Why are two of my older children wetting the bed?

One of our directors, Leslie Miller, sat down with the mother of two children who completed treatment with us.  While she is happy her children are free from the burden of bedwetting, she remains frustrated that bedwetting is still misunderstood by doctors, and that there is so much misinformation on the internet that leads parents astray.  She is speaking out because she wants this to change, and we couldn’t agree more! (We are referring to this woman as “Mom” for purposes of this article).

Mom – When I told my pediatrician that my second child was wetting the bed–my daughter–it was the same response as when I sought advice for my son who wet the bed. I already knew I was going to enter her in your bedwetting treatment because it worked for my son, but I was just curious to see what he would say. He basically said not to worry, she would outgrow it. He never asked about how my son was doing with his bedwetting.

Parents need them to know about your clinic because you only work with bedwetting. And since the bedwetting is not the real issue, this can be very confusing. When I was so frustrated with the lack of direction from the pediatrician for my son, I decided to research the heck out of bedwetting! Your website came right up for me, and I read everything. The sleep part and the other symptoms, it described my son – and now my daughter. Pediatricians don’t know about you. They need to know about you.

Leslie – Some know about us, yet there are roughly 85,000 pediatricians in the United States, and we haven’t been able to reach them all….to educate them.  We have found over the past 44 years that pediatricians tell you not to worry and wait until your child outgrows bed wetting. This is the first and foremost suggestion.  The next step for a pediatrician is to rule out a physical cause, which leads to a referral to a urologist. Less than 1% of bedwetting is caused by a physical problem. There is nothing physical or psychological in origin about bedwetting.  Even if someone fell into the 1%, there wouldn’t be anything a urologist could recommend to remedy the problem. Fortunately, there are specialists who are in the know, and we have received referrals from physicians, psychiatrists, psychologists, and social workers.

Mom – They don’t know about you here in Texas. They should know. They should know it is a sleep problem. They think there is something wrong internally with the person. Like my son was six – bedwetting. Seven – bedwetting.  And then by age eight, the doctor said we will try something to stop the wet bed. I mean he’s 8 now. Living 8 years with bedwetting. And now he said we will give him pills and try to stop bedwetting. Then I researched the hell out of the pills, and you know what, they dry up the urine and dehydrate the body,  and have a ton of side effects.

Leslie – Was the medication called DDAVP? It actually slows down kidney function and may limit urine production temporarily.  It does not cure bedwetting. Thousands of parents have called us and reported trying DDAVP*.

If it worked for someone at all, they have seen the bedwetting return when they stop dosing. Or it doesn’t work to begin with even at the highest dosage.  The worst thing we hear is that a doctor assured someone their child can attend a sleepover and not worry about them wetting their sleeping bag because the drug will prevent it…and then the child actually does wet.  It’s disheartening, unfortunate, and unnecessary. The pediatrician is not looking at the root cause, they are looking at treating the symptom of bedwetting, and we all know that’s not an effective means to permanently change anything.

Mom – Exactly. They are really not a bedwetting specialists, are they. They are not paying attention to the impact the bedwetting is having on someone. It was having an impact on my boy. His sleep was terrible. He was difficult to get up in the morning–cranky and tired. That tiredness carried through his school day.  He was always worn out from using up his energy during school. Then he had a great deal of homework. We had to constantly keep him on track to finish his homework. And then this poor kid wakes up wet, does not know why, feels terrible, and we couldn’t bring much comfort to him. It was exhausting for the entire family. I know he was embarrassed and frustrated. He was refusing offers for sleepovers. I asked him what worried him the most and he said that he would be bullied for life. His friends would turn against him, and he would be alone. It broke my heart.

Honestly, I find it hard to recommend you to people. No one talks about it openly. When you gather around with friends, you don’t bring up “oh yeah, my ten-year-old still wets the bed”.  I mean really, nobody talks about it because it’s embarrassing. I want to talk about you and the success my son had because I know there are people who need your help. Out of all of this, I think the most important thing people need to know is how crappy the sleep is. It’s hard for them to put two and two together based on the misinformation you come across online.  For my son now, the fact that he is getting ridiculously good sleep impacted his life right away…in every way. Once you understand, bedwetting is really the secondary issue. I just don’t know how to phrase it in a way that will help others without embarrassing my son and my daughter.

Leslie – What do you think is the real concern here?

