Bed-wetting is hereditary — Expert

                            

A senior lecturer/consultant urological surgeon, University of Ilorin and University of Ilorin Teaching Hospital, Dr. Ademola Popoola, discusses issues related to nocturnal enuresis

What is bed-wetting?

Bed-wetting also known as nocturnal enuresis or simply enuresis is when an individual who is expected to have had bladder control still wets their beds at night. Bed-wetting could be primary or secondary. Primary enuresis is the persistent bed-wetting (at least two wet nights per week) in an individual beyond the age when bladder control is expected.


Usually most girls by age six and boys by age seven have full bladder control. Beyond this age, the patient could be said to have primary enuresis. Secondary enuresis is another type of bed-wetting in an individual who had previously attained bladder control at night for a period of about six months and there is recurrent bed-wetting.

What causes nocturnal enuresis?

It is caused by factors which include: neurological-developmental delay, genetics, psychological and medical conditions.

Neurological-developmental delay means there may be a delay in the child’s development and this is responsible in the majority of the sufferers. Primary enuresis is more common than the secondary type.

Genetics is when bed-wetting runs in the family. Children whose parents did not have enuresis have only 15 per cent incidence of bed-wetting compared with those whose parents did who have between 44 – 77 per cent risks. Psychological disturbances such as a major family shaking, parental divorce, bereavement, failures etc. may also cause enuresis. Medical conditions such as sleep apnoea from enlarged adenoids, tonsils which are structured along the airway closer to the mouth could also be responsible. This could manifest as obstructive airway disease and snoring; diabetes mellitus type 1, smaller than normal urinary bladder and sleepwalking.

Do lack of sleep and psychological problems aid bed-wetting?

Yes they do. Poor sleep especially due to obstructive airway diseases may be associated with sleep apnoea and enuresis. For psychological problems, this could occur in children who are faced with a major family shaking. Also, children who are punished because of enuresis tend to get worse whereas those who receive a lot of psychological support and understanding from parents tend to do better. No child is happy to wet their bed so shaming a child because of bed-wetting will only aggravate the problem.

Could there be other reasons for bed-wetting?

There may be continuous wetting which is just not limited to when the individual is at sleep. It may be due to congenital abnormality in which there is the abnormal implantation of the ureters bringing urine from the kidneys into the vaginal. Hormonal dysfunction as well as cognitive disorders such as senile / pre-senile dementia have been associated with persistent enuresis.

What are the effects of bed-wetting?

Bed-wetting has a lot of psychological effects. Children may refuse to go to boarding house or spend time outside their home. It may also affect their academic performance. It increases the cost of laundry and maintenance of beddings. It may be an indication of an underlying disease such as diabetes mellitus, diabetes insipidus and obstructive air way diseases.

If left untreated, can enuresis lead to a worse condition?

Enuresis if neglected may impact on the self-esteem of the sufferer. If it is as a result of an underlying disease, it may lead to complications of the underlying disease.

When is the right age for a child to stop bed-wetting?

In girls, bed-wetting should have stopped by age six while for boys, by age seven.

Are there medications to treat this problem?

Yes, there are medications that are available to treat enuresis. These drugs work based on the understanding of the pharmacology of urine production, urine storage in the bladder and urine emptying. Many of these drugs are quite effective. However, psychotherapy and behavioural modifications are very effective in a large number of patients especially children.

Is bed-wetting in adults also caused by hormonal imbalance?

In addition to many other causes which have been alluded to earlier on, enuresis could be caused by hormonal imbalance. Imbalance in antidiuretic hormone which is responsible for restricting how much of fluid in the body is excreted as urine, could lead to enuresis. When there is insufficiency of ADH, the patient produces more volume of urine than usual and more than what the urinary bladder can safely hold, hence with sleep, part of the urine is voided involuntarily. Also diabetes mellitus which is essentially a hormonal disorder has also been associated with enuresis.

Does restricting fluid intake help with bed-wetting?

Yes, restricting water few hours before going to bed helps. However, the individual must take enough water during the day, enough for normal functioning of the body. Restriction of alcoholic drinks and coffee towards late evening would also help.

Are there more adults battling with this problem?

There are many publications on the incidence of enuresis among children in Nigeria but very few among adults because many of these are probably not reported. The prevalence rate recorded by Adekanmbi and other workers in south western Nigeria was as high as 40 per cent among school children while Mbibu and co-workers in Zaria reported about 22 per cent among similar cohorts. However, the incidence rate in adults is expected to be much lower as many children would have outgrown enuresis before adulthood. Some studies outside Nigeria put the adult rate at between 0.5 and 2.3 per cent. This is also likely to be lower than the actual percentage because many adults do not report enuresis.

Aside shame and embarrassment, what other setbacks do adults who wet their beds suffer?

It may be a reason why a lady may refuse to go into a relationship. It affects self-esteem and self-confidence. It may retard general progress of the individual.

Is bed-wetting hereditary?

Yes, bed-wetting runs in families.

If an adult wets their bed once, is there need for concern?

If an adult wets their bed once in a blue moon, it is not a reason for any concern apart from the immediate embarrassment that may attend the episode depending on where and when this single episode happened. Imagine an adult who slept outside his or her home and wet their beds. Otherwise, there is no cause for alarm and it is not an indication that it would happen again. It may however recur after several months or years or never again.

How can they prevent it from reoccuring?

Adults who have the tendency to wet their beds should observe the following: they should seek medical therapy / advice, reduce the intake of alcoholic beverages / coffee few hours before usual bed time; have early supper; plan scheduled voiding i.e. void by the clock without waiting to have the urge. For example, they could plan to void every two – four hours; and they should avoid stressful situations as much as possible.

Can bed-wetting be totally stopped?

The question is, is this a primary or secondary enuresis? In my experience, I have come across ladies in their 20s with primary enuresis but with treatment, they have come out of it. I guess such adults may not just outgrow but may need treatment. This may be different from children who may have delayed neurological development.