Bedwetting Archives

how??

Follow Ups:

• Re: how?? (Archive in enuresis.) Walt Stoll 09:03:46 9/06/00 (0)
• Re: how?? June 09:55:13 9/04/00 (0)

In Reply to: how?? posted by kim on September 04, 2000 at 00:41:10:

Kim,

I looked to Harrison's Principles of Internal Medicine and the association was not well-defined. It says that the most common complaint is pruritus ani (anal itching), most troublesome at night and is related to the migration of the gravid female worms. The worms migrate through the anal canal at night and deposite 10,000 eggs each on the perianal skin. In female patients the worm may enter the vagina. Shortly after being deposited the egg progresses from embryo to infectious larva which is released in the small intestine and migrates down the bowel lumen to the cecum. Less than a month later the newly developed fertile females again make eggs & start the process again.

The itching is related to complaints of irritability, insominia, & enuresis (involuntary discharge of the urine; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night). An association has been noted between pinworms and cystitis in young females.

Since hygeine is so important in assisting with stopping the cycle preventing reinfection is noted to be problematic in children. Hygeine, according to the book, is of dubious benefit in treating pinworms because of frequent reinfection. (Not that all family members shouldn't practice meticulous hygeine, of course!).

I'm not sure I understand how they relate the pruritis ani to the enuresis - and the only reference in that whole huge book was on the pinworms page. If that makes some sense to anyone else, please elaborate.

June

In Reply to: how?? posted by kim on September 04, 2000 at 00:41:10:

Hi, Kim.

Listen to June (Thanks, June.)

No one knows exactly why but the migration of the pinworm, from the cecum (where they stay all day) to the rectum (where they go to lay their eggs every night at about 3AM) causes sensations in the rectal area that triggers the release of the bladder sphincter. After all, it is the sensation of fullnes in the bladder that stimulates ALL of us to know that we have to urinate.

ANY persistant case of enuresis (by the age of 4yo) needs to have a competent exam for pinworms (before the enuresis becomes a psychological habit). If several exams are negative, the next thing to do is to eliminate dairy for a month and then, if there is still a problem, eliminate wheat for a month. When trying the elimination approach be sure that the substances are eliminated TOTALLY since the slightest trace will ruin the test. Within a week of elimination of the triggering substance the enuresis will stop. The only reason for the trial to be so long is to convince everyone that it is the culprit.

THEN, after a few years (When healthy urinary habits are established.) the offending substance can be reinstituted (Remembering that it had been influenciong other aspects of their health at the same time as the bladder symptoms were so annoying.) One would be advised to observe the health of the child very closely for the first month of reinstituting the offending substance.

Walt