AS a boy, Wandile* had anxiety waking up. It wasn’t because he loved the deep rest and dreamy state of sleep and didn’t want to detach from it, but rather what he would find, wet and pungent all around him.

His urine.

“I don’t have a recollection of when it started I think it was something that just didn’t stop when I was a toddler, when it was meant to”, the now 30-year-old artist said.

Wandile (surname withheld), who lives in Cape Town, says: “Apart from the physical discomfort of it, there was an element of anxiety waking up and how people around me would react. While my parents never scolded me for it, you could tell it was an inconvenience.”

Bed-wetting or enuresis (the medical term) is characterised by complete bladder emptying during sleep, without any symptoms of bladder dysfunction, and affects children aged 5 and older.

Dr Margaret Fockema from the Pelvic and Urotherapy Institute at Sunninghill Hospital said that overall the prevalence of bed-wetting in South Africa was 16% and in boys the prevalence was double than that in girls.

“Enuresis is often seen as a psychological problem. Many authors have reported that it is the most common childhood problem. It is perceived that enuresis is rarely discussed at home and treatment is not sought.

"Children are told they are naughty and wetting on purpose. This is incorrect, and they are punished unfairly,” Fockema said.

According to Fockema there are three causes: an overactive bladder, causing the bladder to empty spontaneously during sleep; a lack of vasopressin (an anti-diuretic hormone or ADH), causing an overproduction of urine at night; and a lack of arousal from sleep.

In terms of how it it was caused by an over-active bladder, Fockema explained that normally when the bladder was full, the brain activated it and the bladder emptied. With an overactive bladder, the bladder contracted during the filling phase, causing it to empty spontaneously. When this occurred during sleep, the child emptied his bladder unconsciously.

“During sleep the brain excretes ADH. We make a quarter of our total amount of urine in 24 hours during sleep, and the other three-quarters during the day. If a child lacks ADH they don’t concentrate their urine at night and they produce more urine than the bladder can hold, so they wet themselves.”

Now a confident professional, Wandile remembers the psychological impact bed-wetting had on his primary-school aged self. He said it made him feel “out of place”.

"I would withdraw into my own little world, I was always by myself drawing”, he said.

Fockema said bed-wetting resulted in low self-esteem, psychological problems and poor performance at school.

“Epidemiological studies have shown that a third of children with bed-wetting manifest behavioural disorders and these disorders cause poor school performance

"Whereas it was previously thought that bed-wetting was caused by psychological problems, it is now widely believed that bed-wetting causes psychological problems.”

When children are treated for bed-wetting, there is an improvement in self-esteem and other psychological factors.

Wandile doesn’t remember when or how his bed-wetting stopped, but it did before he reached his teens. And he believes that because it was something he was so anxious not to do, and thus was always on his mind, it persisted longer.

“Emotional or psychological problems are infrequently the cause of bed-wetting, but may be the result of the parental response to bed-wetting, leading to shame, guilt and avoidance of peer contact.

"Children with primary bed-wetting are psychologically normal and psychological treatment is ineffective in treating it,” said Fockema.

Contrary to popular belief, Fockema said waking children to go to the toilet at night had no curative effect.

Rather, she advised parents to avoid giving children) large amounts of fluids before bed, or the following, especially after lunch:

Carbonated beverages.

Caffeine drinks such as coffee, tea, dark sodas, some darker herb teas (including decaffeinated versions), chocolate, many cough medications and other over-the-counter medications.

Fruit (high acid) and fruit juices: orange, grapefruit, lemon, lime, mango, pineapple and vitamin C supplements.

Tomato-based foods: tomato juice, spaghetti sauce, barbecue sauce.

Spicy foods.

Dairy products: milk, cheese, cottage cheese, yoghurt, ice cream

Sugar: corn sweeteners, honey, fructose, sucrose, lactose.