Mom – It’s like taboo. Nowadays people who are gay are coming out, but bedwetting is such a shame…still that it has to stay a secret. It is a stigma and sad. I was not about to have my son wet year after year and suddenly he is a teenager and wetting the bed.  I read about how teen bedwetting is on the rise because parents wait and wait. They aren’t to be blamed. They’ve just been brainwashed that that’s what there is to do. To wait. I found also that some people believe that the person who wets the bed has a problem…like they are doing it on purpose. I have heard people say bedwetters are babies, refuse to grow up, or have mental problems. Can you believe in 2018 that anyone would think that?  It’s truly unbelievable that few people know it’s a sleep problem – truly a sleep problem. Crappy sleep. How can someone do their best if they are not getting good sleep night after night on top of feeling terrible and tired, and for my daughter, feeling sad and as though something is really wrong with her, especially wearing pull-ups at age six. If everyone would just go to your website, it would become crystal clear.

Parents need to Google for an expert. You will show up and tell them everything. Everyone thinks you go straight to the pediatrician for this problem. Western society is like that.  They don’t give you a clear-cut plan or pay attention to everything that is going on with the sleep. They really don’t know, and they won’t admit they don’t know. I guess they also don’t have time.  You need to train the pediatrician about the cause, not just the symptom of a wet bed. I think underneath it all, they are interested in treating the source for their patients, but if they can’t get to it, they go with helping someone live with the symptoms of their illness or challenge, and that is truly unfortunate.  I think you need to go right to the medical schools and tell them what you know.

Leslie – What an insightful idea. Thank you so much.  And thank you for your time today. We appreciate you, and it’s been a delight to work with you and your children.

* https://www.kidney.org/patients/bw/BWmeds

* Desmopressin Acetate (DDAVP)

  • DDAVP is a drug to treat children with bed-wetting. Although DDAVP does not cure the condition, it does help treat the symptoms while the child is on the drug. Numerous studies report reduction in the number of wet nights.
  • DDAVP is a man-made copy of a normal body chemical that controls urine production. The therapeutic benefit of DDAVP might be due to a reduction in the overnight production of urine or possibly to an effect on arousal.
  • Many studies have attempted to identify those childrens most likely to respond to DDAVP. Older children are more responsive. Children with a normal bladder capacity are more likely to respond than those with a small bladder size.
  • The drug can be taken as a nasal spray or tablet. However, the tablet has several advantages. If your child has no problems swallowing pills, the tablet is more discreet for sleepovers and other special occasions. Additionally, the tablet has reported a better response rate. The nasal spray can be affected by a stuffy nose from colds or allergy. DDAVP should be given at bedtime. Because it works right away, it does not need to be given everyday to be effective.
  • DDAVP has few side effects. The most common side effects with the nasal spray are nasal discomfort, nosebleeds, tummy pain, and headache. The only serious side effect noted in children treated with DDAVP is seizure due to water intoxication. This serious problem is preventable with care not to overdo fluids on any evening that DDAVP is taken. Children should take only one eight once cup of fluid at supper, no more than 8 ounces between supper and bedtime, and nothing to drink in the two hours before bedtime. Early symptoms of water intoxication include headache, nausea, and vomiting. If these symptoms occur, the medication should be stopped and the child should be seen by a doctor immediately. Caution should be used in children with attention deficit hyperactivity disorder since they are often impulsive. These children might require especially close monitoring of their fluid intake.

Case Study of 11-Year-Old Twins Who Wet the Bed

Patricia, 42, a mom of twins we’ll call Adam and Aaron, reached out to our Bedwetting Clinic as a referral from her pediatrician’s nurse practitioner.  This practitioner had seen many youngsters come into their office whose parents were trying desperately to stop bedwetting only to have to tell them there was nothing they could do except wait and hope it stops.  The alternative was a drug with substantial side effects, and which could only provide temporary relief from the wetting—if that.   The medical profession feels that bedwetting is caused by a physical problem.  The nurse practitioner revealed to Patricia that it’s been seen as a physical issue in less than 1% of all reported bedwetting cases.

