Bed-wetting profoundly affects children
DEAR DR. DONOHUE: Our grandson soon will be 15. He still wets the bed. His parents have done everything from pills to alarms, but nothing helps. Sometimes he gets depressed, and that scares us. He says he will never be able to have a relationship with a girl. Sometimes we worry that he will hurt himself. Is there anything that can help this situation? — W.M.
ANSWER: I feel deeply for your grandson. No one can understand the isolation and hopelessness he has to grapple with. He could stand professional counseling. Perhaps a few facts will help him. Between the ages of 5 and 6, 15 percent to 20 percent of children are still wetting the bed. Of that number, every following year, 15 percent will stay dry during the night. By age 18, only 1 percent to 2 percent of these youngsters are still battling the problem. Your grandson has three years in which his chances of gaining control are good.
The problem of bed-wetting appears to stem from a brain that doesn’t respond to a full nighttime bladder by rousing the sleeper. It might be a delay in developing that response. Or it might be a delay in the attainment of a large enough bladder capacity to hold nighttime urine production. Or it might be that these children produce too little of the hormone vasopressin, which suppresses nightly urine formation.
Your grandson can once more try things he probably has already tried. He should measure carefully how much fluid he drinks in one day. Once he learns that number, he should drink 40 percent of the total in the morning, another 40 percent in the afternoon and limit fluid to 20 percent of the daily total from 5 p.m. on. He can increase his bladder’s capacity by holding off on urinating during the day. If he delays each time by five or 10 minutes for one week and then gradually lengthens the delay in following weeks, the bladder will stretch. This takes time. He has to be patient.
Alarms can work. They sound or vibrate when the first few drops of moisture touch them. It can be as long as six months of use before the training takes hold.
For occasions when he is invited to stay at other people’s homes for the night, desmopressin, as a pill or nasal spray, slows nighttime urine production.
DEAR DR. DONOHUE: My 37-year-old son has Henoch-Schonlein purpura, a vasculitis that comes from a strep infection. He has been on medication but still has pain. Please help us understand this disease. What is the prognosis? Will it happen again? — P.O.
ANSWER: Henoch-Schonlein purpura happens to adults, but it happens more often to children between the ages of 4 and 15. The body’s immune system is responsible for attacking blood vessels and inflaming them (vasculitis). Infections like a strep infection, some drugs and even insect bites have been cited as triggering the immune attack. Purpura are bruises. Here they’re raised above skin level. Abdominal pain is a frequent symptom. Arthritis is common. And kidney involvement is the most serious consequence.
Medicines that control the immune system are the ones used for serious attacks. The prognosis usually is good, especially if kidney involvement is controlled. An attack can last several months. Recurrences are common, but they are less severe than the initial attack and of shorter duration.
DEAR DR. DONOHUE: The death of Natasha Richardson has inspired me to ask you about the death of my sister 45 years ago. She drowned in a lake in the Catskill Mountains. My older sister recently told me that the day before her death, she rode a bike down a steep hill and fell off, and she was not wearing a helmet. The next day she was wobbly and not feeling well. She was found in 4 feet of water. Is it possible she had a closed head injury? Would an autopsy have found that? — J.P.
ANSWER: The actress Natasha Richardson died following a minor head injury that occurred during a skiing lesson. She waved off help after the accident, because she felt well. Three hours later, she complained of a headache, and shortly thereafter lapsed into a coma. She had a blot clot pressing on her brain.
Yes, a similar thing could have happened to your sister. An autopsy would have found the problem.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.