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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

 

Stop Bedwetting – Happy 10-Year-Old Boy

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“First of all, I can’t pull this part to I say thank you to the whole team over there. I think it’s only those families who are in the same situation as we were What a huge relief it is for everybody really to get to this point to have a child who is not wetting the bed anymore.

I can say now that I have a happy 10 year old boy who is highly intelligent and proud and confident and happy! For me to be able to see my boy going to a birthday party and sleep over night and have no fear of wetting the bed at someone else’s house is the most important to me.

There was a time when I thought maybe we would maybe never get to this point, but we did it. It’s only because we got into this program to end bedwetting, which i think is wonderful. I had Claudia –wonderful Claudia–all the way supporting us.

I had my moments when all the family found it difficult to keep on going and do the practice and do everything that we were asked to do, but it was worth it….more than worth it.

I would encourage all the families in the world to try this method–to go after the problem– because bedwetting is not something that will just disappear by itself. This is something we are told; that it will disappear through time. I think this is the biggest problem–that we believe in it–and we keep waiting and waiting.

I just couldn’t understand why we didn’t find your bedwetting program sooner.

I’m glad we found it. It’s so logical.”

Miriam G

Sarasota, NY

Our whole team thanks you for sharing your experience with the Enuresis Treatment Center for Bedwetting.

To listen to additional audio testimonials click here

To watch videos 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/

Case Study of Adult Bedwetting Patient

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This is a case review of a 42-year-old Caucasian male, who we will refer to as William. He was suffering from bedwetting for his entire life.  Bedwetting is also known as nocturnal enuresis and primary nocturnal enuresis.   William reached out to our clinic after reading about our expertise in solving adult bedwetting.  He commented about his experience of relief while reading our website information, and that it made so much sense.  He then knew unequivocally that his heavy, deep sleep had to be the underlying issue, not only for his years of nighttime accidents, but also for his teenage son’s bedwetting.

Family History of Bedwetting:  

William’s father experienced bedwetting into his teen years.  William’s grandfather also wet the bed as a teenager.  His father’s father experienced teenage bedwetting as well.  Now William’s son continues to experience nighttime bedwetting as a teen.  He has always wet the bed – never been dry at night.

In recent years, William’s father was diagnosed with sleep apnea, and he currently wears a c-pap device, also know as a continuous positive airway pressure therapy, to help regulate breathing.  This is not an uncommon diagnosis stemming from the sleep disorder with which we work.   Also, not uncommon is the sleepwalking and night terrors experienced by his aunt.  These are symptoms that cannot be eliminated.  The only possibility is to manage these symptoms as best as somebody can.  Since bedwetting was “outgrown” by his dad and aunt, the detriment it poses is that these other untreatable conditions can surface and affect quality of life.

We know  a new pattern of sleep is needed which will not only eliminate bedwetting; it will also cut off the possibility that the untreatable conditions will arise.   

Dr. Roger Broughton, a neurologist and foremost sleep researcher from McGill University in Montreal, is an expert upon whose findings have led to our initial protocol.   He highlighted a condition called deep-sleep bedwetting.  The sleep study conducted by Dr. Roger Broughton is titled, “Sleep Disorders: Disorders of Arousal? Enuresis, Somnambulism, and Nightmares Occur in Confusional States of Arousal, not in “Dreaming Sleep.”

The result of this study shows the differences in normal sleep patterns and those of a bedwetter.  In normal sleep, people 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 minutes to achieve.  A person who wets the bed falls quickly into deep sleep and stays there for longer periods.  This is the problem.  The brain is not supposed to stay in Stage Four for very long.  Cycling doesn’t take place consistently throughout the night, and the bedwetting occurs as a result.

The study’s findings concluded that all bedwetters share a deep sleep pattern. Our center has decades of clinical and anecdotal experience, which proves that the only effective treatment and cure for bedwetting is to change the pattern of sleep. Chronic bedwetting is the symptom caused by the inherited sleep disorder. 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.  The infographic below illustrates the effects of sleep deprivation:

sleep deprivation

Initial Assessment:

A thorough assessment, required for preparing for one of our programs, revealed  that he also experiences difficulty awakening in the morning, had sleepwalking episodes as a child, and was prescribed Ritalin during his late teen years to help with focusing and hyperactivity.

When we discussed the frequency that the bedwetting is occurring, William claimed he has wet the bed every week of his life.  In the past year he has seen an increase in the frequency of the bedwetting with a pattern of two to three times a week on average.  

