From the Guidelines
Adult onset nocturnal enuresis requires a comprehensive evaluation to identify underlying causes, which may include sleep disorders, cardiovascular conditions, renal disease, endocrine issues, or neurological problems, as highlighted in the Planet study 1. The diagnosis involves a thorough medical history, physical examination, and baseline investigations such as a 72-h bladder diary, blood tests, and urine dipstick analysis. Key aspects of the evaluation include:
- Establishing the impact of nocturia on the patient's quality of life and identifying potential medical causes, such as nocturnal polyuria 1
- Reviewing the patient's past medical history and medications to identify potential contributing factors, including diuretics, calcium channel blockers, lithium, NSAIDs, and other medications that may cause xerostomia 1
- Screening for sleep disorders, such as obstructive sleep apnea, insomnia, restless legs syndrome, and periodic limb movements of sleep, using questions like "Do you have problems sleeping aside from needing to get up to urinate?" and "Have you been told that you gasp or stop breathing at night?" 1
- Assessing for cardiovascular and renal conditions, such as hypertension, congestive heart failure, and chronic kidney disease, through questions like "Do you experience ankle swelling?" and "Do you get short of breath on walking for a certain distance?" 1 Treatment depends on the identified cause but may include lifestyle modifications, such as limiting fluid intake before bedtime, avoiding caffeine and alcohol, and scheduled bathroom visits. Medications that might be prescribed include desmopressin (DDAVP) at 0.1-0.4 mg orally at bedtime to reduce urine production, anticholinergics like oxybutynin (5-10 mg daily) to reduce bladder contractions, or imipramine (25-75 mg at bedtime) which has both anticholinergic and antidepressant effects. Behavioral therapies, such as bladder training exercises and moisture alarms, can also be effective, and for sleep apnea-related enuresis, CPAP therapy may resolve the issue 1. Patients should maintain a voiding diary to track patterns and treatment effectiveness, as adult onset bedwetting rarely resolves spontaneously, making identification and treatment of the underlying cause crucial for successful management.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnosis of Adult Onset Nocturnal Enuresis
- The diagnosis of adult onset nocturnal enuresis involves a comprehensive evaluation, including a focused history and physical examination, urinalysis, and when indicated, ultrasound examination, flow rate, urine volume chart, urodynamics, and cystoscopy 2.
- A careful clinical history is fundamental to the evaluation of enuresis, and diagnostic procedures may include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine 3.
- The evaluation of adult onset nocturnal enuresis requires an understanding of the patient's history and symptomatology, as well as the pathophysiologic processes that can occur 4.
Treatment of Adult Onset Nocturnal Enuresis
- Therapeutic options for adult onset nocturnal enuresis include lifestyle modification and medications, such as desmopressin and anticholinergics 2.
- Treatment should first target identifiable etiologies, and a generalized algorithm can then be utilized with behavioral and lifestyle modifications, followed by medical therapy 4.
- In some cases, treatment may involve addressing underlying conditions, such as obstructive sleep apnea, neurogenic bladder, or voiding dysfunction 5, 6.
- Transurethral prostatic resection may be recommended for patients with severe prostatic or vesical neck obstruction, and alpha-adrenergic antagonists may be used as an alternative treatment 5.
Associated Conditions and Quality of Life
- Adult onset nocturnal enuresis is often associated with other conditions, such as neurogenic bladder, overactive bladder, voiding dysfunction, and obstructive sleep apnea 6.
- The use of sedating medications is a common contributing factor to adult onset nocturnal enuresis 6.
- Adult onset nocturnal enuresis can have a significant impact on quality of life, with patients reporting symptom bother and decreased health-related quality of life 6.