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.
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.
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.
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.
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.
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 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