When bedwetting is a thorn in a pupil’s flesh RACHEAL NINSIIMA

Jack is 12 years old and is preparing for secondary education next year. However, he lives with a nagging crisis – he can’t stop wetting his bed.   

Worry and misery morph is face into frowns as he cannot easily associate with schoolmates because they shun him. Jack says he has grown accustomed to being called names like ‘kafukirizi,’ ‘kawunya’ and worse, he is entitled to three strokes of a cane whenever he wets his bed. Looking at him narrate his story, one cannot help but sympathise.

“My parents do not have enough money to take me to a qualified doctor and the best they have done is to take me to herbalists and traditional healers which have all failed,” he painfully reminisces.

Jack has therefore resorted to swallowing the bitter pill of negative publicity and every day, he takes thirty minutes off class time to wash his dirty linen.

Like Jack, we all wet our bed at one time X. The difference is that some stop years earlier than others. Culturally; it is understandable or rather acceptable up to about the age of six. When it leaps beyond this age, then some of us are quick to judge that there is a problem. Nevertheless, many others (I mean teachers, parents and guardians) spank child-adults who ‘pee’ on bed and brand them all sorts of victimizing names which sets the child’s esteem aback.

Julie (not real name) recalls that during her primary school days at St. Joseph’s Primary School inNabbingo, bed wetters were made to carry their mattresses and beddings in front of the school assembly as a way to embarrass them out of the habit. 

Mary Ayamo, aboys’ matron at Mivule Primary School in Mutungo has handled bed wetting among pupils for eight years now.  Ayamo has learnt how to deal with this problem mechanically as fast as she came to accept that it is normal for some children to pee on their bed.

“At the start, this dormitory used to smell because some boys would urinate and hide until we introduced the idea of using a mackintosh to cover mattresses,” she says.

 

To ensure that those who urinate do not hide, Ayamo has instituted two pupil spies who investigate everyone’s bed after they have departed to class. At the moment, she registers 10 bedwetters at the end of the week and three cases daily. Many of these, she argues, add unspeakable vices of dodging showering and brushing their teeth which puts their health at a risk. But Ayamo is not slow in administering justice as she won’t tolerate any of this behaviour. 

“I parade those who wet their bed before other dorm members with their beddings and they are now used to it,” she says.

But is the phenomenon of child-adults wetting their bed worth the indignity or is there something more to it?

Nocturnal enuresis, commonly called bedwetting, saysDr Sabrina Bakeera Kitaka, a paediatrician and adolescent health specialist at Mulago Hospital, is involuntary urination while asleep after the age at which bladder control usually occurs. 

Nocturnal enuresis is divided into primary and secondary. It is considered primary (PNE) when a child has not yet had a prolonged period of being dry whilesecondary nocturnal enuresis (SNE) is when a child or adult begins wetting again after having stayed dry.

“Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations but this condition is frequently associated with a family history of the condition,” Dr Kitaka says.

She adds that most girls can stay dry by age six and most boys stay dry by age seven. By ten years old, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%. Dr Kitaka says most bedwetting, is just a developmental delay and not an emotional problem or physical illness.

 

However, bed wetting may be associated to constipation, diabetes and urinary tract infections. According to www.doctordot.com, bed wetting may be due to hormonal imbalance of the Antidiuretic Hormone (ADH) responsible for controlling urine production.

“ADH tells kidneys to produce less urine and often sends signals at night. The imbalance of this hormone causes urine production to increase making it difficult for one to go through the night without wetting their bed,” the site reads.

Bedwetting may also be a result of psychological effects like trauma, divorce, sexual abuse and bullying.  Because of bed wetting, child-adults suffer emotional stress or psychological injury if they feel shamed by the condition.

“These children may develop anger as they keep asking themselves why is bed wetting happening to them, may be withdrawn, frustrated and fearful,” Dr Paul Nyende, a counselling psychologist at Makerere University says.

He adds that the extreme effect of bed wetting is depression. Rather than victimize children for a condition they have no control over, Dr Nyende advises parents and teachers to be steadfast in counselling and to minimize threatening environments like bullies and caning. 

To administer herbal drugs to abet this problem is only but a hoax. According to Dr Saddam Lukwago, a herbalist under the umbrella body of theNational Council of Traditional Healers and Herbalists Association (NACOTHA), Ugandan herbalists have not yet discovered herb concoctions that address bed wetting. 

“The problem with herbalists is that they do not want to accept that they cannot solve some problems thus they concoct herbs which do not work. Let no one deceive you, there are no herbs which address bedwetting in Uganda,” Dr Lukwago says.

Schools, in a bid to avert this problem have adopted ideas. At Entebbe Junior School, all children are required to carry a plastic mattress cover in case of bed wetting.

Myths associated with bed wetting:

According to an article, ‘Bedwetting myths and facts on www.commondiseases.org, some of the myths associated with bed wetting are:

Bed wetters are too lazy to control their urination.

This assumption is not only inaccurate, but also destructive because it only makes the child feel bad about him or herself. The truth is bed wetters have no control over their condition. 

Children who wet their bed have emotional or mental problems.

This misconception may have stemmed from the fact that autistic children usually wet their bed. That is not the case in most bed wetters. Although enuresis results in psychological problems such as low self-esteem, these problems do not cause children to wet their bed. But stress and other emotional issues such as divorce of parents or death of a loved one can trigger enuresis in children who previously have had dry nights.

Wearing diapers at night will slow down the process of getting rid of the habit.

Experts say that using diapers does not prevent a child from outgrowing enuresis on his own. In fact, diapers offer some benefits. For the bed wetters, diapers prevent them from getting wet and cold when they wake up. For parents, diapers spare them the burden of changing the bed covers or washing the mattresses frequently.

Fluid intake before bedtime causes enuresis.

Restricting the amount of fluid intake before your child goes to sleep can lessen the volume of urine released during nighttime. However, drinking liquids before bedtime does not cause the child to wet his bed.

Dr Kitaka advises parents to set alarms for their children to wake up and go pee at night. If the conditions persist, she recommends that one visits an urologist (kidney and blood specialist) to have the child checked and to get advice on the possible treatment methods to stop enuresis.

ninsiima@observer.ug