Patricia remembers being a devastated 13-year-old who wet the bed, and she didn’t want her twins to reach their teen years still wetting the bed, especially since there was no guarantee they would. She continued having vivid memories of shame.  She remembers being subjected to all sorts of invasive tests and had to wear disposable diapers in middle school.  She refused to go to sleepovers for fear of discovery.  She said it was a “dark family secret” that she did not share with her husband…that is until the twins continued to wet the bed beyond potty training. She did not want her twin boys to miss out on the social development opportunities like sleepovers and making important childhood connections.  An added worry in her mind is that one twin might stop wetting before the other, and she didn’t even want to imagine the potential psychological impact of that experience.

Fortunately for Patricia and her boys, the practitioner started to see some of her patients returning to them dry at their annual wellness visits.  This is how she came to discover Enuresis Treatment Center’s specialized programs that provide a proven bedwetting solution.

Our Initial Assessment:

Our initial assessment is a purposeful inquiry designed to understand a child’s circumstances, patterns, behaviors, and challenges prior to them stating the program.  This is essential to being able to develop a specialized protocol for each patient to meet their particular needs.  The information and insights we obtain are also essential to be able to tell parents what to expect as it relates to their child’s particular protocol.

The twins were delivered six weeks premature.  They were healthy and showed no medical issues, yet they remained in the hospital for seven days.

Patricia wondered if premature birth might have been the cause of their very heavy sleep as well as the wetting the bed.

At their first encounter with the nurse practitioner, it was when the boys were seven and a half years of age.  The nurse suggested they wait until they were eight to see if the bedwetting resolved on its own.  Six months later, they were back in the office.  The next step was a prescription for Desmopressin, otherwise known as DDAVP.  Aaron was also prescribed Zoloft for symptoms of anxiety with which he presented.  As it turns out, the boys took the DDAVP for four years with only sporadic results.  They would have only one or two nights a week when they would be dry, even though they were both at the highest dosage allowable.  What the medical profession is calling “bedwetting medication” is actually intended to slow down kidney function and limit urine production.  Essentially it is creating a condition of dehydration.  When Patricia decided to stop the intake of medication, the bedwetting ramped up to every night of the week.

In addition to the medication, Patricia was told to restrict fluids before dinner.  It was recommended that an ultrasound be done of the kidneys and bladder.  They explored the idea of enemas for constipation, which is sometimes believed to cause bedwetting.  Yet the boys did not present with constipation symptoms.  All methods were expectedly unsuccessful to end bedwetting

As for the twins’ father, he was diagnosed with severe sleep apnea two years ago, and currently wears a c-pap device, also known as continuous positive airway pressure therapy to help regulate breathing.  Since we learned that the father was a former bedwetter, sleep apnea is not an uncommon diagnosis stemming from the sleep disorder that both of the boys have.  Bedwetting is one symptom of the disorder, and apnea is another.  It’s the result of an inherited gene.  The father’s brother also wet into his teens.  Another brother was a sleepwalker as well as their father.  This is another common symptom inside the sleep disorder, which can also include night terrors, teeth grinding, and heavy snoring.

Side note:  Bedwetting (enuresis) is treatable.  The other symptoms are not.  The only possibility somebody has in living with apnea, for example, is to manage these symptoms as best as they can.  For the father, it’s wearing the c-pap device.  Since the bedwetting symptom was “outgrown” by their mother, father and father’s brother, the detriment it poses is that these other untreatable conditions can effect their quality of life, and if the boys’ sleep pattern is not changed, they stand the possibility of experiencing future untreatable symptoms like apnea.  Almost three times as many males wet the bed than females.  Three times as many males as females have sleep apnea.

Adam: 

Adam, born three minutes before his identical twin brother, was daytime potty trained at age 2.5.  He is slightly below average weight for his height and age and has no medical diagnoses, nor is he currently taking any prescription medication. He has a good intake of fluids, very athletic, and plays two school sports.  He sometimes talks in his sleep.  Adam experiences multiple wets every night.  It was determined that he wets the bed approximately three hours after bedtime, and again closer to morning.  He wears underwear with pads to bed.  He will wet through a pullup and does not wake up, even when Patricia attempts to change the pullup.  Adam has zero recall in the morning and would argue with her stating nothing happened in the night.

Adam has daytime symptoms of urgencies and dribbling during the day.  The daytime dribbling has increasingly become an issue at school.  A change of clothing needs to be in his school locker, and a few students have mentioned the smell of urine.   We have found that if a child is discovered by his peers to have accidents or even come to know that they wet the bed, bullying can become a real problem.  There is also a real concern about challenges arising relating to one’s self esteem.  A child can feel traumatized, withdrawn, and even depressed.  At this time, Adam is not presenting with those symptoms, although he is extremely sensitive to his condition.  He also feels very tired during his waking hours.

