Nevis Island Health Kick Program Series

Charlestown, Nevis
April 02, 2008

Another in the series of Health Kick Initiatives on Nevis was recently held at the Alexandra Hospital. Dr. Dwayne Thwaites said the programmes were successful and for the final leg of the tour, he invited Dr. Joseph Ortenberg to Nevis, to conduct a Screening Clinic for children.
Dr. Ortenberg, an expert Pediatric Urologist by profession, deals with the disease process of Hydroceles and Hypospadias. He explained Hydroceles as fluids around the testicles and Hypospadias was a condition with an opening at the head of the testicles and all the way down to the penis scrotal junction.
He is also an expert in the repairs of hernias and deals with children struggling with a condition, termed “Enuresis,” commonly known as Bed-wetting.
The Urologist said Enuresis was a common medical problem that started among 10 -15 percent of children of Kindergarten age, which sometimes cause them to develop social problems.

“If the child was bullied at school or if the child had a bad interaction, then there may be stress and they may likely wet the bed. Yes, there are psychological overlays but the underlying problems were attributed to three medical factors”.
The underlying factors he referred to were, “deep sleeping, overactive bladder symptoms and hormone related problems.  He further elaborated on the three underlying medical factors.
“Some children are deep sleepers. Their parents revealed that they would go to their child’s bedroom during the night and turn on the light or a radio and the child would not wake up and of course, they don’t wake up when they wet the bed. The child would have a more active bladder or normal bladder during the day that they control but during the night the child’s overactive bladder becomes uncontrollable, which would cause the child to wet the bed,” he said.
According to Dr. Ortenberg, the third type was related to a hormone that regulated urine production, when produced in the brain that acted on the kidneys. He added that when a child sleeps at nights and the hormone was not produced, the condition caused the child to make too much urine and wet the bed.
He said a more serious situation of Enuresis would be determined by a few visible signs in the urine. The visible signs mentioned were urinary tract infection, blood in the urine and uncontrollable wetting throughout the day and night.
He also added that if children only wet their bed at nights, it was indicative of some degree of developmental slowness, which children would outgrow overtime without any treatment. The Urologist pointed out that if bed wetting became a social problem for children, there were a variety of treatments for them. He indicated a few advices that he would give to parents with children struggling with Enuresis.
“Depending on the situation, we may advice the use of medication, we may advice for the child to urinate more often or we may advice for the child to use a bed wetting alarm device. I do want to stress that bed wetting wasn’t something that is under the child’s voluntary control. Sometimes parents would say the child was lazy or that the child had wet the bed to be stubborn and it was an involuntary response,” he said.
He said some parents used discipline which made children more nervous and anxious. Dr. Ortenberg encouraged a more positive reinforcement approach to the situation. He further indicated that the children’s cooperation with some of the measures that he recommended would give them control of their body and not wet the bed.
“We encourage children to do what we call positive reinforcement, which means that parents would give their child a very small reward each night that they are dry and gradually they build up the number of night that child would be dry to get the reward, not necessarily a big reward after a month of dryness but just one night at a time, which would help the child to see the next step to be dry and be rewarded,” he said.
Dr Ortenberg said Enuresis was common among children diagnosed with Attention Deficit Disorder (ADD) but Enuresis was more prevalent among boys than their female counterparts.
Dr. Ortenberg did most of his Medical training in Toronto, Canada and later practiced Medicine in the United States of America (US) at the Cleveland Clinic in Ohio. He is currently Chief of Pediatric Urology for the Louisiana State University (LSU) Hospital.

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