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Bed wetting (nocturnal enuresis)

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bluesheart

Posts : 148
Join date : 2014-12-20
20150503

Bed wetting (nocturnal enuresis)

Post by bluesheart

Here is a guide to adult bed wetting, if you have had problems in the past or still wet the bed as an adult then why not consider joining and let others know how you deal with it.



Adult bed wetting, or adult nocturnal enuresis, is a condition which plagues many men and women of all ages and from all walks of life.

Bed wetting occurs when an adult or teenager cannot control his or her bladder during sleep or overnight and ends up urinating or wetting the bed. This loss of bladder control in bed may or may not actually wake the person from sleep.

Nocturnal enuresis is generally used to describe wetting that specifically occurs at night or during sleep. There are different types of adult bed wetting with different causes associated with them. Some adults who are older or have physical ailments may also suffer from daytime enuresis or wetting for various reasons.

Adult bed wetting is a rarely advertised and less discussed problem in both the medical and online communities than many other physical ailments. Adults who suffer from nocturnal enuresis often have bed wetting problems for reasons much different from children.

Adult bed wetting is often preventable and even “curable” through a number of different methods, including taking certain medicines, changing behaviour or working through psychological issues.

Wetting the bed as an adult, especially when you never have before, is usually a symptom of a larger problem. Your enuresis problems could be alerting you to a potentially serious physical problem and you should consult a medical professional. Ideally, finding and solving that underlying problem will stop your bed wetting.

Adult bed wetting is a potentially embarrassing and under reported problem that can often be corrected with the proper medical treatments. There are actually several different classifications of adult nocturnal enuresis, or adult bed wetting,

primary nocturnal enuresis sufferers are people who, as children, teens and adults, had bed wetting issues throughout most of their life.

secondary nocturnal enuresis is defined as bed wetting which begins as teen or adult often years of not having any such bed wetting problems.

Adult bed wetting can be caused by any one of a number of conditions such as an enlarged prostate in men, pelvic issues in women, physical abnormalities, urinary tract issues and infections, bladder cancer, sleep apnea or even diabetes. Certain medications, excessive alcohol or other lifestyle changes could also contribute to adult onset nocturnal enuresis.

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Post on Thu May 07, 2015 1:43 pm by pkg1

Early Signs and Symptoms


Over 20 years ago, I would wake up in a wet bed about two or three times a year, but as this only happened occasionally I ignored it, and pretended hoped that the problem would go away. Unfortunately over the next 10 years or so the problem became very gradually worse.

About six to seven years ago, somehow or other, I managed to get a severe lower urinary tract infection, which cleared up after being given some strong antibiotics. Unfortunately frequency with passing urine was very frequent and becoming a major problem, sometimes as often as every 20 minutes or so. A urine sample indicated a PSA of 5.1 ng/ml and that was considered to be quite high. Further hospital out-patients visits saw me undergoing a prostate biopsy, to check for prostate cancer, but happily no signs were found.

An ultrasonic test found that I was retaining a considerable amount of urine after voiding. I was then prescribed Tamsolosin. This brought about an improvement and a later urine test revealed that my PSA levels had dropped to 3.4 ng/ml. My doctor decided to leave me on Tamsolosin, but keep the problem under periodic review.

I subsequently moved house to a new area and obviously had to register with a new doctor. The new doctor seemed quite happy to renew my Tamsolosin prescription, although he never examined me.

Problems becoming Troublesome in 2009


In the winter of 2009, the opposite started to occur in that I had a few wetting accidents particularly at night to the point where protection at night became necessary. The problem was that I did not feel the urge to use the toilet until my bladder was overfull. I then have about five to ten minutes warning before the inevitable occurs. Consequently I became very proficient in searching out public loos in my area, and using them, even if I did not feel the urge to urinate. This was simply to avoid accidents in public.

The situation however improved during the summer months of 2010, but got markedly worse during the autumn when the night time wetting accidents in particular, became 3 or 4 nights per week. I tried various disposable pads but none were very effective as I am tend to sleep on my side. The most effective means of containment have proved to me to be the shaped terry nappies from Arizona and plastic pants from Suprima but even with all that I can have occasional leaks and this combination is far too bulky in my view for day use.

