Between ignorance of the causes and social taboos, the distress of those affected

An adult who wets the bed faces all kinds of slander and sometimes mockery. In Nigerien society, deeply rooted in tradition, this is a taboo subject. Indeed, the phenomenon of wetting the bed is a known problem in children. However, for multiple reasons, it happens that this evil also affects many adults and in this case, we speak of enuresis. This handicap, however involuntary, leads people with the disease to withdraw into themselves, sometimes preventing them from consulting specialists. The causes of bedwetting in adults are multiple and vary according to beliefs.

According to Omar Abdoul Karim, a traditional healer better known by the nickname ”Docta”, this problem is due to three causes. The first cause is linked to a “ritual” that new mothers tend to neglect. According to Omar Abdoul Karim, a baby must, during the quarantine period, be well massaged with hot water. We must explain the traditional practitioner to him “burn the lower abdomen” with very hot water in order to allow his organs to be very solid and to retain urine well. “When it’s not done right, it gives you that bedwetting problem in adulthood,” Docta bluntly asserts.

The other cause would be related to the supernatural; a work of Sheytan. “The person affected by this evil tends to have dreams in which he sees himself in a toilet. It’s Sheytan who does that”, explains the traditional healer with great conviction. Finally, the third cause of the bedwetting problem in adults is, according to the traditional healer, due to an illness called in Zarma ”yeni” or ”sanhi” in Hausa. It is an infection, he argued, that affects the urinary tract.

To deal with this problem, Omar Abdoul Karim said that there are special barks that can put an end to this evil definitively. “There are special barks that we give to people who suffer from it like what is called Gounbi-bi, a plant with fine leaves that we take from the bush. It is a very effective plant and adapted to treat any ailment both natural and supernatural,” he adds. In addition to this bark, the traditional healer mentioned another, ”Gonga-Banda”. However, Docta was later to clarify that when the bedwetting problem is due to what is called ‘yeni’, it is the bark that is called ”Komni-tanda kadji” with another ”garbay-banda or garbay-kadji” which is boiled or used as an infusion to give to the person affected by the disease.

What does modern medicine say?

According to Dr. Amadou Saminou, Urologist Surgeon at the Magori Clinic, enuresis or the phenomenon of bedwetting in adults is a symptom that has nothing to do with the supernatural.

Indeed, he explained, in scientific language we speak of enuresis when it occurs after the age of 5 years. “We think that from that age, the child or the person is able to control his bladder area. If after this age, the person is unable to hold back and continues to wet the bed, we are facing a case of enuresis. Bedwetting is not a disease but a symptom. That is to say that it is the sign of a disease”, nuanced the urologist. Dr. Saminou added that bedwetting “is not a drama”. You just need to know the cause to cure it. “Certainly the treatment is long but it is effective,” said the urological surgeon with a reassuring tone.

The causes of this symptom can be, according to the urological surgeon, functional, organic or linked to a poor lifestyle or a psychological disorder. “They are functional when it comes to a manufacturing defect of the antidiuretic hormone called ADH. They are organic when it is caused by a urinary tract infection. However, it should be noted that the cause in adults, which is very important, is poor lifestyle. For example, those who drink a lot of alcohol or smoke a lot, can have bedwetting,” argued the specialist. According to Dr. Saminou, people who are alcoholic or drug addicts tend to have illusions. Sometimes they think they are in a toilet urinating when in reality this is not the case. Smoking is an aggravating factor for enuresis according to this specialist, it acts on the level of grisol, the muscle of the bladder and it causes contractions.

The last cause of enuresis in adults noted by the urological surgeon is the psychological one, in particular unfortunate events such as death, separations, trauma, etc.

A silent but pernicious evil

Dr. Amadou Saminou has, from March 2021 to today, received in consultation about 10 patients, more than 80% of whom are adult women. Patients, said the urologist, usually come for consultation under the guise of health workers. “Either someone in their neighborhood is a nurse, she or he will talk to him about it and he too comes in turn to say that he has a niece, a neighbor who has such a problem. Never, someone who suffers from enuresis comes for consultation as someone who suffers from malaria does”, confided Dr. Saminou.

It is noted that the women who come for consultations with the urologist are “desperate women” who are unable to marry because of this evil from which they silently suffer and women who are divorced or separated from their spouses because of of this problem. “During the consultations I face stressed women, we feel that it is a problem that bothers them a lot and hinders their development,” said the urologist.

However, treatment is possible and effective

For management, the urologist surgeon initially advises patients on what are called lifestyle and dietary measures. These are a certain number of behaviors to adopt which are recommended to the patient in particular: the reduction of the consumption of water or drink from 6 p.m. (good according to his habit). And if the person takes alcohol or smokes, he must stop. Then Dr. Saminou prescribes desmopressin to these patients, a molecule which plays the role of the antidiuretic hormone which concentrates the urine and allows the kidneys not to secrete urine continuously but to concentrate it to secrete only one. Small party. Added to this is the alarm system which consists of programming the alarm for every 3 hours even if the urge to urinate does not feel. According to the specialist, this treatment has been effective for all patients except one who has so far not been able to obtain satisfaction.

Note that upstream, Dr. Saminou specified that a small assessment is made to see if the patient does not suffer from a urinary tract infection. “He is also asked a number of questions about whether he drinks a lot of water in the evening and usually they answer yes. So we tell them to take only a small amount, just enough,” he added. “After these factors there we associate a treatment which is administered according to the cause”, explained the urologist.

However, says Dr. Saminou, psychological support is very important in the treatment. According to the specialist, we must try to make the patient understand that it is not the end of the world. There is always a possible solution. “It’s not a drama as such; a specialist should be consulted. Support can be long, but it is effective,” he says.

Enuresis is an illness that places affected adults in an uncomfortable situation vis-à-vis their spouses and those around them. A taboo subject, this evil affects their dignity. It can have an impact on self-esteem. Ignorance of the scientific causes of this evil exposes those affected to all kinds of rituals supposed to solve this problem. Despite advances in medicine and the healing it brings, bedwetting still remains a taboo subject in Nigerien society.

Despite being freed from this evil (healed), the resource people we contacted to testify have, still have difficulty talking about it. “It was really difficult and above all very exhausting mentally. Ultimately it traumatized me to the point where I was even afraid to sleep at night. Only my mother knew about it and she was very understanding. She comforted me. But with the treatment prescribed to me by the doctor, I can only say Alhamdulillah,” says Miss K. B, a patient who preferred to remain anonymous.

Raising awareness and providing information about the symptoms is absolutely necessary to help these people open up and free themselves from this insidious evil that eats away at them and affects their self-esteem.

Rahila Tagou (onep)

Between ignorance of the causes and social taboos, the distress of those affected