For most, there is no identifiable cause of enuresis.
Factors that may play a role are genetics; having bladder muscle spasms; deficiency of the anti-diuretic hormone; sleep problems; excessive stress; and medical conditions like urinary tract infection, diabetes, constipation, nerve problems and urinary tract abnormalities.
Dear Doctor,
I have a 13-year-old son who still wets his bed. Punishing him doesn’t seem to work. He can’t go for any overnight visits, and I don’t know how he would cope in boarding school. Please help.
Martha
Dear Martha,
Nocturnal enuresis is bed wetting that continues beyond six to seven years of age, which is the age by which children usually achieve bladder control. It may be primary enuresis, meaning that the child has never achieved bladder control from birth, or it may be secondary enuresis, which develops months or years after the child had achieved bladder control.
For most, there is no identifiable cause of enuresis. Factors that may play a role are genetics; having bladder muscle spasms; deficiency of the anti-diuretic hormone; sleep problems; excessive stress; and medical conditions like urinary tract infection, diabetes, constipation, nerve problems and urinary tract abnormalities.
Measures to manage the bedwetting include:
Limiting fluids in the evening and using the toilet just before going to sleep. Taking adequate fluids during the day can reduce thirst in the evening
Avoiding caffeine as it increases the formation of urine
Bladder training by having timed toilet visits and gradually increasing the time between the toilet visits to increase the bladder’s capacity to hold urine
Using an alarm to wake the child up once or twice during the night to go to the toilet. The timing of the alarm is adjusted to just before the child wets the bed. It may take a number of days to get the timing right to prevent bedwetting. Once the routine is established, the child can manage himself.
Positive reinforcement: bedwetting significantly affects the mental health of the child, and negative talk and punishing do not help. Any positive gains need to be celebrated in addition to building the capacity of the child to manage himself.
It is also advisable for the child to be reviewed by a doctor for diagnosis and management of any underlying illnesses. There are medications that may be prescribed to manage the bedwetting, though they are not always effective, or they may only work while they are being used.
Dear doctor,
Sometimes my neck cracks when I tilt my head. Should I be worried?
Johnson
Dear Johnson,
Cracking of a joint is called crepitus. This is the popping or grinding feeling at a joint due to formation or bursting of gas bubbles when the joint capsule moves, changing the pressure within the joint. Crepitus is normal and can be felt in any joint of the body including the neck, the fingers, the hip, the ankles and the toes. Normal crepitus happens only during some movements, not every time you move, and it takes about 20 minutes before gas bubbles can cause crepitus again.
The cracking sound can also occur due to movement and tightening of the tendons and ligaments around a joint.
Sometimes, the cracking sound can be due to damage to the joint as a result of wear and tear of the joint tissues over time, resulting in osteoarthritis. The damage may also be a result of injury. In addition to cracking, this damage may cause pain, stiffness and swelling, and the symptoms are present every time the joint is moved.
Normal joint crepitus does not require treatment as it harmless. However, in case the cracking is present every time the neck is moved, or if there are other symptoms like pain, stiffness, numbness, tingling, weakness or dizziness, then it is advisable to be seen by an orthopaedic specialist for evaluation and relevant tests, which may include x-rays and scans. Management will be specific to the underlying diagnosed problem.
Dear doctor,
I have been having recurrent dandruff for many years. It is quite embarrassing, especially when I am wearing a black top. What causes it and how do I get rid of it once and for all?
Mercy
Dear Mercy,
Dandruff refers to the itchy flaking of skin on the scalp. It is a mild form of seborrheic dermatitis, which is an inflammatory skin condition that causes scaling on oily areas like the face and the scalp. With dandruff, the inflammation is very mild and the scaling of the skin is limited to the scalp.
Different factors that affect developing dandruff include sebum secretion, presence of fungus in the skin and individual factors. Other risk factors include having dry skin, inflammatory skin conditions like eczema and psoriasis; or inflammation caused by sensitivity to hair products. Dandruff is more common in males than in females and in those with weak immune systems or with some neurological diseases.
To manage dandruff, clean your hair and scalp regularly with a gentle shampoo and avoid scratching the scalp as this irritates the skin. If the gentle shampoo does not work, you can use a medicated shampoo twice or thrice a week. There are many different formulations and you can try different ones until you find one that works for you. In addition, avoid over-drying your scalp and take adequate water daily.