By Dr Monda Ang’awa
John is a healthy and active nine-year-old boy. Until recently, when he learnt he was ‘different’ from his friends, John was outgoing. Since he discovered his embarrassing problem, he has become more introverted, fearing the taunts of his peers. John wets his bed at night and his parents are getting worried, especially as his three-year-old sister is completely toilet trained. John’s parents want him to join a private boarding school, but he is reluctant because of the problem.
Bedwetting at night by a child by whose age and development should have achieved bladder control is called nocturnal enuresis. It is a common childhood condition, more prevalent in boys than girls — girls tend to achieve bladder control earlier than boys.
Bedwetting is embarrassing especially when it occurs in older children and young adults and many suffer in silence. It is particularly difficult if a child or young adult has to sleep away from home and the host does not understand the condition.
The bedwetting would become a topic for gossip. Also, affected children are often ostracised in boarding school.
Bedwetting is normal from birth to the age of about three because normal bladder control has not been achieved, usually between the ages of 18 months and five years. Bedwetting is recognised as a problem after the age of five for girls and six for boys when all other possible causes of the condition have been ruled out.
It is a symptom, not a disease in itself, and is usually an indication of delayed development, such as delayed speech.
Causes of with bedwetting:
Family history plays a role in over 70 per cent of affected children, where at least one parent had the same problem during his or her own childhood.
Low social economic status is also a factor, whereby some children may grow up with social inadequacies especially when they mix with other children from more affluent backgrounds. Their growth may also be affected by poorer nutrition or chronic illnesses.
Bedwetting is also common in children who are emotionally neglected by absentee parents and those in orphanages, some large families and some single parent homes. Children with low birth weights, low IQs and poor speech development are also affected.
Bedwetting is said to be primary when the child has never achieved sustained dryness and is most often due to faulty toilet training when a child is punished for wetting the bed. A punitive attitude of the parents creates anxiety in the child and makes the problem worse and also affects the child’s self esteem.
Other causes are a small bladder capacity, a delay in the maturation of the nerves and muscles of the lower urinary tract including the bladder, physical abnormalities that the child is born with, sleep disorders and behavioural problems.
Bedwetting is said to be secondary when it occurs after a child had achieved bladder control and is more common in older children particularly those over the age of 12. The most common cause for this is usually a urinary tract infection but it can also be due to a stressful issue like bullying at school or a sudden change in the child’s environment like a change in school or loss of a parent. It may also be an indication of a disease like diabetes or sickle cell anaemia, or due to a medication that interferes with bladder control.
Lowering self esteem
Bedwetting is a problem that has to be properly evaluated by a doctor before a course of action to be taken is decided upon. A parent must be patient and understanding because punishing a child every time he wets the bed only makes the problem worse by making the child more anxious and lowering self esteem because the bed wetting is not intentional. Instead, reward him for ‘dry’ nights. Bladder exercises and avoiding drinking fluids in the evenings before the child goes to bed are attempted before turning to the use of drugs.
There are drugs that can be used, but only under the supervision of a doctor. These are only recommended after the age of six or seven, and only after all the other possible causes of bedwetting have been ruled out and the non-medical means of treatment have failed.
— drbrigidmonda@gmail.com