Aaron:

Aaron has a stockier build, no medical abnormalities, a low intake of fluids, and an average level of activity.  He sweats and thrashes while sleeping.  He presented with a sporadic wetting pattern.  Patricia was unable to pinpoint a time frame as to when the bedwetting might be taking place.  It is likely he has an underdeveloped bladder because he has to use the bathroom quite often during the day.  He also experiences lethargy during the day.

Aaron suffers from anxiety.  He was diagnosed with Acute Anxiety/Mild Depression, and he was put on small dosage of Zoloft.  (.05)   Patricia reported that he is also “easily triggered” by things people say or do.  His teachers say he is beginning to have trouble focusing on tasks that she gives to him.

Patricia reported that both boys have a “horrendous” time waking up in the morning.  It’s “impossible” to awaken them at night, and clearly very difficult to awaken them in the morning.

This private assessment was conducted via a Skype call since the family resides on the west coast, and was unable to visit the clinic for the clinical assessment. It was explained that even though they were not able to come in, the treatment is no less effective than if they were to see us in person.

Given the important preliminary information provided by the parents in their assessment, it was clear that needed to develop different protocols for each boy, even though they are the same age and have similar genetic presentations given their twin status.

Our Bedwetting Programs:

Dr. Roger Broughton, a neurologist and foremost sleep researcher from McGill University in Montreal, is an expert upon whose findings led to the development of our successful and specialized programs.  He conducted an extensive and long-term sleep study of people who wet the bed which was entitled “Sleep Disorders: Disorders of Arousal? Enuresis, Somnambulism, and Nightmares Occur in Confusional States of Arousal, not in ‘Dreaming Sleep’.”

The result of this seminal study shows the differences in healthy, normal sleep patterns and those of someone who wets the bed.  In normal, cyclical sleep, individuals fall slowly from Stage 1 (lightest sleep) into Stage 4 (deepest sleep), and then back to lighter stages where it’s easy to awaken.  A full cycle takes approximately 90 to 100 minutes to achieve.  An individual who wets the bed–which can include a child, teenager or an adult–falls quickly into deep sleep and stays there for longer periods.  This is the problem.  The brain is not supposed to stall in Stage Four.  Rhythmic cycling doesn’t take place consistently throughout the night, and the bedwetting occurs as a result.

The study’s findings concluded that all individuals who wet the bed share a particular type of sleep: A very deep and heavy sleep.  Our bedwetting center has decades of clinical and anecdotal experience which proves that the only effective treatment and cure for bedwetting is to change the heavy and unhealthy pattern of sleep, and that’s what we do.  Chronic bedwetting is the symptom caused by the inherited sleep disorder.  According to Dr. Broughton, this same sleep disorder causes sleep apnea, excessive snoring, sleepwalking, night terrors, insomnia, and bruxism.

This type of deep, heavy sleep produces a poor-quality sleep rather than a high-quality sleep.  This is essentially a sleep-deprived event and can result in:

  • Irritability
  • Cognitive impairment
  • Memory lapses or loss
  • Impaired moral judgement
  • Severe yawning

–    Symptoms similar to ADHD

  • Impaired immune system
  • Increased heart rate variability
  • Risk of heart disease
  • Decreased reaction time and accuracy
  • Tremors
  • Aches
  • Risk of diabetes Type 2
  • Growth suppression
  • Risk of obesity
  • Decreased temperature

In the past 44 years that we have been ending bedwetting for children, teens, and adults, there is validation that a new pattern of sleep is needed regardless of the age of the individual, their circumstances, their diet or fluid consumption, and regardless of any physical or psychological condition. Creating a new pattern of sleep will not only eliminate bedwetting, it also prevents the possibility that any of the untreatable conditions—especially the life-threatening condition of sleep apnea–will arise.

As of this writing, both boys are progressing wonderfully as expected.  Their counselor laid out the proper protocol plan of action for each boy, and walked the parents through the process step by step.  As a result, a comparison is becoming available between “good sleep and bad sleep”, (before treatment and after treatment), and it’s now clearly seen that the good sleep (new sleep pattern) is positively effecting mood, energy levels, their ability to focus, and Aaron no longer needing Zoloft.  His symptoms of depression lifted once his brain was able to get what it needed through healthy sleeping.