I've avoided the usual suspects such as tea and coffee. I've also tried setting the alarm clock to go off every two hours throughout the night in an effort to keep my bed dry. It brought about an improvement but left me extremely tired by morning. At the time I was working full time and held a job on the railways which was safety critical, so I felt I had to give up that method. I've since been made redundant, though not because of my continence problems.

Forced to seek help in 2010


In the autumn of 2010 my continence problems forced me to my new doctor, (for the first time), who has referred me to a Urologist at my local hospital.

Hospital tests in 2011


I underwent a flow-test in 2011. It was explained to me that this is a special toilet intended to measure the flow of urine during voiding. A graph is produced that a person with a normal bladder should produce a print-out looking roughly like the shape of a bell, (ie peak flow reached quickly and maintained until the bladder is nearly empty, when the flow should tail off rapidly to nothing. The graph that I produced show that I reached the peak flow normally, but then showed a gradual decline to empty. A post residual ultrasound scan revealed that I was still retaining 185ml. My urologist decided on further investigations to ascertain the causes of this and decided that I should undergo a Urodynamics test

Prior to the Urodynamics test I was asked to fill in a bladder chart for seven days. During this monitoring I was wet overnight on four occasions and just once (slightly) in the day. The Urodynamics test itself seemed to me to be very uncomfortable and I had to go through the procedure twice because the first test was a failure. The preparation for the test involved a small catheter being placed via the penis into the bladder, (very uncomfortable especially when it reached the prostate area) and another placed in my anus. My bladder was gradually filled with about 500ml of a saline liquid, whilst I was lying on my back. During the filling phase I was asked to indicate if I could feel the bladder filling and when I felt that I needed to urinate. I never reached the latter stage possibly because of the discomfort caused by the catheter was not causing me to reach that stage. I was also asked to give a cough at various intervals but each time I did so, the nurses had to keep pushing the catheter into my penis causing further discomfort because the coughing was causing the catheter to become partially ejected. Having filled my bladder with I think it was 500ml of the saline solution I was asked to urinate this saline solution back out after I was manoeuvred to a special toilet and the nurses had left the treatment room. The catheter was supposed to remain in place. However, on the first occasion that I did so the catheter partly withdrew itself which meant that no meaningful results were obtained. I think the problem was partly that I had to exert quite a lot of pressure to initiate the flow. On the second occasion that they did the test, they asked me to physically hold the catheter in by placing my fingers over it.

After the second test the nurses did a post residual ultrasonic test which revealed about 75ml retained. I was hoping that a change of medication would solve my problems at this point.

After a further consultation with my Urologist in July 2011, I was placed on the waiting list for a Transurethral Resection of Prostate (TURP) operation. The hospital gave me a leaflet on the procedure but it didn’t mention what the success rate is for such operations. The leaflet mentioned side effects such as retrograde ejaculation, impotence and re-growth of the prostate gland but nothing about the incontinence side of things. However my Urologist was of the opinion that things will only get worse over time to the extent that total urinary retention could be a possibility, hence the need to undergo this operation. However I was told to expect at least an 18 week delay for this. A letter in the post eventually revealed the date – 10th January 2012.

Pre-op assessment 2012


Prior to the operation I had to attend a pre-operative assessment on the 3rd January. This involved taking my blood pressure and heart rate, followed by the measuring of both my height and weight. I was told that this was to work out my body mass index which is vital information for the anaesthetist. That was followed by swabbing for MRSA and involved rubbing swabs in both nostrils of my nose plus another in the perineum area. If I test positive for that then apparently I will be isolated from other patients in a room to myself!

Next I was interviewed in great detail about my medical history, next-of-kin etc etc. This has followed by a visit to cardiac department for a heart reading print-out.