Currently he has no medical issues other than seasonal allergies.

He has previously – during childhood and even as a teen – been examined by two pediatricians, three urologists, and a neurologist to determine a cause of the bedwetting, also know as primary nocturnal enuresis.  At no time was a physical symptom diagnosed.  Enuresis workups included:  Urinalysis, urethral obstruction scope, several ultrasounds, and an MRI.  

According to the American Pediatric Association, less than 1% of bedwetting is caused by a physical problem.

He stated that typically the physicians’ focus of bedwetting treatment was placed upon managing the bedwetting rather than a full resolution.  After a failed attempt using a bedwetting alarm, being told to wait and do nothing until puberty when he is likely to stop wetting was the direction his parents were given.   Clearly it turned out to be inaccurate (as it is with most of our patients)

He did not recall a physician providing any statistics regarding the length of time he would suffer from bedwetting, and of course he was not provided the statistics for primary enuresis: 1-30 for teenage bedwetting or 1 -100 adults who would continue wetting the bed as an adult.  

No medications were prescribed until he reached age 24.  Over time, he was placed on three different drugs, which included Ditropan and Tofranil to no avail.  His last desperate attempt was with Desmopressin.  William researched the side effects of Desmopressin when the dosage was increased to three pills each night, and when he started regularly feeling queasy and irritable, which he said was not typical.   William lives in a warm climate, is physically active, and knew how important hydration was to his well-being.   Desmopressin is meant to purposely cause dehydration in the body in an attempt to eliminate the bedwetting.  When his discovered the extensive list of side effects of Desmopressin, as well as the ineffectiveness, he stopped taking the drug immediately.

What makes drug intervention for bedwetting a completely ineffective approach is because it doesn’t remotely touch the causal factor of the core issue – sleep.   

Below is a list of some of the side effects of Desmopressin.  

Source  https://www.rxlist.com/ddavp-side-effects-drug-center.htm

Also known as DDAVP, it is an antidiuretic and anti-hemorrhagic drug used to treat bed-wetting, central cranial diabetes insipidus, and increased thirst and urination caused by head surgery or head trauma. DDAVP is also used to treat bleeding due to platelet dysfunction. DDAVP is available in generic form.

Common side effects of DDAVP include:

Headache, nausea, upset stomach or stomach pain, diarrhea, or flushing of the face (warmth, redness, tingly feeling). DDAVP can infrequently cause low levels of sodium in the blood, which can be serious and possibly life-threatening. Seek immediate medical attention if you have symptoms of low levels of sodium in the blood, including:  loss of appetite, nausea, vomiting, severe headache, muscle weakness/spasms/cramps, weight gain, unusual tiredness, dizziness, severe drowsiness, mental/mood changes (confusion, hallucinations, irritability), loss of consciousness, seizures, or slow/shallow breathing.

Physicians continued to tell him he was not trying hard enough, which he confided was scarring his self-esteem, and resigning him to the point of view that he would have to live out his life continuing to wet the bed. He expressed a deep resentment over the dismissal of this problem of wetting the bed, and was amazed and confused that it would even be intimated that he hasn’t done his part to end the stress of this condition.  

We can see more about how the problem with doctors saying bedwetting will be “outgrown” can cause psychological havoc to its victims, attacking self-esteem, increasing a sense of failure, and feeling “different”.   For many of our adult patients, they tend to live more solitary lives because they feel too uncomfortable disclosing the bedwetting to a potential mate.  Unfortunately, intimacy often becomes what they feel is an impossibility to them.   We understand it can be difficult to open up to somebody about this condition.  Many adults in our program have expressed anger or sadness or regret for having “missed out” on opportunities as a result of having to hide an extremely sensitive and often shameful part of their lives.

He was highly motivated to enter as well because his wife had recently filed for divorce.  One of the reasons involved her perspective on William’s bedwetting.  She eventually began to accuse him of deliberately wetting the sheets.   In fact, in a most unfortunate experience for William, his wife used this perspective and had her attorney introduce it publically in divorce court.   We have the utmost respect for William to ride that through, and then do whatever it would take to eliminate a problem that he thought he had no control over, and that has clearly impacted his life to the extent of being publically humiliated.  