Mornings are much easier during the awakening progress, and each boy is down to wetting an average of once every two weeks.  Both outcomes indicate that the sleep pattern has changed drastically, and the treatment is nearing completion.  They will be entering an observation phase wherein we can be certain that the new sleep pattern has taken root and the bedwetting has been permanently resolved.  Because of our bladder and pelvic floor muscle exercises, daytime issues have been resolved for the boys.  With everything in place, soon they will successfully graduate from our care.

Author:  Michael Stallsmith, M.A., Sp.A.

The Enuresis Treatment Center’s Director of Treatment is also a school psychologist.  Michael has been involved in successfully treating over 20,000 children, teens, and adults who wet the bed.  He is responsible for overseeing the counselors on our staff who work directly with the patients, and he is effective at implementing what’s needed for any challenging situations that may arise during treatment.

Michael continues his outreach with the medical community and school systems educating them about bedwetting and its relationship to the non-arousable sleep disorder.  Michael has been on staff at the Enuresis Treatment Center since 1982.

Bedwetting Help – 16-Year-Old Can Now Focus on College

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It is now July 2018 and he is 16 years old and dry at night! Finally, bedwetting help for my teenager.

This summer was the first time ever he was at camp and was dry the entire time.  We also had a vacation with success and did not have to pack all the extras that were needed in the past to protect mattresses from my teenager wetting the bed.

Thanks to your complete understanding of the underlying cause of the bedwetting – deep, deep, sound sleep, and how to “fix it”,  our son now wakes up during thunderstorms and gets up during the night to use the bathroom.  He loves being dry at night and it has taken a big weight off of his mind when he travels and has overnights with friends.

College was also in the back of his mind and now he can look forward to that without the fear of wetting the bed and trying to manage all that goes with it in a dormitory setting.

The staff are very helpful in managing  his program through phone calls and emails.  It’s not necessary to be there in person to be successful. They were responsive to any questions we had and were supportive the entire process.

We can’t thank them enough for their program and are thrilled with the results!  Theresa was an excellent bedwetting counselor! It really helps to have one person working with you, her focus was on my son’s progress. We would recommend the program and wished we hadn’t waited so long to find this remarkable solution.

A thankful family in Texas   2018

bedwetting information

What Can I Do About My Child’s Bedwetting

Dr. Wendy Glaberson’s April 10th, 2018 article in the Miami Herald, “What Can I Do About My Child’s Bedwetting?” is well intended, however, it is filled with myths that we at the Enuresis Treatment Center have seen all too often.

To be brief, here are Dr. Glaberson’s errors and our responses to them.

  1.  Enuresis most common cause is constipation leading to “dysfunctional elimination syndrome” that causes bedwetting.

ANSWER: Enuresis Treatment Center has successfully treated thousands of bedwetters throughout our forty three years of work.  A very small percentage        of our patients, regardless of their age, from five to fifty, also report constipation.  Our treatments 97% success rate is directed toward ending the underlying deep sleep/arousal disorder that is at the heart of the problem.  Patients suffering from constipation either remain so after the bedwetting is ended or no loner suffer from the problem due to the “fluid challenge” impact of our treatment program.

Our 43 years of treatment of enuresis has shown us that constipation and enuresis are not clinically related.  Constipation does not cause bedwetting.

  1.  ADHD or anxiety are causes of enuresis.

ANSWER:  Many of our patients present with one or both of the difficulties.  However, we have found that hyperactivity symptoms disappear when the underlying unhealthy deep sleep is treated, resulting in a return to more healthy sleep.

Also, many of our patients, regardless of their ages, experience anxiety which does not cause the bedwetting, but instead is the psychological result of the many stresses that the bedwetting produces – fear of discovery, feeling of failure, low self-esteem.

  1.  Enuresis can happen in the daytime.

ANSWER: Enuresis, i.e. bedwetting occurs only at night.  It is the involuntary release of urine during sleep.  Children who cannot control their bladder while awake are experiencing daytime accidents usually resulting from the bladder sphincter muscle’s weakness due to its frequent opening during sleep.  The bladder sphincter cannot remain closed during the day because it has not been kept closed automatically during the night.  Those bladders do not develop the strength to remain closed during the day when the urge to urinate first arrives.  Daytime accidents result.  They are a major source of anxiety that results from bedwetting, not the cause of it.