Finally I had to go to another part of the hospital where they take blood samples. Three such samples were given and I have to go back for another on Friday to give yet another sample, the envelope that the sample is sent in is marked Blood Transfusion but I was told that it would be very unlikely that I would need one - its merely a precaution.

I was then sent home with four booklets, one about Deep Vein Thrombosis, another about anaesthetics, one was about welcoming me to the hospital as an inpatient and finally one about transuretharal resection of the prostate. There was also leaflets advising me to obtain supplies of paracetamol or ibuprofen, discharge to home and finally a leaflet for the information of carers but I didn’t need that one!

Hospital Operation 2012


Prior to my hospital admission, I was instructed to eat nothing at all from midnight, but I was allowed water only until two hours before admission. By this time things were starting to look a bit worrying for me as I had never undergone a hospital operation before.

On the day I was told to report directly to the ward at 07:30. I was shown to a ward bay that had no beds just armchairs. I was handed a gown by the Ward Sister and told that I would be first on the operating list. I was then seen by the anaesthetist who explained my options - we decided that for me the best option would be a general anaesthetic. My next visit was from the consultant who explained that they would be shaving away parts of my prostate.

At about 08:30 a trolley was produced and I was duly wheeled to a holding area outside the operating theatres. At 08:40 I was wheeled into an a Anaesthetist's room where two anaesthetists worked on me from both sides, one placing tabs on my chest, and measuring my blood pressure, the other was busy inserting a cannula in the back of my left hand. The next thing I knew was when one of the anaesthetists said that I might feel a bit light headed, the clock fast forwarded to 10:30 and I found myself back on the ward with an oxygen mask over my face and a urethral catheter inserted!

Back on the ward I was instructed to drink copious amounts of water and the colour of my urine gradually changed from bright red to a pink colour. Late in the evening I was transferred to a bed and wheeled to another part of the ward.

Later at about midday the surgeon visited me in bed to say that they diddn’t actually carry out the TURP operation but instead performed a Bladder neck incision instead.

At 6am the next day, the urethral catheter was removed and I was to continue drinking large amounts of water. Three urine bottles were produced and I was instructed to use them rather than the toilet as the nurses were to measure the urine output. By the time I had voided three times a bladder scan was carried out which showed retained urine as being over 800ml. More bottles were produced but this time instructed not drink water. Eventually the last measured amount was 612ml after feeling like I had voided gallons. The other problem that the nurses had noted was that post operatively my heart rate was very slow at between 50 and 55 beats per minute. Not sure as to the reason for that is, but it only measured 60 at the pre-op clinic.

I was then faced with a choice, either to remain in hospital a further night or to go home. I chose the latter, because I was afraid of yet another embarassing wetting accident, and partly because I didn't want yet another sleepless night and told that if I suffered major pain to go to A&E. I finally went home at 18:10 the same day immediately after the canula was removed, and issued with with codine and paracetamol tablets, even though I feel no pain, just a little tender in the abdomen. I was able to read the notes that the Surgeon made, This stated, “Admitted for Rigid Cystocopy and bladder neck inscion. Uncomplicated. High residuals on the ward post operatively. Patient was happy to go home and risk of retention explained."

I was therefore sent home to rest and told not to lift heavy objects for four weeks, nor to drive for at least two weeks.

When I arrived home I managed to void more urine but that had returned to the red colour again, but I was told not to worry too much about that.

Further Infection


I thought that things were slowly improving, until the evening of 14th January 2012, when my urine became suddenly became stained brown, stringy, was very cloudy, and smelt strongly of ammonia and stale rubber. My urine also became impossible to control and I was passing ever smaller amounts.

The next day, I rang NHS Direct who told me to ring the out of hours doctor's surgery. I rang them and they made an appointment for me to see a GP and asked that I bring in a urine sample.

When I saw the GP he tested the sample and said that the dip-stick 'lit up like a Christmas tree'. My temperature had apperently hit 102 degrees F. He gave me a prescription for 10 Ciprofloxacin tablets. The emergency doctor that I saw said that the indications on the dipstick indicated blood and puss was present. I remember that he must of thought that the sample itself was very much a bio-hazard, because having donned on disposable gloves, discarded the sample and the materials, the sink and draining board was thoroughly washed down with a lot of water and plenty of disposable cloths before being sprayed with a disinfectant spray and yet more disposable cloths even spraying the inside the orange waste sack.