Enuresis Treatment Center

Years of research and development dictates a two-week meeting schedule in order  to properly develop a  personalized plan.  We assign to our patients one of our staff counselors to work closely with them and facilitate their plan.  Our counseling staff includes a school psychologist, nurses, and teachers.  William was offered the opportunity to conduct his appointments via Skype.  He chose instead to have phone contact because, as he described, “the pain and embarrassment is too deep to face anyone”.

Our protocol dictates that our Director of Treatment reviews each case before a customized program is designed.  It was determined that a male bedwetting counselor would work with William throughout his program.  

Focus was placed upon ending the heavy and problematic sleep that had caused the continuation of the nocturnal enuresis.   Besides the enuresis, William presented with always feeling unrested, having difficulty focusing, being exhausted upon awakening rather than refreshed, and becoming more and more withdrawn over the years.  

We found out that William had symptoms of urgencies, a need to empty his bladder multiple times during the day, and we know this was attributed to the bedwetting itself.  It was determined that this is an actual a symptom of the bedwetting because the bladder tends to remain underdeveloped as a result of emptying regularly in the night.   We therefore developed and implemented a seriesces of targeted exercise, introduced at varies segments of his program ,develop to needed to fully support him and thus eliminate excessive needs to urinate during the day.   

In week six of our progressive and holistic approach, William began to see a change in his wetting pattern, and he was thrilled.  Of course, he would be!  For the first time in his life, he began to see progressive results leading to an end to the bedwetting.  He told his counselor that he was able to see progress and the finish line was in sight!

What is required for each appointment is pertinent data as it relates to the bladder development and the sleep intervention training.  Incremental changes are often difficult for the patient to detect, but the job of the bedwetting counselor is to identify and design the next step to maintain progress.

Enuresis Treatment Center’s sleep training protocol focuses on the relationship between the deep sleep and the disconnect with the bladder signals.  

As we know, the brain becomes less malleable as we age, and it was known that Williams program would possible take longer than it would take a child’s brain to respond.  

William’s counselor noted that he followed all directives in a timely fashion.  The Reinforcement Phase took longer, as was anticipate, but completed.  His counselor was satisfied, via current data, that his new sleep pattern had emerged.  The bladder and brain synchronized and the adult bedwetting ceased to be a problem.

William entered his teenage son into one of the Enuresis Treatment Center’s specialized teenage bedwetting programs four week after he finished his program.   
Source of graphic:
http://jonlieffmd.com/wp-content/uploads/2012/07/800px-Effects_of_sleep_deprivation2-300×220.png

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

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.

The Bedwetting Battle – The Misunderstandings Continue

Dr. Bill Sears in his article, “Battling Bedwetting” makes suggestions to parents regarding dealing with their children’s bedwetting.  Our staff psychologist, Dr. Lyle Danuloff, disputes Dr. Sears’ tips and claims.  Below you will find his perspectives.

Dr. Sears – Dr. Sears instructs parents to have the bedwetter “grunt it out” before bed, i.e. completely empty the bladder as a way to stop the bedwetting.

Dr. Danuloff – Bedwetting does not occur because a bladder does not empty.  It occurs because of the failed brain-bladder connection.  Bedwetters’ bladders are significantly underdeveloped.  Because of this, even a small amount of urine in the bladder can trigger the bladder to empty.  It will empty, no matter the amount of urine in the bladder, because the deep sleeping brain fails to keep it closed.

Dr. Sears – Have a “talk” with the child so they can repeat phrases such as, “I will get up and go to the bathroom when I feel my bladder gets big.  I will splash water on my face to wake up and grunt three times.”

Dr. Danuloff – Dr. Sears’ directive exposes his noticeable failure to understand the impact and power of the deep sleep someone who wets the bed experiences.  Bedwetting is a totally involuntary phenomenon.

No amount of self-talk before bed can reduce the profound distance from any level of consciousness that the bedwetter’s sleep creates.  His suggestions of a “talk” and methods of self-awakening provide evidence of his lack of understanding.

Dr. Sears – The doctor suggests that the above two methods “usually work 90% of the time.”

Dr. Danuloff – Unfortunately, they don’t.  His suggestions for cure are based upon a fundamental misunderstanding of bedwetting.

Dr. Sears – Go “high tech” and use a “bladder conditioning device”, i.e. A pad and buzzer that goes off at the first drop of urine, thus awakening the child.