  1. Enuresis is caused by making large amounts urine overnight and having a bladder that does not relax properly to fill and store urine.

ANSWER:  Someone who wets the bed almost always has a very small bladder.  A small amount of urine can trigger the sphincter to open since the enuretics’s deep sleep cannot be aroused enough for the brain to send the “stay closed” signal to the sphincter.

As a result, the bladder does not grow or cannot hold the “large volume of urine” that Dr. Bladerson reports. Someone who wets the bed does not produce any more or less urine than non-bedwetters.  The difference between them is the brain-bladder connection with the deep sleep.

  1.  Dr. Glaberson recommends: 1) regular bladder emptying during the day and before bedtime, 2) use of laxatives to aggressively treat the underlying constipation, 3) behavioral therapy and positive reinforcement as methods to treat bedwetting.

ANSWER:  Regular bladder emptying can make the bed wetting problem worse.  Emptying bladders lead to the bladder’s failure to grow and retain urine.  The bedwetting process is accelerated by the proposed method and daytime accidents are much more likely to happen.

We have found that only by treating the underlying deep sleep/arousal disorder, regardless of constipation, if it presents at all, can bedwetting be permanently ended.

Behavioral therapy and positive reinforcement only works with difficulties that can be brought under the patients control.  Bedwetting does not respond to such treatments because it occurs when the bedwetter is not awake. It is involuntary.

Dr. Glaberson is correct when she opines that medication used to treat bedwetting “does not cure the problem but helps control the symptoms”.  Ending the medication often leads to a return of the bedwetting.  Should the medication be used lifelong?

  1. Dr. Glaberson recommends the use of pullups inside of a sleeping bag for enuretic children who attend sleepovers.

ANSWER:  While this method can work in the short term, it does very little to decrease the possibility of discovery and the shame it can bring.  The “logistics” of the recommended method are daunting.

Dr. Glaberson’s article remains a repository of the myths and misconceptions that the medical field unknowingly promotes.  Physicians can be wrong. Her article supports this opinion.

Author – Dr. Lyle Danuloff, Staff Psychologist, Enuresis Treatment Center

Dr. Glaberson’s article

What can I do about my child’s bedwetting?

BY WENDY GLABERSON, M.D.

April 10, 2018 04:06 PM

Enuresis, also known as “urinary incontinence” or “bedwetting,” can be extremely distressing for both parents and children. It can lead to lower self-esteem in children, frustration among caregivers, and disruptions in sleep for both.

Enuresis is a common problem in the United States with approximately 5 million children affected, with boys experiencing it three times more often than girls do. Enuresis can run in families — often times a parent will come to the office and say that he or she also “wet the bed” when younger. In most children, it will resolve by the age of 6 years. When it persists much past that age, particularly when a child begins sleeping outside the home, at sleepovers, is typically when it becomes most distressing.

There are some known risk factors for enuresis. One of the most common ones is dysfunctional elimination syndrome. This syndrome represents a collection of abnormal urinary patterns associated with constipation. For example, it can mean your child is holding his or her urine for too long and overstretching the bladder, or having difficulty relaxing the bladder outlet during urination, straining the muscle. Other risk factors for enuresis are breathing problems such as sleep apnea, or neuropsychiatric disorders such as attention-deficit hyperactivity disorder (ADHD) or anxiety. Constipation and sleep apnea should be treated by your child’s pediatrician or another specialist. Children with ADHD should be reminded to empty their bladders every few hours.

Enuresis can happen during the daytime, but it is more common overnight. There are two forms of enuresis, primary and secondary. Primary enuresis is more common and means that your child has never been completely dry. It can be caused by making large volumes of urine overnight, having a bladder that does not relax properly to fill and store urine, and lower than normal levels of a hormone which causes water retention by the kidney. With secondary enuresis, your child was previously dry for a period of at least six months and is now experiencing symptoms. Causes include bladder infections, things that cause large volumes of urine such as diabetes, and emotional stress or trauma in a child’s life such as a family divorce, bullying at school or the loss of a beloved pet.

If your child is experiencing enuresis, see your pediatrician first. He or she can likely make the diagnosis with a simple history and physical examination. In addition, your pediatrician may want to screen your child’s urine for infection or excess glucose. Imaging studies are rarely needed to make the diagnosis.

