Excerpt from The New York Times (Health)
For Some Adults, Bed-Wetting
Is Far From a Distant Memory
by Warren E. Leary
WASHINGTON, Nov 3 - For some adults, bedtime is something to be dreaded, a reminder of a problem most people have outgrown long ago and of their inability to master a skill acquired by most 6-year-olds.They are adults who have trouble waking up dry. They are mature people, who experts say probably number in the hundreds of thousands, if not the millions, who are bed-wetters. Because of their problem, they often live in constant fear of embarrassment, afraid to share their beds with loved ones or even to be house guests.
Bed-wetting, or involuntary nighttime urination, is usually considered a problem of childhood and adolescence, when most cases are noticed and treated. However specialists say, a significant number of those who suffer from nocturnal enuresis, the condition's formal name, are adults who missed being treated or cured.
Despite suspicions that large numbers of adults suffer from bed-wetting, there are few programs specifically aimed at treating adults. Many suffer silently in a world of adult diapers, rubber pants, soiled laundry, plastic sheets and the unending worry that others will find out about their problem.
"Bed-wetting is a closet issue within the closet issue of urinary incontinence" says Cheryle B. Gartley, president of the Simon Foundation for Continence, a national voluntary group concerned with urinary and bowel control problems. "There is such a stigma attached to bed-wetting in adults that most people don't even seek help," she said, "and those that do have trouble finding it. It's something that is practically ignored in adults."
An estimated 20 million American adults have urine control problems, or incontinence, three-quarters of them women and the majority elderly. For these people, defective urinary organs, weakened muscles, descending bladders and other physical problems make voluntary control difficult around the clock.
But enuresis, or bed-wetting, is a problem that afflicts from 10 percent to l5 percent of 5-year-olds who have no serious impairment of their urinary system, experts say. The incidence drops to about 5 percent for children 10 to 15 years old, and to 1 to 2 percent for those 16 to 18 years old.
Many children's hospitals and health centers have enuresis programs for children, but after the age of 18, those who are not cured are often on their own and go underground with their problem, specialists said.
"When they're older, most doctors tell enuresis patients that they will outgrow it and, in some cases, this is true," said Dr. Kenneth Miller of the University of Illinois Medical Center in Des Moines. "But if they don't, they become closet bed-wetters."
"There is so much prejudice and misconception out there about enuresis that no one is talking about it," Dr. Miller said.
Most adult bed-wetters are reluctant to mention the condition to their doctors because of fear of how the physicians will react and because of past experience with ineffectual treatment, experts said.
Dr. Diane N. Rosenbaum, a psychologist at the Center to Assist in the Regulation of Enuresis, which is part of Children's Memorial Hospital, Chicago, said even many pediatricians did not know how to deal with bed wetting, which is a common problem with children. "And adult practitioners are even less trained to deal with this problem," Dr. Rosenbaum said. "Until the last 10 or 15 years, the psychiatric community felt enuresis came from some underlying conflicts in the person," she said, "and for years, a lot of people were told it was a psychological problem and all in their heads. This meant that a lot of people with the problem were not helped."
Those who seek help for bed-wetting often spend years going from professional to professional seeking relief, and when they get no relief, they give up.
In a letter in the Oct. 17 issue of The Lancet, a British medical journal, a 47-year-old chemical engineer from the Netherlands described more than 40 years of seeking help. Coming from a family of past and present bed-wetters, he said he wet his bed six nights a week, often twice in one night.
"Over the years, I have consulted six general practitioners, four urologists, one neurologist, two psychologists, one psychiatrist, one hypnotherapist, two naturopaths, one homeopath, and one acupuncturist," he wrote. Since almost all these specialists had no experience treating adult enuresis, he said, he was often offered experimental treatment that did not work, like the Pavlovian method of punishing himself with a cold shower every time he wet his bed.