Updated: Jun 13, 2020
In today’s world, as a child approaches their second birthday, parents and schools, introduce them to the concept of potty training. By the third year, children are expected to be off diapers or nappies and get teased by other adults if they are seen with a bulging bum. Parents then begin to frantically communicate to the child, where to go to wee- wee and even make funny sounds which is believed to make the child wee. At the potty training stage, the ‘all too important object’ is the potty which is stationed in a very visible spot in the home, for accessibility by child. Most times these practices, pay off so that on or before the fourth birthday, the child is able to achieve both daytime and night time continence of urine and also importantly, may have graduated to the use of toilets from the potty. Having noted this, we know of children, who delayed in achieving this overly anticipated milestone. For children who continue to have night time accidents into middle childhood and late teenage years, they are shamed, humiliated and receive no empathy or mercy from family and friends. There is even a specially curated local song we sing, to mock them (read Goodwill’s Enuresis story to see the song). Often there are practices put in place to curb bedwetting, some of which are detrimental to the child’s well-being. The healthy ones include restricting bed time fluid intake, night lifting and waking however, traditional approaches such as “the red ant” bite method, in which a red ant is placed on the perineum to bite several times, weeing over the embers of coal should be discouraged. Also, physical punishment such as beatings have been employed without achieving its intended result of night time dryness.
WHAT IS ENURESIS (BEDWETTING)
Enuresis is the repeated involuntary voiding of urine occurring after the child is expected to have achieved continence after 5 years of age. This condition however must occur in the absence of other medical or physical condition. Enuresis is characterized as an Elimination Disorders, alongside encopresis, which is repeated involuntary passage of feces or passing it in inappropriate places after the age of 3 years. Enuresis can result in emotional distress in the child because it can impose limitations in partaking in activities such as sleep dates or going on holidays.
HOW COMMON IS ENURESIS?
The prevalence rate of enuresis in different places may vary, depending on the definition and the method of assessment. Among 5-year-olds, the prevalence stands between 5%-10%, among 10-year-olds, 3%-5%, and 1% among individuals 15 years or older. In a study carried out in Zaria, Northern Nigeria, enuresis was found in 22.2% (214/1416) of the children. Enuresis is said to be more in Males than females. From the same study, a total of 142 boys were diagnosed with enuresis, compared to the 72 females found. In some other studies carried out, the ratio of Boys to girls diagnosed with enuresis is far greater than the results from the Zaria study.
FACTORS ASSOCIATED WITH BEDWETTING.
The inability of a child to achieve urinary continence has been attributed to various factors. These factors are environmental, physiological, genetic and psychological/stressful life events.
• Environmental factors include parental upbringing, with regards to late or poorly handled toilet training, large families with overcrowded living conditions.
• Physiological factors associate to late maturation in the normal circadian rhythms of urine production.
• Genetics is strongly associated with enuresis, in that children diagnosed with nocturnal enuresis in particular have first degree relatives e.g. fathers who have been enuretic.
• Psychological/stressful life events implicated include: loss of a parent, family breakdown, moving house, migration, change of school, birth of a sibling, prolonged hospitalization, family financial problem, bullying etc.
SUBTYPES OF ENURESIS
Enuresis is divided into two subtypes, ranging from night time bedwetting to daytime involuntary urination.
• Nocturnal Enuresis is the most common subtype of enuresis, and is a characterized by children involuntarily passing urine during sleep at night. This form of enuresis is also referred to as Primary enuresis. Here the child has never achieved night time dryness.
• Diurnal Enuresis involves the inability to control urination while awake or whilst taking afternoon naps. It may be referred to as secondary incontinence/enuresis. This subtype is further divided into two groups. One group called “urge incontinence” involves children who have difficulty delaying the urge to urinate, and “void postponement” which involves those who consciously try to defer the urge to urinate until urgency forces them to go to toilet, and leakage occurs along the way.
GENDER DISTRIBUTION OF ENURESIS.
• Nocturnal type is commoner in boys, while diurnal enuresis is commoner in girls.
SYMPTOMS OF ENURESIS
• Repeated bedwetting
• Wetting clothes when awake or during siesta.
• Bedwetting occurs in the absence of no medical or physical condition.
• It should occur at least twice a week for a period of 3 months after the age of 5years.
MANAGEMENT OF ENURESIS
Enuresis is usually managed in Primary care unit, by pediatric psychiatrist.
• If enuresis is not caused by any medical condition, it should be explained to the parents and the child that the condition is common among children, and the child is not to blame.
• The parents should be enlightened that punishment and disapproval do not help the child during this phase. Parents should be encouraged to use more rewards when the child has dry nights
• Advice is usually given about restricting or reducing intake of fluids before bedtime. Parents are also encouraged remind the child to visit the toilet at different times of the day, or before bedtime, and lifting or waking the child during the night to the toilet.
• If simple measures do not work, the Enuresis alarm is employed. The enuresis alarm is attached to the child’s waist, and activates only when the child begins to urinate. The child turns off the alarm, and continues the urination in the toilet, changes pyjamas, and bedsheets. Adaptability to the enuresis alarm involves the help of the parents.
• Medication is also employed in the treatment of long lasting cases of enuresis.
It is important that parents and guardians are enlightened on this disorder affecting many children. Being informed would help parents on the next step to follow when faced with this situation. Punishment and mockery would affect the child’s self-esteem, and could likely result in other behavioral problems and psychological disorders.
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