Bed wetting, medically called nocturnal enuresis, refers to the unintentional passage of urine while sleeping.

While bed wetting, which occurs mostly at night, may not be worrisome for children, it is frustrating and demoralizing for adults. 27-year-old Tolulope Joseph who battled with the condition for 25 years shares how she overcame the troubling experience.

For 25 years, Tolulope Joseph’s nights were riddled with fears, insecurity, and shame because she was trapped in a problem she didn’t know how to solve. She grew up to know herself as a perpetual bed-wetter, despite efforts by her family members and loved ones to find help for her.

She wallowed in low self-esteem; she was beaten and ridiculed. There were nights she was denied food and restricted from drinking water because of her predicament.

Most days, she went to school sad, thinking how she was going to overcome it. She hated going to sleepovers because she would not want people to know.

However, two years ago, Joseph started noticing that her nightly bed wetting experience was gradually becoming dry.

Recalling, the Ogun State indigene said, “Children didn’t want to associate with me but they would come around me when it comes to academics because I was brilliant; bed wetting was a stigma in my life.

“I remember my grandparents had to go all the way to prepare a concoction for me when I was about 10 years old and I couldn’t reject it because I was also desperate for a way out.

“Anytime my grandmother went to the market, she bought whatever anyone told her that could help because she wasn’t happy either, and she was ready to do anything to assist me.

“I did a lot of sneaking in and out of the house, trying to tidy up the mess after bed wetting. Nobody was able to think that the issue could be medical; nobody ever mentioned going to the hospital. All we were trying was traditional medicine but they never worked.

“I remember my grandmother was always telling me to kneel before the traditional grinding stone and beg it not to allow me to bed wet. I used to greet the electric pole, too.”

According to a Consultant Urologist at Alimosho General Hospital, Igando, Dr. Badmus Adeola, enuresis is an involuntary leakage of urine that occurs during sleep, especially in children up to three years of age but persists in about 15 percent of children at age 5 and almost one to two percent of children at age 15.

Dr. Badmus Adeola

Dr. Adeola said all children older than five years with enuresis should undergo a urologic evaluation, as it could be hereditary from an enuretic father.

He said the causes of enuresis can be primary or secondary.

“Primary means the child never gained continence from birth, while secondary means that the bed wetting started after the child had gained continence. There are controversies regarding its etiology but it is generally accepted that it’s multifactorial.

“If there is small bladder capacity, it can predispose to enuresis; although the cause is multifactorial, including disorder of sleep arousal. Ideally, having small bladder capacity should lead to frequent urination but if there is associated disorder of sleep arousal, that will lead to enuresis,” he said.

A Consultant Clinical Psychologist at the Lagos University Teaching Hospital, Idi-Araba, Dr. Charles Umeh, says children who wet their bed usually have low self-esteem, restrictions on social activities, and are at risk of emotional abuse.

Dr. Charles Umeh

“A child who bed wets may find it difficult interacting with peers because it comes with a lot of embarrassment and frustration. They are going to have low self-esteem; they may even get depressed, and in some cases, if they can’t find a solution to it, some of them may start contemplating suicide,” Umeh said.

The struggle continues

Joseph had thought she would outgrow the condition when she got into secondary school or the higher institution but her hope was dashed.

She began to research into the condition when she was teased by some of her family members that her mother had bed-wetted for years.

“That was when I thought of really giving it attention. I did my research and discovered that enuresis can be genetic. I asked my mum and she said she had it till when she was 18. At that time, I became curious because if my mum could have the same experience, then there should be a link.

“My family members got used to it and I was used to the abuses too. I remember one of my aunties took me to a lot of churches. I remember drinking a lot of perfumed water but it didn’t work,” she told PUNCH HealthWise.

When she got admission into AdeniranOgunsanya College of Education, Lagos, in 2011, keeping her enuresis a secret was just for a while.

“When I went to AOCOED, my mum wanted me to stay in a private apartment, but we couldn’t afford it. For weeks, I didn’t bed wet but one day, I did. My roommate was soaked but she was very understanding; she prayed with me.

“She encouraged me and we went to see some people she knew. We prayed, fasted, but after then, I was still bed wetting, but not regularly.”