Most parents recognize enuresis but don’t know what to do to treat it. Parents should understand the natural history of the problem — that it’s developmentally appropriate in young children, and that most children will “grow out of it.” If enuresis is a stressful problem in your household, here are some of the available treatments to discuss with your pediatrician:

  • Minimize the amount of fluids your child drinks after dinnertime.
  • Encourage your child to empty the bladder regularly during the day and before bedtime.
  • Treat constipation aggressively with laxatives such as polyethylene glycol. Stool should be soft like a banana and come every one to two days.
  • Some families find success using a bedwetting alarm: a device which is placed in the child’s bed and will activate if it becomes wet. This type of device is used every night and improves arousal from overnight bladder filling and storage of urine, through repeated conditioning.
  • There are also formal programs developed by pediatric psychologists that use behavioral therapy and positive reinforcement —often in conjunction with bedwetting alarms. These programs are more successful when implemented consistently.
  • If your child is over the age of 6, your pediatrician may refer you to a specialist with advanced knowledge in medications to treat incontinence such as a nephrologist or urologist. These specialists can prescribe medications which are taken every night to help keep your child dry. These medications do not cure the problem, but they help control the symptoms. One type of medicine called desmopressin leads to decreased urine in the bladder, another type called imipramine causes the bladder to retain urine overnight, and still another called oxybutynin relaxes the bladder muscles allowing it to fill more normally and empty completely with regular voiding. These medicines are often successful.

What can you do for your older child in the short term who wants to stay at a friend’s house without suffering embarrassment? One suggestion is to send your child with a pull up inside of his or her sleeping bag. This technique offers a little more housework for a parent, but allows your child not to miss out on fun with friends. Finally, a closing note — if your child or your family dynamic is suffering from incontinence, we can offer hope — 99 percent of cases spontaneously resolve without the use of medications.

Dr. Wendy Glaberson is a pediatric nephrology fellow at the University Of Miami Miller School Of Medicine. For more information or to find a doctor, contact the UHealth Pediatric Nephrology department at 305-585-6726. 

Read more here: http://www.miamiherald.com/living/health-fitness/article208490119.html#storylink=cpy

 

Bedwetting Option

Bedwetting – A Good Problem

Why Is Bedwetting A Good Problem To Have?

I have been searching for answers to my son’s bedwetting for seven years.  Yes—seven years!  He is a freshman in high school and would be horrified if he knew I was writing about his “dark secret”, the one that almost strangled the life out of his self-esteem.

Once I understood what was really happening to cause the bedwetting, it completely changed my perspective, as well as my commitment to finding the best treatment for my son.  My background is in process management and root cause analysis.  I wonder why it took me so long to apply this knowledge to my research for my son’s enuresis!

Every night my son slept with the real problem.  However, my husband (the engineer) and I could only focus on the morning failure.  This is what my husband began calling it when our son turned seven.  Then my son began calling it The Failure.  Every morning we tried not to make a big deal of the wet being contained In a diaper, then a pull-up, and then the wet mat.  Even when we did nothing but remove it and throw it away, my son would look at me with sad eyes and even apologize.

I am sure the struggle is the same for parents of an aging bed wetter:  You turn to the pediatrician who dismisses it from the very first time you bring it up – when your child is about to enter first grade, and every visit thereafter until they are tired of hearing you ask, beg, complain; demand a solution.  Next comes a prescription for DDAVP, which I later researched and learn it is called Desmopressin and the side effects are extensive.  My son has always been active in life and active in sports.  We also live year round in a hot climate so hydration is essential.  The physician never explained that dehydration is one of the side effects of this drug.  How crazy is that?

We were directed to another doctor in the building, a urologist.  He explained the steps he needed to take to rule out any internal issues.  I asked about the chances of bedwetting being caused by a physical problem, and was stunned to learn how small the percentage was – less than 2%.   He said he would not make any recommendations until he was satisfied with his test results. In addition to the nighttime wetting, my son was experiencing some daytime issues.  I explained to the urologist that it appeared as if my son was waiting until the last minute to go to the bathroom, and would have some very small accidents if he could not make it to the bathroom in time. At nine, he did not soak his underwear, but he often came home from school and from soccer practice with damp underwear that had a faint odor.  It would be enough for anybody to notice.  If other children were to find out, there’s no telling what would happen.

