Bedwetting (Nocturnal Enuresis)
Despite the fact that bedwetting is a common problem, it is one of those things that cause deep anxiety for parents and children alike.
For the child or teenager, an end to bedwetting is a whole new lease on life - they can wake up dry every day; feel normal like everyone else; sleep better which means better focus and better grades; no longer have to keep secrets; enjoy sleepovers with friends as well as camp stays and trips without anxiety and, best of all, there is no more blame!
For the parent it means a whole lot less work and a huge release of anxiety, irritation and blame - both toward the child and towards themselves.
What is it? 
Nocturnal Enuresis (the medical term for bedwetting) is the inability to maintain urinary control during sleep beyond the age of 5 (when most children would be expected to have control). To be diagnosed as sleep enuresis, there has to be at least two episodes per month in children 3 to 6 years and at least one episode per month for older individuals. Sleepwalking can also occur during an episode.
Primary Nocturnal Enuresis (PNE) is when the child has never had control at night and Secondary Nocturnal Enuresis is when the child had control for at least six months and then began wetting the bed again.
How common is it?
"Nocturnal enuresis affects about 1 in 75 young people aged 15-21. Some may only wet the bed occasionally, whilst others may have never experienced a dry night" (Source: Enuresis Resource & Information Centre)
There are many other studies around the world which seem to produce similar figures. The fact is that more than half-a-million under 16s in the UK wet the bed regularly, and up to 2% of over-16s continue to wet the bed on a semi-regular basis. It occurs more often with boys than with girls.
What causes it?
There is basically an imbalance between night-time urine production, bladder capacity and an effective signal from the bladder to the brain that it is full.
Possible causes :
Slow development of the regulatory system that allows the bladder to gradually distend over many hours without emptying.
A sleep disorder, where the sufferer sleeps too deeply, little REM sleep is experienced, and the signal to wake-up and to 'hold-on' doesn't get through to the brain. This seems to be the most common reason for Nocturnal Enuresis.
Stress, tiredness or anxiety - more likely to be the cause with SNE, where children have been dry at night for some time before starting to wet the bed. Anything which disrupts the child's emotional stability can be the cause or an exacerbating factor. (It is now believed that psychological disorders are an unlikely cause for PNE in children.)
Genetics. Bedwetting may run in families. Research has shown that if the father wet the bed as a child, there is a 39 percent greater chance the child will wet the bed, and if the mother has a history of enuresis, there is a 23 percent greater chance. If both parents have a history of bedwetting, there is a 77 percent chance the child will also wet the bed. (Source: University of Iowa Science Relations)
Fairly rarely, bedwetting can be a sign of an underlying medical problem like diabetes, urinary tract infection, sleep apnoea, epilepsy, kidney disease or a congenital abnormality of the urinary tract. In these cases, you would usually expect to find difficulties with bladder function in the daytime as well as at night. Constipation could cause urine to leak at night. Psychiatric disorders are also a rare possibility.
How is it treated?
Primary Nocturnal Enuresis Treatment is based on the following factors:
- Reduction in night-time urine production (e.g. medication, less liquid taken in before bed time).
- A normal functional bladder capacity; (e.g. medication,, exercises to increase bladder capacity).
- Effective arousal when the bladder is full. (e.g. Hypnotherapy, visualisation, alarms, habit forming and behavioural therapy).
- Simply waiting it out until the person eventually develops control naturally. SNE Treatment is usually based on treating either a current medical condition; or an underlying emotional problem. (Hypnotherapy, EFT, Various other complimentary therapies and psychotherapy)
Your options:
A Visit to your GP
Because of possible medical problems it is a good idea to check things out with your GP in order to exclude medical problems, even though this is a rare occurrence. If no definite underlying cause is found, some GP's prescribe medication in the hope that it will work while other GP's will advise you to simply wait out the problem as it is a 'developmental thing' and will get better in time.
Prescription Medication - Your GP may prescribe one of the following:
Imipramine, a tricyclic anti-depressant, sometimes called 'Tofranil' can help the bladder to relax and hold more urine. If it is going to work it will do so within a few days. Side effects with imipramine are numerous and due to these adverse effects, imipramine has fallen out of favor in many Western countries.
Desmopressin, is a nasal spray or tablet that causes the kidneys to produce a smaller amount of urine. It is non-addictive and side effects are rare. While the success rates are similar to imipramine, DDAVP has fewer side effects and the onset of action is much more rapid. Thus this agent can also be used for quick short-term relief, as may be needed for an overnight trip.
Oxybutynin, or hyoscyamine, are anti-cholinergic agents that relax the bladder stabilize uninhibited contractions. They are sometimes prescribed for young people who have day-time urgency.