I finally managed to speak to my own GP on Monday 16th January. Judging from his questioning he has not had the paperwork from the hospital yet. Anyway he mentioned that it was too soon to establish whether or not there was a radical improvement and to let him know if there was not, in two days time.

By the 17th January the colour of my urine had returned to normal although the stinging sensation was as bad as ever. I was still drinking vast amounts of water as advised by the doctor

Recovery


I saw my GP again on the 26th January 2012 who carried out another urine test. That showed significant amounts of blood present but no significant infection. Nevertheless, my GP sent the sample off for further analysis. The stinging sensation had by this time eased somewhat, but unfortunately left me with virtually no bladder control. When leaking I estimate that I would only pass between 100 and 200ml of urine but frequently. I tried very hard trying to keep dry overnight, but that proved to be virtually impossible. Out of desperation, I tried setting an alarm clocks to go off every hour, but that didn’t work either, so I reverted to nappies just to get some restful sleep. At least in that way although the nappy would be very wet, at least that was the only thing that got wet. Similarly, when venturing outside, I would have to wear some protection against leaks to avoid accidents.

A few days later the results came back from the laboratory to confirm my doctor’s findings stating that they found “…no significant bacterial growth” in the sample.

I was also getting a dull ache from the pelvic region, that wouldn’t be present in the morning, but gradually got worse during the day. By the evening it would be significantly worse, relieved only by lying down. I spoke to my doctor about this, but he thought it was something that would settle with time. The incontinence however had not improved at all.

On the 20th February, I performed another flow test at the local hospital. The letter confirming the appointment stated that I must pass at least 150ml of urine in order to obtain a good result. I did manage 177ml and had 44ml residual left in the bladder after a few failed attempts, in not managing to start the test in time before a leak occurred.

I then had a further follow-op appointment at my local hospital on the 29th February. The surgeon suggested that I try a drug called Vesicare, as he thought that this would improve the urgency symptoms. He also mentioned another drug that could be taken at night, but he wanted to see how well things were progressing with Vesicare first.
Having taken the Vesicare, I noticed no improvement at all. There were a number of side effects that were also making life difficult, including a very dry mouth and skin so dry that is was cracking and splitting.

Continence Advisory Service


I finally bit the bullet and by early March I had referred myself to the local Continence Advisory Service. It seems to be staffed by nurses rather than doctors and they were very helpful over the phone. They knew about Vesicare but stated that it is amongst the safest drugs of that type available in terms of side effects. They are also going to sort out my continence problems with a Male External Catheter, or sheath catheter, which they think is best for me and should be very effective at keeping me dry, both day and night. There is less chance of contracting a UTI with this because it is non-invasive, than with a foley type of catheter. I have an appointment with them for next Wednesday morning to be measured up. They also asked permission to contact my own GP so that they have my medical history, which of course I gave. Prior to the appointment I was asked to produce a bladder diary, indicating the times when I drank fluids, voided urine, and opening of bowels etc.

On the morning of the 7th March I attended the Continence Clinic. The appointment lasted one hour and there were two female nurses present.

One took down some personal details and showed me the how to do the pelvic floor muscle exercises. In my case I've been asked to practice both slow muscle fibre and fast muscle fibre exercises. For the slow muscle fibre exercises, I have been told to sit or lie with knees slightly apart, the squeeze and lift the pelvic floor muscles as hard as possible for five second seconds relax and repeat five times. It got a bit painful after a while so she reduced the period from five seconds to two seconds for me. The fast muscle fibre exercise is exactly the same but you hold the squeeze for just one second. I was given a leaflet showing how the exercise was to be performed.

