INTRODUCTION
Enuresis has been conventional defined as the involuntary discharge of urine after the age of 3-4 years in the absence of demonstrable organic pathology. For instance, Crosby (1950; 534) defined essential enuresis as ;
"the involuntary and unconscious passing
of urine after an arbitrary age limit of
three year s in the absence of significant
congenital or acquired defect or disease of
the nervous and uro-genital system, and
in the absence of significant physiological
defects"
Michael (1955:7) defined it as:
"uncontrolled, unintentional voiding of
urine at one expulsion usually occurring
during sleep; it may be considered to
be present if bed-wetting occurs past
the age of three, a liberal time for
control of urination to have been
established in so-called normal
individuals".
Tracing the etiology of enuresis, the behaviouristic approach holds that:
I. In the new born child, the voiding reflex is an extremely powerful natural reflex and that this is essential if the infant is to survive.
II. The problem faced by the growing child is to develop the higher nervous centers by both maturation and learning, to the extent that inhibitory factors are strong enough to hold in check the natural reflex until voluntary voiding can be achieved.
III. This achievement represents a high level skill of considerable complexity and that it is not, therefore, surprising that some children have difficulty in achieving such control.
- Yates (1970:81)
Inspite of the difficulty in achieving such control, it has been observed that:
I. The incidence of bed-wetting in the general population declines almost exponentially from the first year to reach an apparent asymptote in adulthood;
II. The pattern of bed-wetting is highly variable, some children wetting the bed regularly several times a night, and others wetting only infrequently or in sporadic outbursts.
III. The age at which children are expected to become dry at night shows considerable variation between communities and between social classes within communities.
- Lovibond and Coote ( )
Enuresis is a serious social problem because of the implication which it may have on the child's adjustment to home, school and community. This study was, therefore, carried out primarily to determine the incidence of enuresis among a sample of Nigerian school girls. Specifically, the study sought to find out:
I. The proportion of Nigerian school girls who bed-wet at school age.
II. The modal age for bed-wetting among school girls in Nigerian.
III. The approximate age of continence among the sampled group; and
IV. The factors which probably induce bed-wetting among female secondary school students in Nigeria.
Sample:
To meet the above objectives, the researcher carried out a survey of an enutretic population in the Federal Government Girls' College, Benin City. The enuretic population comprised students in JSS 2 and 3 Classes. This group was chosen because the JSS 1 students had not stayed in school long enough to permit adequate observation to be made about them. The SS1 class had a mixture of new students and old students, hence any observation among this group would have been unreliable. Finally, cases of bed wetting among the SS2 and SS3 students were infrequent. Also, only students who stayed in the boarding house could be used as sample since they provided ample opportunity for the house-mistresses to observe and report on them. the total number of JSS 2 and 3 students in the boarding house therefore was 250 (two hundred and fifty).
Data Collection Procedure:
Information about the number and identity of enuretic students was supplied by the school counselor. All the students were invited to the counseling room by the counselor where the researcher gave them a brief talk on:
"Bed-wetting: A normal phenomenon of childhood and adolescence". The purpose of the above talk was to desensitize them to the researchers' presence and create the needed rapport for interview. Afterwards, the labeled students were interviewed individually for the instances and genesis of their nocturnal emission.
Results:
From the available cumulative records of the school, 10 students in JSS 2 and 11 students in JSS3 were labeled as entretic. Data concerning their age and percentage are presented in table 1(a) (b) below. Graphic presentations of the data showing modal age of enuresis and age of continence are also provided in figure I and II respectively.
Table 1(a): Table Showing Level of Incidence Within the Enuretic
Population
No. of Students in the Population
No. of Enuretic
Students
Level of Incidence of Enuresis
250
21
o.84 x 100 = 8.4%
Table 1 (b): Table Showind Mean Age and Distribution of Incedence
Level by Age Within the Enuretic Group
Age
Frequency
X
Mean
SD
Standard Deviation
Level of Incidence in %-age
11 years
12 ''
13 ''
14 ''
15 ''
2
7
8
3
1
12.71
1.007
9.52
33.33
38.09
14.29
4.76
Information collected from the students revealed that about 90% of he students were secondary enuretic. Further probe into the instances revealed that some of then only bed-wet in school and attain temporary continence at home during the holidays. Some bed-wet when they over-eat or take in too much fluid, while others bed-wet when the toilet is dirty and sticking. A few said that they bed-wet when they cannot have escort to the urinary at night. Others admitted that they find it difficult to descend from the double bunker at night to visit the urinary. One particular case reported that she wets her pants involuntarily when she sees or hears the sound of running water or slip splashing tap.