Dr. Danuloff – Again, Dr. Sears displays his misunderstanding of the profound depth of sleep the bedwetter experiences.  Someone who continues to wet the bed can sleep through thunderstorms, loud music and alarm clocks.  A buzzer or bedwetting alarm, used alone, never awakens someone who wets the bed.

Dr. Sears – Dr. Sears refers to the many “little bedwetters” he has helped.

Dr. Danuloff – Bedwetters come in all ages.  At Enuresis Treatment Center, while we treat children as young as 5 years of age, the age range of our patients goes into adulthood.  Our typical patient is 10-16 years old and a child who has experienced failed efforts to end the bedwetting similar to those suggested by Dr. Sears.

Dr. Sears’ suggestions reveal his lack of basic knowledge regarding the disorder. In our 42 years of treating bedwetting our expert staff has never encountered a bedwetter who could accomplish what Dr. Sears suggests.

 

Source: Lyle Danuloff, Ph.D.
Dr. Danuloff is a Fully Licensed Clinical Psychologist and has been in practice since the early 1970′s. He has been on staff with the Enuresis Treatment Center for Bedwetting since 1984. Dr. Danuloff has intimate clinical knowledge of a bedwetter’s emotional and psychological challenges. Additionally, he participates in our staff development progress, and consults on a regular basis.

 

Here is the original article to which Dr. Danuloff is referencing:

Battling bed-wetting

Author Link By Dr. Bill Sears

Tips to keep young children waking up to dry mornings.

During my 50 years as a doctor, I have helped many little bed wetters enjoy dry nights. It’s physiologically more accurate to call this nighttime nuisance “sleep wetting.” Commonly misunderstood as a psychological or discipline problem, bed-wetting is really more of a sleep quirk. Some kids, more commonly boys, sleep too soundly to respond to their bladder’s get-up-and-go signals. Just as there are normal late walkers and late talkers, there are normal late dry-nighters.
In my pediatric practice and in my own family, I have used five specific steps to conquer bed-wetting:

  1. Draw a picture
    I draw a picture of the brain with “wires” connected to the bladder, explaining to the child, “Your bladder is like a balloon the size of a baseball. Inside the balloon are tiny sensors that tell you when your bladder is full. The full bladder then sends messages to your brain, and the brain tells you to get up and go pee. Because you sleep so deeply, the brain says, ‘Don’t bother me. I don’t respond to text messages while I’m sleeping.’ But your bladder becomes so full it needs to empty, so you pee in your bed. We’re going to help your brain and your bladder listen to each other at night.”
  2. Go before bed
    You are your child’s bladder-training coach. Many bed wetters go to sleep with a half-full bladder because they are tired or in a hurry and only dribble a bit when they go to the bathroom before going to bed. Show and tell your child to “grunt it out” — squeeze all the pee out of your bladder and grunt, grunt, grunt three times so you go to bed with an empty bladder — as you use your hand to show him how the bladder squeezes all the urine out.
  3. Enjoy a talk before bed
    As your child is dozing off to sleep, repeat phrases to program his brain: “I will get up and go to the bathroom when I feel my bladder get big. I will splash water on my face to wake up and grunt three times.” This bedtime rehearsal imprints on your child’s brain and helps his bladder and brain cooperate at night. Alternately, since most children wet the bed within a few hours after retiring, set an alarm to go off a few hours later to prompt him to get up and go.
  4. Wake and relieve
    Before you go to bed, fully awaken your child, help him walk to the bathroom and prompt “grunt three times” to completely empty his bladder. Then escort the sleepy child back to bed.
  5. Go high-tech
    While the above measures usually work 90 percent of the time, if your child is becoming increasingly wet and bothered, try a pad-and-buzzer apparatus called a bladder-conditioning device (available online or in the of office of your health care provider). When a drop of urine strikes the moisture-sensitive pad, it sets off a buzzer that’s attached to the child’s T-shirt or pajama top. Explain this conditioned response to your child as the “beat the buzzer” game. Encourage him to get up and go to the bathroom before the buzzer sounds.

This technique can be effective 90 percent of the time if used correctly. For best results: Have your child empty his bladder completely with the triple voiding technique just before going to bed.

Explain to him that the buzzer will help his bladder and brain listen to each other at night while he’s sleeping. Tell him what to expect: “Imagine waking up and taking a trip to the toilet. Pretend your bladder is full and starting to stretch and it’s time to get up.”

Source: http://healthylivingmadesimple.com/battling-bed-wetting/