The problem of bedwetting

Recently, it seemed like an epidemic having to deal with this frustrating problem among worried parents.

Bedwetting is one of the most challenging problems to treat and it is problematic for the patient, parents and attending physician. It is a problem that cuts through various age groups and it has even been observed in adults. It is usually more known in clinical parlance as ‘enuresis’, which indicates that there is an involuntary voiding of the urine during sleep.

While it commonly occurs at night, day-time episodes are also recorded. Children who wet their beds at least three nights in a week after the age of five are qualified to be labelled as having this unique problem. In this age group, there is almost equal incidence between boys and girls. However, as the children grow older, the girls begin to do better, such that by the mid-teenage years, it is almost exclusively a male phenomenon.

Different things have been attributed to bedwetting. Children who do not have the full complement of nerve supply to the bladder, which is caused by some other problem are prone to having it. These people are said to have a neurogenic bladder, which means the bladder ends up being less competent at holding urine than it should be. Consequently, voluntary control of the bladder and its function is impaired in these individuals.

There are two broad classes of those who have this abnormality. There is the primary enuresis found among those who have never learnt how to control their urination. Then there is the secondary type seen among those children who were at some point able to control their urine during sleep and then lost that ability. This type is thought to occur when the child has experienced a stressful event such as the arrival of a sibling, marital disharmony or the loss of a loved one. Some others have a relatively small volume bladder which is unable to hold a reasonable volume of urine before it gets full and there is a desire to void. Some other cases may be caused by urinary tract infection or diabetes.

In truth, however, many of these latter situations are rare causes of this malady. Often, no definite cause is related to the problem. Hence the emphasis now that psychological factors may be an important cause. Urinary tract infection and diabetes are easily detected after the routine investigations carried out at the first visit to the hospital and if any of those reasons are responsible for it, then treatment is the key to stopping it.

Usually, though, the causes are much deeper and affected parents would have tried several ways to help their children control it. Some parents deprive their children of drinking water after dinner as a way of controlling it. Others make the children have an early dinner, while others ensure that dinner does not consist of foods with significant water content.

These are remedies that have never been proved to work. Some attempts at treatment are as ridiculous as they sound; one of these is the practice of asking the affected children to urinate in a mass of hot coals. It is speculated that the urine produces steam which should cause the sufferer enough discomfort to wake him from sleep. Other practices are equally laughable, but it all goes to demonstrate how frustrating many people find this problem to be.  And even though it is more common in boys in the older age groups, it is the girls who mostly get embarrassed by the occurrence.

Importantly, though, is the fact that these children remain dry most times, especially during the day. Their release of urine during sleep occurs mostly at night and it is not malicious. Indeed, some are known to hold on to the urine consciously for so long until they are finally unable to keep holding on and so let it go while sleeping.

More realistically, many parents seek medical advice and although a number of strategies have been tried, no singular remedy is gratifying. Some take the stance of waking up the children at regular intervals to prevent the incident from happening. It is thought that when this is done frequently enough, the person eventually becomes sufficiently used to waking up at such times on his own. In reality, this is seldom the case and even the short periods between such intervals of waking are enough to wet the bed.

In one encounter just last week, a particularly unhappy mother narrated how she would awaken the daughter, who is not allowed to go to bed early, to avoid wetting her bed one hour after sleeping off. By the next rousing two hours later, she would have done so. In several places, alarms triggered by sensors which detect wet beddings are installed to break the cycle of bed-wetting. These are thought to wake the sufferers in the nick of time and help prevent bed-wetting.

However, in the real world, the experience is much different as sleep continues until the bladder is completely emptied. Others have used various medicines to bring about some succour, but these have also proved to be disappointing. Some of these medications are drugs which reduce the production of urine, called Desmopressin, and the hype which initially heralded its advent was not supported by the real life events as they unfolded. The other medication is a tricyclic antidepressant, a prescription medication initially designated for the treatment of certain categories of depressive illness. It was found to have some ability to improve the urine-holding ability of the bladder and thus delay or prevent the occurrence of bed-wetting. This medication too has failed to uniformly impress.

More to the point, however, is the usage of a combination of some of the practical remedies mentioned above to attain some semblance of normality. Although no age is exempt from suffering this particular problem, most sufferers stop by themselves quite spontaneously, with or without treatment.  As a result of this reality, parents need to be assured that this is a problem that will probably go away on its own. There is no degree of parental anxiety that will take it away and certainly, parents need to understand that denial of certain things to their children will do little to help them combat the condition. Medications can be tried with the advice of a doctor and there is room for counselling by a psychologist, but the person most important in bringing an end to the problem remains the person who suffers from it and the attitude they bring to it.

Usually, a stoppage occurs before the age of 18, except in some of the more unusual cases. In the last decade or so, I have come across two adult males who suffer from this problem without any associated medical illness. For them, everything that could possibly be tried has been tried with little results. And even when one discarded the habit of heavy beer drinking, nothing was gained in terms of bringing a stop to the condition. More usually, adults who experience enuresis would do so because of uncontrolled diabetes, the side-effects of certain medications, dementia, prostate problems and weakened bladder muscles as a normal consequence of aging.

Punch