I was also asked to do bladder retraining exercises. These I thought were going to be more difficult for me. The idea at first is to measure your urine output for the first two or three days to work out roughly how much urine is being passed. For me that was between 100 and 200ml per visit. The next bit is to try holding on for extended periods with the goal of only needing to visit the toilet 5 or 6 times in 24 hours or every three to four hours. However when I was asked how much fluids I drink per day, they told me it was not enough and I need to double my intake to two litres per day, but to increase that gradually. I was given a Haynes Owners Workshop Manual titled 'Overactive Bladder Syndrome' for information on correctly doing that particular exercise. Yes, its by the same publisher of Haynes Workshop Manuals for Cars and motorcycles!

The other nurse was there to show me the sheath catheter system and the correct method of putting it on. She also did the measuring. A basic start-up kit was provided to see me through the next few days whilst an account was set up with a supplier. In the start-up kit were two lengths of sheath a standard length and a short length. I was asked to try both and to report back which type suited best. I eventually chose the standard length.

Now for the first time, since my operation about two months ago, I can wear normal underwear again! A follow up appointment was made for a month later.

For the next few weeks it was very much an exercise of trial and error, who to get the system working efficiently but comfortable enough to wear. Meanwhile I was still taking the Vesicare as prescribed, and carrying out the exercises as described above. I attribute the successful wearing of the system to the way that the continence Service nurses acted. They were at great pains to measure accurately, ask questions as to life style, and warned me about some pitfalls to avoid.

I had another appointment to attend at the Continence Service clinic on the 3rd April 2012. The nurse wanted to know how I was getting on with the pelvic floor and the bladder retraining exercises. I can do the pelvic floor exercises but the bladder retraining exercise is very difficult for me to do successfully. I submitted the three day bladder diary that I was asked to complete on my first visit. I'm still not drinking enough, and to drink between 2 and 2.5 litres per day. Currently I've only been drinking half that amount.

The nurse also asked how I was getting on with the sheath catheter system. I am getting on fine with that apart from the initial problems for which I've improvised to overcome them. In particular, I've had absolutely no skin problems with the system after using it for about one month so far, nor had I suffered any leakages from the system, so far.
Despite all the exercises as recommended by the Continence Service, I saw no improvement at all.

Finally, the nurse mentioned that if I still had problems with bladder control, even after carry out the exercises and by taking the Vesicare, I could have an artificial sphincter inserted, but that would involve a further operation. That's something that I was definitely not keen on, and would stick to the sheath system in preference to submitting to a further invasive surgery. I only agreed to the last one because by not doing so, it was thought that urinary retention was likely to cause damage to my kidneys over time.

The Future

In the meantime I spent some time experimenting with different products, until I had a arrived at a comfortable solution. The incontinence was (and still is the same), so for me it was important to reach this goal. Having said that the system allowed me return to work, something I did not feel able to do with leaking incontinence pads or the fear of them leaking.

After a few months experimentation, I have now arrived at a comfortable compromise. I now use a Coloplast Aquasleeve in addition to the supplied leg bag straps. Not only does it help to support a nearly full bag but it makes the leg bag less conspicuous. With a bit more experimentation I discovered the right tension on the supporting leg bag straps to ensure that the bag doesn’t slip, even if full. I also use a ‘G’ strap to support the inlet tube to the leg bag to the upper leg. At night because it is not essential to keep everything sterile, I swop the leg bag for a 2 litre night bag (and stand). The sheath itself is changed daily first thing in the morning when my bladder is least active and when I can be close to a loo.

I think this system is excellent for men, but to be able to take full advantage of the system it is vital to be properly assessed by a trained professional. Some men cannot tolerate the system because of skin breakdown issues, but I've overcame this by using the prep-wipes that were available. Others found that the sheath was either too tight or tended to “blow-off” whilst connected. This is probably because the sheath was of the incorrect size or you were not measured correctly. I’ve never experienced a “blow-off”, or for that matter any leaks with the system at all, and I have over three years experience of this particular system.

Hope that is at least useful to somebody.

Regards

PKG1

    Current date/time is Tue Sep 18, 2018 6:04 pm