Each and every person, without exception, spent the first night of their life in a wet bed.

And a good many--for one reason or another--will so spend their last.

Indeed, it is a shame that for reasons of physical or mental disability, perhaps, as many as one-third of those people over 60 who live at home have some degree of urinary incontinence. And this is one of the leading causes that triggers admissions to nursing homes, where 50% of the residents are affected.

Causes in adults

Due to the muscle damaging effects of childbirth, menopausal thinning and laxity of tissue, the exposure of the bladder to the frailties of the uterus and vagina, upon which it rests for support, all together allow incontinence to be twice as common in women. These combinations of faults cause urine to seep from its stronghold by the pressure exerted by stooping, squatting, coughing, sneezing, etc. This, of course, is a different problem than nighttime and restful loss of control, which occurs due to weakness of the sphincter, deep sleep confusion, dreaming, inability to move freely in bed, etc., as it might occur in the private or nursing home.

In males, the same problems of aging occur, but they are mostly due to prostrate-related dribbling. Few of them need to be diapered. Instead, they leak on the way to the bathroom.

Treatment in adults

Medication such as the "alpha agonists" (Dimetapp, etc.) which often are used for colds--phenylpropanolamine, ephedrine--do tighten the bladder outlet valve and are helpful day and night. So are the anticholinergic remedies such as Pro Banthine (usually used in stomach problems), which accomplish the same result by reducing the intensity of the bladder wall to contract and squeeze urine out.

In cases where the bladder has "fallen," surgery can be helpful. In those unsuited to surgery, a pessary can be placed to help hold up the bladder.

In those men where the stream is slow, "alpha blockers," such as Hytrin or Minipress, do the opposite of what is needed in women, and relaxes the outlet muscle. These medicines are mainly used for high blood pressure, but are not out of line if such doesn't exist. The dribbling man may come about because of age or perhaps as an unwanted result after prostate surgery.

The cases of either sex that can't be helped through pills or surgery are, of course, the big users of disposable diapers. The last ditch effort, in some cases, is to insert a permanent catheter to prevent skin breakdown due to continual wet surroundings. It can be inserted through the genitalia or, better still, through a small incision on the lower abdominal wall.

Diuretics that are needed for heart or blood pressure treatment cause overproduction of urine and aggravate the problem. Most patients like to take them in the morning to offset nighttime problems.

The problem in children

A lot of busy parents think once a child is a year old and able to walk, talk and listen, he or she should be able to saunter into the bathroom and take care of his or her bodily needs. It just doesn't work that way. Of course, some mothers take the time to plop their little one the stool, turn on the water and wait. When the child surprises itself and the mother with a trickle, at least one of them is overjoyed. Has the child, or the mother, been toilet trained?

Each child is different. Some go on to become heroes, while others keep wetting their pants or their beds too often for family peace.

What can a parent do to speed up the process of toilet training? Some try punishment for misses, while others use the reward system. A "dry day" is so noted and displayed on the refrigerator door, and a treat is in order. All of these things seem to help. The mother knows she is attacking the problem and compares notes with her friends.

Sometimes, and probably too often, the damp bed becomes a real concern if the age of 4 or 5 is reached. Usually, the daytime wetting now is a thing of the past, but nights are a continuing nightmare.

Some experts in the field say not to worry until age 5 is reached. Then, the most successful treatment is an alarm triggered by water. The new ones are pinned on the panties, instead of being on top of the sheet. This can awaken the whole family, while the little demon sleeps on. In order to oviate this social injustice, newer devices are planned to vibrate, instead of squeal, as the wet sets off the alarm.

The latest intervention is a medication that is a pituitary hormone, desmopressin acetate, that the body uses to conserve water by decreasing urine formation. By injection, it is used in a rare disease called diabetes insipidus, in which literally gallons of urine are excreted daily; for whatever reason, it also is used to combat bleeding in certain types of hemophilia.

But recently, it has been found to be successful when used as a bedtime nasal spray to stop bedwetting. So far, no upsetting side-effects, but recurrence of the wetting can occur when it is stopped. It is expensive, and some doctors have mothers use it on specific occasions--as when the child sleeps over at a friend's house, or goes off to camp.

For the most part, we seem to outgrow nocturnal enuresis in due time. Rather than being mystified about the faults of bladder emptying, I am overwhelmed by the fact that nature has provided us with a device that allows us to urinate thousands of time and year after year without ever having to press a button or turn a switch.

All we have to do is think that we want to urinate and it happens automatically. And it shuts off when we are through!.

Copyright Dec. 25, 2000: Burke Scagnelli, MD

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