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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

 

Research All You Need to, But You’ll End up Coming Back to This Program Because it Works.

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“Hi, I’m Charity, and my little boy is Jack, and he’s nine years old.

I had done a lot of research. We worked closely with our pediatrician and a urologist to try to make sure that I could find something. I didn’t want him to suffer without a program.

I actually looked at the references or the testimonials of other parents, and they had mentioned that their children had ADHD. People from all over the country and world were able to be successful in the program, so I thought I’d give it a try.

He has been diagnosed with ADHD since he was four, and he’s been on a constant regiment of different medications. We’ve tried melatonin at night to get him to sleep He has definitely had sleep problems since he was born.

He ended up on medication called Quantity. We’ve basically been on that medication throughout the program.

You were fabulous, and I mentioned that to you when we graduated us that I felt really blessed to have you consistently stick with us, and I didn’t feel judged when I couldn’t feel I could do it anymore with this long process. You provided a lot of information that was tailored to him, and it worked.

I felt supported, and it was definitely something that each and every time I talked to you, you would make things specific to him. You also gave me encouragement about how you had other parents and clients going through certain things as well.

It was just really nice knowing I had you the whole time.

LORI: What has been the best thing for Jack as a result of not wetting the bed anymore?

MOM: Probably his self esteem. Just something as simple as wearing the same underwear up to the next morning without having to take a shower every single morning because he wets. He can go to the next evening and shower because he feels like it, and not because he has to.

Of course, I get to sleep during the night now if I don’t have to worry, and it feels like a weight has been lifted off our shoulders. He is looking forward to going to friends’ houses that he hasn’t been able to go to because he was worried about wetting.

So the sense of freedom and his self esteem… those are probably the big things.

LORI: Have you seen any difference in his behavior?

MOM: He’s acting a lot more mature and independent. I would honestly think that his behavior has changed because he slept better, and maybe it has even effected his grades. He’s always done fairly well, but just being able to get a good sleep pattern has made a difference in that.

I would encourage any parent to go through this bedwetting program.

Research all you need to, but you’ll end up coming back to this program because it works. It’s tailored to you and your child, and it’s successful. I wouldn’t waste any time whether they are three years old or 12 years old or older. Just start this program and you will have amazing results. I just wish I had found it earlier and started earlier than I had.”

 

To listen to additional audio testimonials click here

Bedwetting Is Complicated

Bedwetting is a totally involuntary phenomenon, and it is complicated.  Most professionals’ suggestions for cure are based upon a fundamental misunderstanding of bedwetting.

42 years of successfully treating bedwetting has proven that no amount of restricting fluids before bed or trips to the bathroom in the middle of the night will put an end to bedwetting.  Drug therapy is only a temporary “fix” for someone who wets the bed and usually leads to another failure experience.

No amount of self-talk before bed can reduce the profound distance from any level of consciousness that the bedwetter’s sleep creates.

We are forever grateful when a parent is willing to take the time to write about not only their experience with our bedwetting programs, but the frustrations and misdirection that occurred trying to solve the problem.

This mom wrote to her private counselors here at the Enuresis Treatment Center and asked that her son’s story be shared with other parents searching for help to put a permanent end to bedwetting.

Hi Jasmine,

Peyton is very confidential about his journey with Enuresis.  So I will tell the story.  We have been working actively on trying to stop the bedwetting since Peyton was 4.  Around the age of 5 we went to a Pediatric urologist in the area, which they are supposed to be renowned.  All they suggested was to stop drinking fluids close to bedtime and for him to take Miralax to help him go to the bathroom daily so that wasn’t adding to the issue.  They also suggested a medication that was supposed to help and encourage him along.  With hesitation we started the medication, and Peyton ended up with one of the side effects, getting overheated when he was active.  I just didn’t feel right about the medication in the first place, so I stopped it.

I tried doing the recommendations from the urologist, and nothing was working.  We pretty much struggled with it for another 4  years, as close family would tell me that he will just grow out of it and to be patient.  Be patient, really?  Do they have any idea what it is like to wake up 3-5 times a week in the middle of the night and change the sheets?  He didn’t want to wear the underwear (pull ups) he felt humiliated, so we used the disposable bed pads.  It was both tough on us, because I tried so hard not to get mad, but in the middle of the night, you aren’t always rational.  The worst though is how it affected Peyton, he would pretend that it didn’t bother him, but now and again he would just breakdown and cry and ask me if he will ever be able to get married or go to college?  Completely heartbreaking!  Be patient, as my poor son is slowly entering pre-adolescence and he still wets his bed, his self confidence just crushed.   I pursued another option put together by some psychologist in Israel.  He actually had some beneficial tips, his thing had a mat with tiny electric wires, and an alarm system.  The whole deep sleep component however was missing from his method.  We tried that method over and over for a couple of years.  I was struggling and felt horrible for my son, who was now in 5th grade, and they had a science camp activity.  He was only gone for 3 nights, but he literally had cotton underwear with little pads in them shoved in the bottom of his sleeping bag.  So when he got in at night he would put them on.  Then in the morning he would take them off and if wet, he would just run to the common bathroom and throw them away wrapped in a paper towel.  It turned out he really just dribbled in them and left them in the bag, after 2 nights the smell wasn’t too bad, but by the time he got home I could tell it needed to be changed.   This was so tough for him socially, and he is a happy well-liked kid in school, very active and has lots of friends.

As he entered 6th grade, nothing was working, and I was at my wits end.  I stayed up all night researching something that could help him.  Peyton also was diagnosed by a pediatric neurologist with being “overactive” not ADD or ADHD, but very active.  He also has tics, so he was suggested to take some magnesium and B6, that seemed to calm down the tics.  Poor kid, what more could he have to decrease his self-confidence, but he is always happy on the outside, but I know deep down it really hurt him.

He has always been a VERY DEEP sleeper, very groggy in the am, and lots of mumbling at night.  I found your bedwetting program information through a google search online, and you had actual research to back it, and mentioned the connection with the deep sleep and how helping the individual work on achieving healthy sleeping patterns, how this can help with things like over activity, and possible other neurological things.

It took us less than a year, although after 5 months, he really was having episodes that were VERY infrequent.  What a difference from the wetting every night.  You have helped so much in this whole process, you helped me feel that we aren’t the only ones, and Peyton although he would only talk to me about it, it helped him have more self-confidence.  So far, he has been dry completely for almost 4 months now.

We officially graduated a couple of weeks ago.  We got him a new bed, sheets, and comforter.  He is so happy, and his self confidence is up, the other wonderful thing is, his tics are a lot less noticeable and some days I don’t even see them.  We aren’t taking the supplements for them either, so I truly believe it has had a positive effect on them.  We aren’t on the edge of our seat anymore in the middle of the night if I hear something, and in the morning when I wake up, I am no longer feeling his bed to see if it is wet.   You have changed our lives and have helped my sweet son.  I can’t thank you enough.  At one time I felt like it was going to be a lifelong struggle for my son, and to know that it is no longer part of his life, is priceless.  This is the best program for anyone with Enuresis.  Thank you, thank you and THANK YOU!  What a journey, and the fact that we no longer live with it, is beyond words!

Sincerely and forever grateful,

Melissa M
Saratoga, NY

Author Michael Stallsmith, M.A., Sp. A., Director of Treatment

The Enuresis Treatment Center’s Director of Treatment is also a school psychologist.  Michael Stallsmith has, over the past 20 years, been involved in over 20,000 cases.  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.

Click her to learn about our Critical Factors for Success http://172.81.118.1/~nobedwetting/critical-factors-success/