatment Strategies for NE
Lifestyle Modifications and Behavioral Therapy
Treatment of NE includes lifestyle changes, behavioral therapy, and medical therapy. Addressing underlying medical conditions is also a crucial part of initial management. Lifestyle modifications include avoiding caffeine, alcohol, diuretics, and sedatives that could alter sleep cycle function. Weight reduction and regular physical activity can help decrease episodes of NE.
Behavioral therapy includes timed voiding every two hours and alarm systems. However, compliance with enuresis alarm systems is low among adults, with a high withdrawal rate. Additional behavioral approaches are adapted dry behavioral therapy (ADBT) and prompted voiding therapy, which involve frequent waking during the night, alarm use, and day-time timed voiding. While effective, these methods can be costly and time-consuming, and are generally less effective in adults than in children. (4, 5)
Pharmacological Interventions
First-line pharmacological therapy includes desmopressin (0.2–0.4 mg daily at night, with patients with detrusor overactivity often requiring the higher dose) and the anticholinergic agent imipramine (25–50 mg per day). (6)
Advanced Interventions for Resistant Cases
For resistant cases, other interventions such as neuromodulation (peripheral and sacral) or botulinum toxin injections into the bladder may be considered. These treatments are typically reserved for patients who do not respond to first-line modalities. (7)
References
1- Sakamoto K, Blavias GB. Adult onset nocturnal enuresis. J Urol. 2001;165:1914–7.
2-Abeygunasekera AM, Goonesinghe SK. Nocturnal enuresis in adults. Curr Bladder Dysfunct Rep. 2013;8:217–22.
3- Lee D, Dillon B, Lemack G. Adult onset nocturnal enuresis: Identifying causes, cofactors and impact on quality of life. Low Urin Tract Symptoms. 2017;10:292–6.
4- Hillary CJ, Chapple C. The evaluation and treatment of adult nocturnal enuresis. Curr Bladder Dysfunct Rep. 2014;9:84–9.
5- Osterberg O, Savic RM, Karlsson MO, et al. Pharmacokinetics of desmopressin administrated as an oral lyophilisate dosage form in children with primary nocturnal enuresis and healthy adults. J Clin
Pharmacol. 2006;46:1204–11.
6- Yucel S, Ktlu O, Kukul E, et al. Impact of urodynamics in treatment of primary nocturnal enuresis persisting into
adulthood. Urology. 2004;64:1020–5.
7- Raheem AA, Farahat Y, El-Gamal O, et al. Role of posterior tibial nerve stimulation in the treatment of refractory monosymptomatic nocturnal enuresis: A pilot study. J Urol. 2013;189:1514–8.