Before seeking therapy to help your child to stop wetting the bed consider the following. Do you really think your child needs therapy? The answer in the great majority of cases is ‘NO’, that’s because your child needs a hand waking up and using the toilet during the night.
After age 5, if your child wet the bed then primary nocturnal enuresis will be the main medical diagnoses from your child’s doctor. This can be accompanied by tests for bladder control problems, excessive urine production, blood tests etc, but none of these are actually going to help your child wake up tomorrow morning in a dry bed. Fact!
The greatest influence over bed wetting is not his or her bladder, or even having a small bladder capacity. Almost every parent, who has a child with nocturnal enuresis knows that their child has a deep sleep problem.
That’s the big secret. Your child is sleeping so deeply that they don’t notice their bladder contractions. Therefore, we have to target the unconscious mind of your child in order to naturally correct the problem.
There is nothing wrong with your child, they are just sleeping too deeply, that’s why it’s so difficult for them to stop bed wetting.
The Financial cost of bedwetting
The financial costs of bedwetting can accumulate rapidly as the child’s room begins to smell of urine owing to the child’s mattress being soaked each night. Purchasing a rubber mattress cover may be a wise idea in the short term, to save buying a new mattress every week.
The greatest hidden cost associated with nocturnal enuresis is time. The time spent after your child has wet the bed is enormous when you begin to calculate: changing wet bed sheets, washing your child’s pajamas, purchasing training pants, scouring the internet for alarm devices, behaviour therapy, finding and then meeting with your child’s pediatrician, giving a family history, remaking the bed, getting up during the night to try and stop the bed wetting from happening, hours of lost sleep.
When you begin to total up the list, it doesn’t take long to figure out how costly bed wetting really is. Not to mention that in some countries the child’s doctor and other treatments come with a price tag too.
The Psychological cost of bedwetting
The psychological aspect of nocturnal enuresis on your child can be huge, beginning with their connection to you or their siblings. This is because your child desperately wants to outgrow wetting. Having gone through the stage of bladder training they’ve conquered daytime wetting and now they face the wet and dry nights with the accompanying disappointment and shame.
Going to sleep each night can fill your child with dread, as they know that tomorrow they will awaken with a wet bed. Although you may try to make light of the situation, as a parent the situation can lead you to feeling more and more frustrated.
Believing that there is something you have done wrong as the child’s carer can leave you feeling guilty, which is compounded with each passing day. For some parents the frustration leads to punishing the child, which only adds to the problem.
A study into Self-Image and Performance in Children with Nocturnal Enuresis
A study into nocturnal enuresis, has shown the negative impact this condition can have on a child’s self-image and performance. Interestingly the results showed a correlation with the number of therapy/treatment failures. The more treatment failures the greater the negative impact on the child’s self image and performance.
The child seems to align failure to overcome nocturnal enuresis with their ability to do well. Even though this is only the child’s perception it becomes a self fulfilling prophecy.
How to treat bed wetting (enuresis)
Most children grow out of primary nocturnal enuresis (bed wetting)naturally, is probably what you will have been told or read about, but for some this is simply not the case. Younger children with normal bladder capacity overcome daytime wetting first, and once toilet trained progress to the challenge overcoming primary enuresis bed wetting .
Hypnotherapy for enuresis
The efficacy of hypnotherapy as a treatment for enuresis has been proven to be very effective, even after the child has failed to respond to the traditional bed wetting treatments, enuresis alarm, drinking less water, being awoken during the sleep cycle and medication have failed.
The use of self-hypnosis in the treatment of childhood nocturnal enuresis
In one study 40 children with nocturnal enuresis were taught self-hypnosis. By the end of the first month over 75% of the participants were successful at sleeping and waking in a dry bed.
The use of relaxation-mental imagery (self-hypnosis)
The largest study of 505 children and adolescents who presented to their paediatrician with enuresis amongst other conditions, the results were positive. The main criteria being the child required a dry bed and needed to maintain this.
51% achieved this, an additional 32% achieved significant improvement, 9% showed initial or some improvement; and 7% demonstrated no apparent change or improvement. Children as young as three years of age effectively applied self-hypnosis techniques. In general, facility in self-hypnosis increased with age.
Perhaps, the most puzzling piece of data was the inverse correlation (p less than 0.001) between clinical success and number of visits, the majority of children responded successfully to the treatment in four sessions or less. Therefore, if hypnotherapy is going to work for your child it will happen quickly and not over a long period.
How does hypnotherapy work to treat nocturnal enuresis?
Although, hypnotherapy may get good results for the treatment of nocturnal enuresis, the problem for science is explaining how it actually works. The data as to it’s effectiveness is always to be brought into question until we are able to figure out what happens inside a child’s mind that can create such a profound change.
The hypnotherapist in the next section may be the first to shine light on the neurological impact of hypnotherapy on the brain.
The Enchanted Alarm Clock Method for Bed Wetting
For over 25 years Matt Hudson co author of Kids Now They Come With A Manual has successfully been treating bed wetting, his method targets your child’s natural ability to learn. As a teacher and behavioural change consultant, Hudson engages your child’s mind through a metaphor, which for specific reasons cause your child to create a dry bed.
The speed of the method, when compared to other treatments is remarkable. Your child is placed in the position of power over their body, thoughts and feelings. The realisation that it’s not your child’s fault plays a significant part in the enuresis treatment.
The importance of curiosity
The neurochemicals released during the bed wetting therapy are associated with positive learning states, the main one being curiosity. ‘Curiosity’ has been linked to our desire to seek out, discover and learn from the unknown or unexpected. In early years child development literature points to curiosity as being a key indicator of learning and academic performance.