Discussion;
From the above result, it can be observed that a enuretic constitutes a serious social problem among early adolescents in Nigeria secondary schools. The 8.45 level of incidence is significantly higher than the 2-3% level of incidence observed by livibond and Coote ( ). however, the observed incidence of 11 years and the dramatic increase to 33.33% and 38.09% at the ages of 12 and 13 years suggest that majority of the subjects are secondary enuretic. It tends to support the work of Jones (1960) that primary enuresis approaches zero at the age of 10. The study also shows tat at the age of 15 many of the children approach continence.
Attempt to explain the incidence of enuresis have been made by the psychodynamic and behaviouristic school respectively. In psychodynamic view, infantile enuresis is a sexual discharge which represents a substitute and equivalent of suppressed masturbation (Jenichel, 1946) Brezin (1954) pointed out that enuresis may represent a prototypical sexual experience which acts as a determinants in masturbation and cvoiltal fantasies later in life. Robertiello (1956) agreed that enuresis represents gratification of a mastubatory wish via the urinary system. The results of this study seem to support the psychodynamic formulation that enuresis is a masturbatory wish. This can be justified if it is argued that the mastubatory wish or coital fantasties tends to rise by the age of 12-13 when the early adolescent girl is beginning to observe maturational changes in her physical features. By the age of 14 many of them are already engaged in experimental sexual relations and at 15 almost all adolescent girls have already acquired some sexual experience, thus decreasing the coital fantasy which probably stimulates enuresis. This may accounts for secondary continence at the age of 15.
Behaviouristic formulation about enuresis view it in maturational and learning perspective. In maturational perspective, as the child matures he gains greater nervous system control over the muscles of the bladder. In the learning approach, the child must acquire the skill of inducing voluntary urination when the act is required to be performed. Both maturational and learning perspective seem to account for primary continence which occurs at the age of 10. The low level of incidence (9.52%) at the age of 11 compare to the high level of incidence (33.33%) at the age of 12 suggests that this study supports previous observations that primary continence occures at age 10. Since the age of continence varies between cultures and class groups within the same culture, it may be aruged that the 9.52% of the 11 years olds represents the remnant of those enuretic childern who are probably approaching primary continence.
Summary and Conclusion:
This study surveyed the incidence of enuresis among JSS 2 and 3 students in a Federal Secondary school in Nigeria. Those who took part in the study were "Labeled" students in the halls of residence of the school. It was not possible to use Day-students as there were no adequate records on such students.
The study showed that enuresis is a serious social problem female adolescent students in Nigerian secondary schools. The high incidence of enuresis can be associated with the conflicting of values between the sexually repressive traditional society and the availability of phonographic literature to the early adolescent during her secondary school years. These conditions increases the emotional conflict between the super-ego and id, thus leading to a high incidence of enuresis in the pre-adolescent population.
Since the age at which boys reach maturation is different from the age of sexual maturation for girls, the levels of incidence may differ significantly for both sexes at the same age. A comparative study involving both sexes and using a larger population is, therefore, recommended.
Reference
Brezin, M. A. : "Enurwsis and bisexual identification" J. of American
Psychoanalytic Association, 1954, Vol.2, 509-513.
Crossby, D.; "essential enuresis: Successful treatment based on
Physiological concepts"
Fenichel, o.: The psychoanalytic theory of neurosis
London: Routlege aand Kegan paul, 1946.
Jones, H.G.: "The behavioural treatment of enuresis nocturna"
In Eysenck, H.J. (Ed.) Behaviour therapy and the neuroses:
Oxford: Pergamon, 1960, pp.377-403.
Lovibond, S.H. & Coote, M.a.; "Enuresis"
In Eysenck, H.J. (Ed.) Disorders of Behaviour, 1973, pp.373-395.
Micheals, J.; Disorders of Character
Sprinfield; C.C. Thomas, 1955.
Robertiello, R.C.: "Some Psychic interrelations between urinang and
Sexual system with special reference to enuresis.'
Psychiatric quarterly, 1956, 30, 61-62.