Alternative treatments
EFT
Emotional Freedom Technique (EFT) is a meridian therapy which works by tapping on the body's acupuncture or meridian points. In many cases it is successful, particularly where stress or anxiety is involved. It is a technique the child can use for themselves, or with parents. It is very useful to uncover and deal with underlying issues as well as the emotional anxieties that result from bedwetting itself. (See www.emofree.com)
Hypnotherapy for bedwetting
Hypnotherapy works exceptionally well for children as they have a natural ability to use their imaginations. Their creativity is used to help them mentally prepare the subconscious mind to a) hold the urine and b) wake up fully to go to the toilet. The advantage of this method is that they are completely natural and safe, no drugs are involved and children enjoy listening to them as they drift off to sleep..
Many children respond well to cd's which they can listen to as they drift off to sleep. I include confidence building and self-esteem into my cd and private sessions.
Alarms for betwetting
An Enuresis alarm makes a noise and wakes the child as soon as they start to wet the bed. Success rates vary widely - the best thing is to try one and see if it works for you. Some children just sleep right through the alarm while the rest of the household all wake up!
Reflexology, Acupuncture, Healing, Homeopathy
All of these alternative therapies have also been found to be successful by some people.
What should parents do if their child has Enuresis?
Keep a diary or chart of your wetting pattern and any relevant factors such as foods, drinks or any particular stresses or worries - these can help to spot any potential 'triggers'. Try to discover any pattern which is related - note difficulties at school (for SNE sufferers), note bed-times, drinking habits, whether being busy during the day causes a deeper sleep etc. Some people use gold star progress charts which can work well if there are some dry nights but are quite discouraging if there are either none or very few
Don't restrict fluids - hydration is essential for proper functioning of the body, and drinking fluids does not cause bedwetting. It is important to drink enough fluid throughout the day (2 pints is about right), but don't leave all your intake until the evening. Some liquids are natural diuretics and so will cause more urine production.
Treat your child as perfectly normal! Your child is not doing it on purpose and will possibly be more disturbed by the wet bed than you are, even though in some cases they may seem not to be bothered. Never shout or punish the child as this will simply cause more anxiety and make the problem much worse. It is important the child realises that they are not alone, and that it is not abnormal - probably two or three other children in their class have the same problem!
Use a mattress protector rather than protective pants. The problem with protective pants is that they keep the body so comfortable that the child is unaware if they are wet or dry.
Leave a light on if there is the slightest anxiety concerning the dark so that they can get up to go to the toilet easily during the night. (Remember that your child may sometimes deny they are scared of the dark for reasons of saving face)
Encourage them to help with changing the sheets to the degree that this is suitable for their age and capabilities but do not make it seem like punishment! They will feel more involved in trying to help with the problem and be less likely to think that you are annoyed with them because of all the extra work they are causing you. Treat it as a normal household chore and part of their growing up process.
Remember that there is no blame involved. Tell your child there is nothing wrong with them - there is something wrong with their sleep pattern. They sleep too deeply, and the good news is that this can be changed. Because of the deep sleep, bed-wetters are in a situation where the bladder is not communicating with the brain. The bladder empties spontaneously without the brain knowing it. There is help available and you will work together until you find the solution.
Lifting - A recent study from Egypt describes the use of a simple alarm clock as a conditioning alarm. The child's parents initially had to determine the critical time after sleeping when the bladder would be full by monitoring the child during sleep for 2-3 days to see when bedwetting occurred. The alarm was then set to go off 15 minutes prior to this, enabling the child to wake up and void in the bathroom. The study assumed that this critical time was constant from night to night. The reported success rates were similar to those of currently used enuresis alarms.
Done carefully, this can cause a subconscious habit to wake up and go to the toilet at a regular time, but if the child is simply lifted without waking up, it can have the opposite effect of extending bladder development time and is not recommended as a long term treatment.
Bladder Training - Some clinicians recommend strengthening the bladder by holding urine in for longer periods, but research has shown that it is more effective to teach the child to respond immediately to any feeling of bladder fullness, thus setting up the habit to respond to the signals at night.
Resources:
Enuresis Resource & Information Centre (ERIC) Telephone: 0117 9603060 Website: www.eric.org.uk
Med Help International. Website: www.medhelp.org
To order a cd for bedwetting/ enuresis , please email
For one to one help (with parent present)
contact Gayle in Surrey, Middlesex
Psychotherapist, Hypnotherapist, EFT, CBT, London, Guildford, Woking, Worplesdon, Fox Corner, Pirbright, St Johns, Knaphill, Ripley, Send, Farnborough, Godalming, Farnham, Byfleet, Lightwater, Weybridge, Cobham, Surrey, Middlesex, Hampshire
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