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By Dr Pius Musau
There are 400,000 Kenyans who are terrified of falling asleep, dreading the inevitable reality, that come morning, their beds will be drenched in urine.
An agonising fear of discovery, shame and feeling odd rules their waking lives.
The adult bed wetter is paralysed by the idea of friends discovering their ugly secrets.
Bedwetting is a common occurrence among children below a certain age and becomes a problem past the age of six years for girls and seven years for boys.
Despite a 15 per cent annual natural regression of the problem, about one to two adults end up being bedwetters.
A urologist can see about six patients with bedwetting problems anually five of who are children of varying ages and at least one adult.
For an adult, bedwetting is a distressing condition that is rarely spoken about due to the deep social implications, not only to the person affected but also to the relatives, partners and friends.
Types of bedwetting
Bedwetting is scientifically referred to as nocturnal enuresis and is classified into two distinct types: primary and secondary.
• Primary nocturnal enuresis (PNE): This is where the person has never, since childhood, had nighttime of dry period for longer than six continuous months.
If not handled properly, the child will turn into an adult bed wetter. Beyond the age of 18 years, one will almost certainly end up a bed wetter for the rest of their life.
• Secondary Adult Onset Enuresis: It sets in after one had established nighttime dryness. It mostly signifies a medical condition that once addressed, will resolve the bedwetting problem.
Causes of PNE
The principal factors that determine existence of PNE are the amount of urine produced at night, functional bladder capacity, and the ease with which the person can wake up.
• Night urine production: The night production of urine is halved by an increase in Anti-diuretic hormone (ADH) in the brain. This makes the kidneys produce less urine.
Studies show that abnormal levels of ADH, leads to an increased production of dilute urine in PNE.
• Functional bladder capacity: This focuses on the amount of urine the bladder will hold before signals can be sent for emptying. Bladders in PNE have higher muscular tones and show instability that sends signals at small volumes of urine.
• Sleep pattern: Bed wetters can do it at any phase of their sleep, contrary to past notions that they are heavy sleepers.
They seem to have an impaired integration of nerves and low level of waking from any phase of their sleep. This makes them not rise in spite of the bladder signals.
Note: These factors are hereditary and run in families. One has 77 per cent chance of wetting a bed if both parents had this problem, 44 per cent if only one did and 15 per cent if none was a bed wetter.
Secondary nocturnal enuresis
It could occur as a result of medicinal side effects, psychological affection or some urological disorder.
The urological causes could be:
• An overactive bladder due to an infection or nerve disorder
• Sphincter problems such as a bypass by a ureter, injury after surgery, or lack of bladder co-ordination
• A poorly contracting bladder
• Blockage of the bladder outflow by the prostate or urethral stricture
• Poor waste elimination leading to constipation and pressure on the bladder
Treatment options
Bedwetting can be treated either through use of medications, mental support, or surgery in the secondary type.
Medical care: Focuses on reduction of urine production, stabilisation of the bladder, regulation of sleep-wake pattern and the synchrony between the bladder and urethral sphincters.
Mental support: It involves motivation, behaviour modification, bladder training, psychotherapy and options such as use of alarms, absorbent underwear and waterproofing the mattress cover.
Surgery: This method can be used where there are surgical causes like growths in the bladder, strictures and prostate ailments.
Psychosocial effects of bedwetting
Bedwetting in adults can be a cause of depression and poor self-esteem. There was a time when it was thought to be part of what was referred to as the Macdonald triad of bedwetting, starting fire and cruelty to animals. We now know that it only curtails social integration but does not breed anti-social behaviour.
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