Yates, A.J.: Behaviour Therapy
New York: John Wiley & Sons, 1970।s
Enuresis has been conventional defined as the involuntary discharge of urine after the age of 3-4 years in the absence of demonstrable organic pathology. For instance, Crosby (1950; 534) defined essential enuresis as ;
"the involuntary and unconscious passing
of urine after an arbitrary age limit of
three year s in the absence of significant
congenital or acquired defect or disease of
the nervous and uro-genital system, and
in the absence of significant physiological
defects"
Michael (1955:7) defined it as:
"uncontrolled, unintentional voiding of
urine at one expulsion usually occurring
during sleep; it may be considered to
be present if bed-wetting occurs past
the age of three, a liberal time for
control of urination to have been
established in so-called normal
individuals".
Tracing the etiology of enuresis, the behaviouristic approach holds that:
I. In the new born child, the voiding reflex is an extremely powerful natural reflex and that this is essential if the infant is to survive.
II. The problem faced by the growing child is to develop the higher nervous centers by both maturation and learning, to the extent that inhibitory factors are strong enough to hold in check the natural reflex until voluntary voiding can be achieved.
III. This achievement represents a high level skill of considerable complexity and that it is not, therefore, surprising that some children have difficulty in achieving such control.
- Yates (1970:81)
Inspite of the difficulty in achieving such control, it has been observed that:
I. The incidence of bed-wetting in the general population declines almost exponentially from the first year to reach an apparent asymptote in adulthood;
II. The pattern of bed-wetting is highly variable, some children wetting the bed regularly several times a night, and others wetting only infrequently or in sporadic outbursts.
III. The age at which children are expected to become dry at night shows considerable variation between communities and between social classes within communities.
- Lovibond and Coote ( )
Enuresis is a serious social problem because of the implication which it may have on the child's adjustment to home, school and community. This study was, therefore, carried out primarily to determine the incidence of enuresis among a sample of Nigerian school girls. Specifically, the study sought to find out:
I. The proportion of Nigerian school girls who bed-wet at school age.
II. The modal age for bed-wetting among school girls in Nigerian.
III. The approximate age of continence among the sampled group; and
IV. The factors which probably induce bed-wetting among female secondary school students in Nigeria.
Sample:
To meet the above objectives, the researcher carried out a survey of an enutretic population in the Federal Government Girls' College, Benin City. The enuretic population comprised students in JSS 2 and 3 Classes. This group was chosen because the JSS 1 students had not stayed in school long enough to permit adequate observation to be made about them. The SS1 class had a mixture of new students and old students, hence any observation among this group would have been unreliable. Finally, cases of bed wetting among the SS2 and SS3 students were infrequent. Also, only students who stayed in the boarding house could be used as sample since they provided ample opportunity for the house-mistresses to observe and report on them. the total number of JSS 2 and 3 students in the boarding house therefore was 250 (two hundred and fifty).
Data Collection Procedure:
Information about the number and identity of enuretic students was supplied by the school counselor. All the students were invited to the counseling room by the counselor where the researcher gave them a brief talk on:
"Bed-wetting: A normal phenomenon of childhood and adolescence". The purpose of the above talk was to desensitize them to the researchers' presence and create the needed rapport for interview. Afterwards, the labeled students were interviewed individually for the instances and genesis of their nocturnal emission.
Results:
From the available cumulative records of the school, 10 students in JSS 2 and 11 students in JSS3 were labeled as entretic. Data concerning their age and percentage are presented in table 1(a) (b) below. Graphic presentations of the data showing modal age of enuresis and age of continence are also provided in figure I and II respectively.
Table 1(a): Table Showing Level of Incidence Within the Enuretic
Population
No. of Students in the Population
No. of Enuretic
Students
Level of Incidence of Enuresis
250
21
o.84 x 100 = 8.4%
Table 1 (b): Table Showind Mean Age and Distribution of Incedence
Level by Age Within the Enuretic Group
Age
Frequency
X
Mean
SD
Standard Deviation
Level of Incidence in %-age
11 years
12 ''
13 ''
14 ''
15 ''
2
7
8
3
1
12.71
1.007
9.52
33.33
38.09
14.29
4.76
Information collected from the students revealed that about 90% of he students were secondary enuretic. Further probe into the instances revealed that some of then only bed-wet in school and attain temporary continence at home during the holidays. Some bed-wet when they over-eat or take in too much fluid, while others bed-wet when the toilet is dirty and sticking. A few said that they bed-wet when they cannot have escort to the urinary at night. Others admitted that they find it difficult to descend from the double bunker at night to visit the urinary. One particular case reported that she wets her pants involuntarily when she sees or hears the sound of running water or slip splashing tap.
