Posted on 4 May 2017
Bed-wetting (enuresis) may not be a particularly harmful or life-threatening situation, but that doesn’t mean it isn’t a serious or traumatic one for those affected. Here’s what you need to know about a condition that is treated most effectively with a multi-disciplinary approach.
Ntsiki is nearly five years old, and has begun wetting her bed every night. Her mother makes sure that she goes to the bathroom before bedtime, but it doesn’t help. Ntsiki has also started wetting her bed at preschool, and the teachers need to wake her up to take her to the bathroom. Ntsiki’s mom, Sandiswa, is wracked with anguish. She’s going through an acrimonious divorce and is worried that this is the root of the problem.
While names have been changed the story outlined above is real, and more common that you’d think. While most children will gain bladder control at night by the age of four, 20% of children above the age of five experience some form of bed-wetting. Most of them will simply outgrow it, but some will be diagnosed with a genetic predisposition or physiological problem that can be treated.
It’s challenging for parents when their children don’t grow out of bed-wetting (the medical term is primary enuresis), but even more distressing for parents when a child lapses back into bed-wetting after a period of six months (or even several years) of control (secondary enuresis).
Finding the reason
‘The likelihood of enuresis in children is almost 77% if both parents had it and 43% if one parent suffered from it,’ says Dr André Cronjé, a urologist at Mediclinic Potchefstroom. ‘The incidence is 15% if neither of the parents had it. A specific gene, called the ENURI gene, has been isolated in chromosome 13, but is also linked with chromosomes 12 and 22. Enuresis also occurs more often in boys than girls.’
Even though enuresis can be hereditary, the condition manifests because of a number of physiological and psychological factors, including:
- excessive urine production
- pathological bladder conditions (from structural and size problems to involuntary contractions and nerve-sensor complications)
- urinary tract or kidney infections
- hormonal irregularities (specifically, the lack of vasopressin, an anti-diuretic)
- sleep apnoea (cessation of breathing during sleep)
Needless to say, conditions like infections, constipation and sleep apnoea need to be diagnosed and treated primarily and separately as a root cause of enuresis.
According to Urologyhealth.org, certain alternative therapies and techniques should be avoided, including scheduled night waking, holding in urine to ‘stretch’ the bladder, and less scientific treatments like acupuncture, hypnotherapy and homeopathy.
There are two main medically accepted options for treating enuresis:
- Technology. A moisture sensor attached to a vibrating pad or electronic alarm can be used to rouse a sleeping child in time to prevent too much bed-wetting, and kick-start the body’s reaction process.
- Medication. The correct prescription will depend on the underlying cause. For example, desmopressin will deliver vasopressin, the abovementioned hormone that inhibits urine production during sleep, while oxybutynin prevents bladder contractions. Dr Cronjé cautions that while these pharmacological options can be effective, ‘they do have side effects and a high relapse rate is seen when these drugs are stopped’.
‘Combination therapy, involving desmopressin and alarm therapy, as well as behaviour treatment, shows better results than those achieved with any or either therapy alone,’ he adds.
What about psychological causes?
While the medical jury is still out on the validity or exact nature of the causal relationship, bouts of secondary enuresis are sometimes accompanied by emotional or social stress like bullying or divorce.
‘A psychological cause is found in only 10% of enuretic patients,’ says Dr Cronjé. ‘In these cases psychotherapy can be used, with treatment focusing on the specific psychological causes for the behaviour. It is very important not to punish the child or in any way increase existing feelings of guilt and insecurity in the child.’
The good news is that most children will eventually grow out of even the most drawn-out bed-wetting phases. In the meantime, treating each case with sensitivity and care is important. The psychological harm that feelings like shame and guilt can cause are much more detrimental than an extra load of laundry or the cost of nappies.