April 16, 2009
Ask the experts
BED-WETTING AT SEVEN
Q: My seven-year-old daughter still wets her bed. She wears diapers to bed but when she does not, she always wets her bed.
Is this a problem of the bladder or a particular brain function? Can hypnosis help?
A: Most children no longer wet their beds after the age of five. Various theories have been proposed when bed-wetting persists beyond that age. The child's bladder might be too small. Or the amount of urine produced overnight is too much for the bladder to hold. Some children sleep too deeply or take longer to learn bladder control.
Constant bed-wetting by a child of school-going age often causes distress to the child and her parents. You may want to take your daughter to a doctor if she is wetting the bed more than two or three times a week. The doctor will ask questions about her health and the wetting problem and examine her to exclude rare causes of bed-wetting such as a nerve disease.
The doctor will also test her urine sample to exclude infection. If she is found to be healthy, the doctor will discuss various ways to help her, such as bladder training, medicine and using an enuresis alarm. The latter is a small battery-operated device that connects to a moisture-sensitive pad on the pyjamas; when the pad senses wetness, the alarm goes off - in time for the child wake up, stop the urine stream and go to the toilet.
It is advisable to stop her from wearing diapers. You can help her to stay dry at night by not letting her drink any fluids two hours before bedtime and by making sure that she urinates just before she goes to bed. If she feels bad about wetting the bed, let her know that she is not to be blamed. Praise her for the 'dry nights'.
There is weak evidence to support the use of hypnosis in treating bed-wetting. Further studies are needed to show the effectiveness of hypnosis in achieving dry nights.
Be patient. Most children grow out of bed-wetting. Some children just need more time than others.
Dr Perry Lau is a consultant at University Children's Medical Institute, National University Hospital
GROWING LUMP UNDER SHOULDER
Q: I am a 46-year-old female. There is a lump under my right shoulder blade that has been there for seven years. It does not cause me any pain or discomfort. However, a month ago, I felt that it had grown bigger.
I went to a GP who gave me some anti-inflammatory medicine and asked me to observe it for a month to see if there is further growth.
I cannot tell if it is growing. I would like to consult a specialist. Could you tell me what caused the lump and who I should consult?
A: What you have described is suggestive of a superficial lump arising from the skin or fat layers. Its most likely cause is an epidermal cyst (some doctors call this a sebaceous cyst).
It usually develops because of a blockage in a sebaceous (oil) gland close to the hair follicles. Keratin and lipids get trapped in this cyst which slowly enlarges over time. It appears as a soft, dome-shaped lump commonly on the trunk, neck, face or behind the ears.
Epidermal cysts are harmless but they can rupture or get infected. Antibiotics can help the inflammation subside but the cyst should eventually be removed by excision. This is a minor surgical procedure done under local anaesthesia.
Other superficial lumps, such as lipomas, can also look like what you have described. All abnormal lumps should, as a rule, be assessed by a doctor to make sure that they are not cancerous, especially if they grow rapidly in size. You should see a general surgeon to have this removed if necessary.
Dr Melvin Look is a general surgeon at Mount Elizabeth Hospital