Discussion;
From the above result, it can be observed that a enuretic constitutes a serious social problem among early adolescents in Nigeria secondary schools. The 8.45 level of incidence is significantly higher than the 2-3% level of incidence observed by livibond and Coote ( ). however, the observed incidence of 11 years and the dramatic increase to 33.33% and 38.09% at the ages of 12 and 13 years suggest that majority of the subjects are secondary enuretic. It tends to support the work of Jones (1960) that primary enuresis approaches zero at the age of 10. The study also shows tat at the age of 15 many of the children approach continence.
Attempt to explain the incidence of enuresis have been made by the psychodynamic and behaviouristic school respectively. In psychodynamic view, infantile enuresis is a sexual discharge which represents a substitute and equivalent of suppressed masturbation (Jenichel, 1946) Brezin (1954) pointed out that enuresis may represent a prototypical sexual experience which acts as a determinants in masturbation and cvoiltal fantasies later in life. Robertiello (1956) agreed that enuresis represents gratification of a mastubatory wish via the urinary system. The results of this study seem to support the psychodynamic formulation that enuresis is a masturbatory wish. This can be justified if it is argued that the mastubatory wish or coital fantasties tends to rise by the age of 12-13 when the early adolescent girl is beginning to observe maturational changes in her physical features. By the age of 14 many of them are already engaged in experimental sexual relations and at 15 almost all adolescent girls have already acquired some sexual experience, thus decreasing the coital fantasy which probably stimulates enuresis. This may accounts for secondary continence at the age of 15.
Behaviouristic formulation about enuresis view it in maturational and learning perspective. In maturational perspective, as the child matures he gains greater nervous system control over the muscles of the bladder. In the learning approach, the child must acquire the skill of inducing voluntary urination when the act is required to be performed. Both maturational and learning perspective seem to account for primary continence which occurs at the age of 10. The low level of incidence (9.52%) at the age of 11 compare to the high level of incidence (33.33%) at the age of 12 suggests that this study supports previous observations that primary continence occures at age 10. Since the age of continence varies between cultures and class groups within the same culture, it may be aruged that the 9.52% of the 11 years olds represents the remnant of those enuretic childern who are probably approaching primary continence.
Summary and Conclusion:
This study surveyed the incidence of enuresis among JSS 2 and 3 students in a Federal Secondary school in Nigeria. Those who took part in the study were "Labeled" students in the halls of residence of the school. It was not possible to use Day-students as there were no adequate records on such students.
The study showed that enuresis is a serious social problem female adolescent students in Nigerian secondary schools. The high incidence of enuresis can be associated with the conflicting of values between the sexually repressive traditional society and the availability of phonographic literature to the early adolescent during her secondary school years. These conditions increases the emotional conflict between the super-ego and id, thus leading to a high incidence of enuresis in the pre-adolescent population.
Since the age at which boys reach maturation is different from the age of sexual maturation for girls, the levels of incidence may differ significantly for both sexes at the same age. A comparative study involving both sexes and using a larger population is, therefore, recommended.
Reference
Brezin, M. A. : "Enurwsis and bisexual identification" J. of American
Psychoanalytic Association, 1954, Vol.2, 509-513.
Crossby, D.; "essential enuresis: Successful treatment based on
Physiological concepts"
Fenichel, o.: The psychoanalytic theory of neurosis
London: Routlege aand Kegan paul, 1946.
Jones, H.G.: "The behavioural treatment of enuresis nocturna"
In Eysenck, H.J. (Ed.) Behaviour therapy and the neuroses:
Oxford: Pergamon, 1960, pp.377-403.
Lovibond, S.H. & Coote, M.a.; "Enuresis"
In Eysenck, H.J. (Ed.) Disorders of Behaviour, 1973, pp.373-395.
Micheals, J.; Disorders of Character
Sprinfield; C.C. Thomas, 1955.
Robertiello, R.C.: "Some Psychic interrelations between urinang and
Sexual system with special reference to enuresis.'
Psychiatric quarterly, 1956, 30, 61-62.
Yates, A.J.: Behaviour Therapy
New York: John Wiley & Sons, 1970।s
UTIBE .ATAHA (२००८
UNIVERSITY OF BENIN
BENIN CITY.
UNIVERSITY OF BENIN
BENIN CITY.
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