Is alcohol the cause of my bed-wetting?

Q : I have a very embarrassing problem and I am not sure how to handle it. I used to wet my bed as a child but outgrew it when I turned six. However, for the past one year, I have been having problems controlling my bladder. On average, I wet the bed at least thrice a week. Initially, it was after having a little too much to drink but over the past few weeks, I wet the bed even without touching alcohol. My relationship with my wife is very strained as she thinks that I am behaving like a big baby and she often ridicules me for my mishaps. I am a 50-year-old man and this is very stressful. What is wrong with me?

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A: Adult bed-wetting, medically known as secondary enuresis is not as uncommon as you would imagine. One to three per cent of adults wet their beds. Although it can be embarrassing to discuss, it should never be ignored because it can be a symptom of an underlying health problem.

Generally speaking, bed-wetting or involuntary night time urination is because of three things:

• The kidneys making a large amount of urine through the night (usually, people pass more urine during the day)

• Not being able to wake up from sleep even when the bladder is full

• Having a bladder that can only store a small amount of urine.

How does alcohol cause bed-wetting?

Alcohol causes increased urine production through hormonal changes. It suppresses a hormone in the brain that regulates urine production. This hormone, known as ADH, usually prevents the kidneys from making too much urine. Excessive urine production caused by alcohol intake can lead to dehydration (commonly felt the morning after an alcoholic binge). Alcohol and caffeine can also irritate the bladder and prevent it from holding urine at a normal capacity. It is, therefore, detrimental to drink alcohol and energy drinks or cola if you are having problems with bladder control.

Is alcohol the only problem in your case?

There is a very high possibility that your bed-wetting is not just a consequence of binge drinking – especially since you also wet your bed on nights when you have not taken any alcohol. You need to go for a health check-up. The initial medical review can be done by a physician who will then refer you to a specialist e.g. urologists should the need arise.

Causes of adult bed-wetting

Genetic: People whose parents bed wet are likely to also have the same problem. The genetic link is usually a dominant factor in adults who have wet their beds throughout their lives. Overactive bladder: the muscles of the bladder wall can sometimes contract inappropriately leading to the urge to urinate even though the bladder is not full. Although this causes bed-wetting, you will also experience problems with bladder control during the day.

Prostate problems: at your age, prostate enlargement and prostate cancer could lead to involuntary wetting of the bed. Usually, prostate enlargement is accompanied by symptoms such as a weak stream, trouble initiating urination and dribbling of urine moments after you finish peeing. Urinary tract infections: usually these cause an urge to pee, frequent urination and sometimes, even incontinence. You may also have a burning sensation in your penis as you urinate.

Drinks: as noted earlier, alcohol and caffeinated drinks can lead to bladder control problems as they increase urine production and irritate the bladder. Prescription medication: some drugs used in the management of mental health issues, high blood pressure, heart, kidney and liver problems can cause increased urine production and night time urination. Take any prescription medication to your doctor during your review to determine if they may be contributing to your bed-wetting.

Diabetes: this medical condition is known to increase thirst, hunger and urine production (especially at night). For this reason, you need to be screened for it. Bladder cancer: this can cause incontinence and may be associated with bloody urine.

Neurological disorders: any problems affecting the spinal cord, degenerative brain conditions or a stroke can lead to problems with incontinence.

Psychological issues: extreme mental stress and anxiety can manifest in many ways – and some people may develop continence problems.

Sleep apnea: People have episodes when they stop breathing whilst sleeping in this condition. Often, their partners report that they also snore.

What treatment is available?

Your treatment will depend on the underlying problem. If you have recurrent urinary tract infections, you will receive antibiotics. There is also medication to manage diabetes, prostate problems, bladder over-activity and reduce urine production. Sleep apnea may need special breathing support known as “Cpap”’ to help you sleep and breath better.

What can you do for yourself?

• Withhold alcohol and limit caffeine intake until you have established the cause of your bed wetting

• Programme yourself to pee every three to four hours (even during the day). Ensure you have peed before entering bed (even though you do not feel like it).

• Set an alarm to wake you up in the night to go void your bladder.

• Special underwear: The market has discreet absorbent briefs that can be worn to bed if you have incontinence problems.

• Protect your bed with special mattress covers (available in most supermarkets).