The issue restrained her from travelling and when she did, she bed-wetted most times.

When she got admission into the University of Lagos, in 2016, she began to gain more knowledge about the condition.

“I had to stay with someone a family member introduced me to, but while in the house, I bed-wetted; I had to wake up early and clean up before dawn.”

Undeterred, she continued her research on enuresis and how it can be controlled.

“I’m surprised that people don’t discuss it openly. While in class, I would be consumed with the thought of how I would get over it,” she said.

Her dry nights

Now 27, Joseph has turned her lengthy embarrassing experience into help for those who are going through what she went through.

She wrote a book titled “Enuresis: A distressful disorder” to share her experience and make sure other people get the right support.

“I learnt that there is actually nothing anyone can give you to make the condition go at once; it’s a process and it’s a gradual thing. I realised that I have a small bladder and it cannot hold much amount of urine.

Tolulope Joseph

“I realised that I use the toilet more often. These are things that were happening but I never thought about it. I realised that I have an overactive bladder; I realised that there are things I should stay away from, like soft drinks.

“I used an alarm which I had been using even before knowing that alarms had been medically proven to help bedwetting adults.

“I had a particular phone that I used for my alarm. I set it multiple times to wake me up hourly from midnight, so it became a part of me. I did that for five years and discovered that it was working gradually. What I was doing was to lighten my depth of sleep because deep sleep is another problem I had.

“I realised that most times when I bed wet, it comes through dream and most people who open up to me also confirm that they usually dream but discover that they have bed wetted once awake. With time, it happened.The alarm system helped to reduce the depth of my sleep. The avoidance of soft drinks and liquids reduced my hyperactive bladder.

“I didn’t have to see a doctor but there were people I spoke with that are health professionals,” she said.

She noted that the condition is rarely talked about, yet it affects many people.

“So many people, including married people, go through this but they are ashamed to talk about it, they find it deeply embarrassing, and it affects their quality of life,” she said.

Controlling enuresis

The urologist said most children with enuresis feel very much alone; therefore, support from the family is very essential.

“A positive attitude and innovation to be dry are important for treatment. Patients with enuresis need caring and patient parental attitude; punishment has no role whatsoever.

“Behavioural modification with positive reinforcement may enhance treatment outcomes. The child should avoid drinking a large amount of water in the evening.

“Holding of urine to the last minute must be discouraged and careful monitoring by the parent is necessary.

“But if the above methods are not working satisfactorily, the moisture alarm system can be used, which rings when the bed is wet. If these are not effective, pharmacologic therapy can be commenced, after a thorough evaluation by the urologist,” he said.

Why adult bedwetting?

Dr. Adeola said nocturnal enuresis relies on abnormal bladder function, excess urine production during sleep, and the inability to awaken to the signals of a full bladder. It often occurs early at night and primarily during deep sleep.

Nocturnal enuresis or bedwetting can also occur in adults. It might be a symptom of bladder control problems, such as overflow incontinence or urge incontinence; bladder outlet obstruction with chronic urinary retention, such as Benign prostatic hyperplasia, cancer of the prostate, urethral stricture, etc. It can also result from medication.

“It is under-reported. The majority don’t present to the hospital, however, it has an estimated prevalence of 28.19 percent (22.37 – 34 percent) according to a meta-analysis by AbubakarAbdulKadir et al, in Bayero University, Kano.

“The prevalence of enuresis varies with the gender, with an approximate 3:2 (M: F). It is found to be more prevalent in males than in females.

“Most children with enuresis without any urological abnormality will outgrow the disorder by the time they reach their teen years, the spontaneous cure rate of 12-15 percent,” he said.

Umeh, who is also a Senior Lecturer at the Department of Psychiatry, College of Medicine, University of Lagos, said If there is a physical cause to the condition, it can be treated but if not, psychological methods could be deployed.

“One of the ways is bladder training. This is done by waking them up to urinate at night, restraining their intake of fluids at night, and regulating what they eat before they go to bed.

“If these are done consistently, the person gets conditioned to it and each time he feels pressed, he can get up to urinate. One can also use the alarm approach,” Umeh said.

PUNCH