The urologist told my son an ultrasound was an easy test, and that the results would help him solve the problem.  My son asked if it would hurt.  The urologist was very patient and told him the bladder ultrasound is painless.  All he might feel is a slight pressure as the little flat wand about the size of a cellphone is moved over his stomach.  He explained that he would need to lie down and be very still during the procedure so the sound waves could produce a picture of his bladder and help discover what was happening to cause the bedwetting.  The technician told him I would be in the room with him at all times.

I was thrilled with the explanation and reassured my son. What he failed to explain was the need to drink a great deal of water before the exam so that you arrive in the room with a full bladder.  Sounds simple enough.  Except my son had a history of urgencies and leaking, which the urologist knew from the history, but apparently forgot to place any significance on when it came to being able to hold a full bladder from the time you drink the water until the time you are taken into the technician’s room for the ultrasound.  They failed to tell him about the gown he would have to wear, which he ended up needed to change twice because he kept leaking urine.  This turned out to be a very embarrassing and challenging experience for my little boy.

In the end, the urologist diagnosed a small bladder as well as an inability to completely empty his bladder.  He then proceeded to tell us that this is what was causing all the problems.  He prescribed Ditropan, another drug, of course,  and wanted to set up a timed-voiding program. He told us to purchase an interval watch that would need to be set at two-hour intervals during the day.  He turned to my son and said he could have fun picking out his favorite color, and would be able to wear his colored watch for the next six weeks.  He also told us to make him drink more water during the day.   How do we gauge that while he’s at school…and how much we would considered “more”?  We ended up purchasing this special watch online, and shared with our son that this would fix the bedwetting problem.

Unfortunately the watch drew a great deal of attention and questions from his classmates.  Questions such as why he was wearing a watch that went off all the time.  Why did he need to go to the bathroom during class rather than waiting, etc.  My son ended up not wanting to wear the watch.  He seemed to try to break it, in fact.  Regarding the Ditropan, my son developed a lack of trust in that as well, and every dose given was a struggle.  Fourth graders are way smarter than we give them credit for!

I must confess we stopped trying and simply told our son—parroting the pediatrician—that his body would eventually outgrow this and he would not be wetting the bed as a teenager.  Reflecting back on this, I cannot believe we continued to feed him this type of unfounded reassurance. Even though he continued with the sad eyes every morning he wet the bed, he stopped calling it The Failure, and thank goodness, so did my husband.  In my mind, this meant it did not bother him as much.  How wrong we were to assume something as insidious as waking up wet was the first thing to greet you in the morning was not bothersome.  How is it possible to expect anyone to simply ignore this and simply wait for it to go away?

The bedwetting dragged on, and during the spring of my son’s sixth grade year, he came to us one night and begged us NOT to allow him to go to the sport’s summer camp his friend was attending.   We had avoided discussing summer camp for several years trying to avoid putting any pressure on him.  I was sad to see him miss the childhood joy of sleep away camp.  He told us he was terrified of what anyone would do to him if they found out he wet the bed.   It was an absolute heartbreak for us.

All of that devastation explained….why would we think bedwetting is a good thing?

Because it led us to the truth behind so much more of what made up my son’s experience of life.  The more he turned into a little man, the more we started seeing changes in his mood like irritability.  He wasn’t nearing puberty, and he said he wasn’t having problems at school, so we weren’t sure what was going on.  And as we started to hear from two of his teacher’s that he appeared to be daydreaming or distracted, we were beside ourselves.

The miracle came when we discovered that bedwetting is actually related to sleep.  So it turns out that my son’s style of sleeping was at the bottom of his bedwetting.  And by recognizing that the sleep is actually not good for him, it made things crystal clear to us.  Everything in our son’s life was starting to be challenged by not sleeping well!  So in that sense, bedwetting was good…because finding a company that works with bedwetting and targets sleep to end it, my son was given the opportunity to flourish and function at his best.  There is no better feeling.  From heartbreak to full on joy!  Persistence to find the truth of something is so important.  You have to learn to go beyond what everyone tells you is true or right or wrong or good or bad.  You gotta go for it based on all signs, symptoms, and gut feelings as a parent.  And as a determined and resourceful parent, you find what you need.  Fortunately, you don’t have to figure out how to make the change.  A determined and resourceful mom has already found the solution.  We are ever grateful to the Enuresis Treatment Center for curing my son and liberating him from his cage.  Thank you also to the “mom”, Barbara Moore.  Truly, we cannot thank you enough!

Cheryl Evans,  January 2018