2 main chemicals required for change
Dopamine – The ‘feel good drug’ dopamine is a neurotransmitter and a hormone it helps to influence our mood and motivation to do things.
Norepinephrine – Also known as noradrenaline it’s a neurotransmitter and acts as a stress hormone.
Studies have shown that the locus coeruleus (LC), is a primary source of norepinephrine in the brain. Pupil dilation correlates to the release of norepinephrine which also happens during curiosity and uncertainty. Wetting the bed is definitely a state of uncertainty for the child, they do not know if they will urinate or not during the night.
Hudson understands the role of dopaminergic and noradrenergic chemicals within his motivational therapy process. However, Hudson does not require the parents to join in with a dry nights equals prizes approach as this may trigger secondary nocturnal enuresis in other siblings.
Creating a positive feedback loop
Creating a positive feedback loop between curiosity and dopamine/norepinephrine, which will activate during sleep is the goal. As your child sleeps they are blissfully unaware that they are heading to a point where their bladder will trigger a positive motivational response inside their brain. The noradrenergic system affects arousal and sleep-wake cycles, therefore it is the most suitable, and natural chemical your child needs at precisely this moment in time.
How feelings play their part
The feelings, Hudson suggests, are excellent for overcoming daytime wetting. Beginning with training pants, then the freedom of normal clothing, feelings are just what is needed to learn about the difference between your child’s underwear being wet or dry. However, to create the optimum state of mind to overcome wetting the bed your child needs a process that addresses the problem directly – The Enchanted Alarm Clock.
In order for daytime wetting to be achieved, your child needs to feel what it’s like when:
-the bladder empties -the bladder completely full – they increase bladder capacity -the child wets
From successful dry days your child is then ready to manage bedwetting using the enchanted alarm clock method.
Psychotherapy for enuresis
A study into the treatment of enuresis with psychotherapy looked at a comparison of conditioning the child, by introducing a bed wetting alarm into the child’s sleeping routine v psychotherapy sessions.
The study could find no firm conclusions as to the effectiveness of psychotherapy for the treatment of enuresis owing to other variables needing to be taken into account. Therapy design, number of therapeutic sessions, length of each session, therapists own interactional skills and experience, all play a part in the intervention.
Motivational Therapy for Bed-Wetting
Motivational therapy as the title suggests, uses praise, encouragement, and rewards in an attempt to have your child gain bladder control. This approach encourages your child to understand that they have control of their body and the more they realise this and focus their attention, then the sooner they will achieve the desired results.
Would you use a reward system?
Parents are asked to create a reward system to celebrate if your child wakes to use the toilet, helps to change the wet sheets or has a dry night. Not all children are motivated by stickers and score boards, if this is your child then it’s recommended that you don’t do this particular part of the behavior therapy.
Instead of highlighting a reward system parents are reminded how important it is to treat children with respect and love. Wetting the bed can impact the lives of many children, so parents must refrain from punishing, blaming, or embarrassing the child if they wet the bed.
Who can deliver this therapy?
This therapy can be delivered by a trained professional who counsels your child to take responsibility for wetting the bed. The main proviso for enuresis treatment is that your child must be fully engaged in the process. The counsellor, parents, and child decide what reward the child will be given for dry days and/or nights.
Motivational therapy helps some children to reduce bed-wetting, but if it doesn’t help your child in 3 to 6 months they recommend that you try something else.
Nocturnal enuresis alarm therapy
Alarm therapy shows good results in children aged 7 and older but not so good for children younger. The enuresis alarms or bedwetting alarms have a moisture sensor, which buzzes or rings if the child begins to urinate. Enuresis alarm therapy has been used successfully over 30 years for the treatment of primary monosymptomatic nocturnal enuresis.
Each time the child’s bladder capacity creates dysfunctional voiding, the child is awoken by the bedwetting alarms signal. The brain is learning bladder training and associating this with a positive feeling of success. The parents then compound this success, which steadily supports the child to being able to maintain bladder control, nocturnal polyuria and monosymptomatic nocturnal enuresis.
Enuresis treated with Tricyclic antidepressants or Alarm therapy?
Desmopressin therapy, tricyclic and related drugs are first-line medications most commonly used in children with nocturnal polyuria and normal bladder range. Tricyclic antidepressants also go by the name of imipramine [Tofranil]) and anticholinergics. Desmopressin is an analogue of antidiuretic hormone.
Studies with randomized controlled trials show a small but not significant change in nocturnal enuresis in children vs enuresis alarms or doing nothing at all.
A recent study was carried out to measure the effectiveness of alarm interventions vs tricyclic to resolve nocturnal enuresis in children, see Cochrane Database of Systematic Reviews. The research concluded that alarm therapy may be more effective than no treatment in reducing enuresis in children.
Considering there were 74 trials with a total of 5983 children, the researchers are uncertain if alarm therapy is more effective to treat bedwetting than desmopressin therapy. The study concluded there were no risk factors with alarm therapy.
The authors conclusions
Although tricyclics and desmopressin are effective in reducing the number of wet nights while taking the drugs, most children relapse after stopping active treatment. In contrast, only half the children relapse after alarm treatment. Parents should be warned of the potentially serious adverse effects of tricyclic overdose when choosing treatment. Further research is needed into comparisons between drug and behavioural or complementary treatments, and should include relapse rates after treatment is finished.
Treatment of bedwetting in a child
If you want your child’s bedwetting to stop, then you may have read enough to make an informed choice or you can contact your child’s health care provider. Your child’s doctor may take a family history and physical examination to see if there are any hereditary conditions, digestive and kidney diseases , bladder control problems or other symptoms. These tests may all prove negative.
Your health care provider will supply patient education, which falls under the remit of family medicine This link will take you to the National Institute where you can download their paper on ‘The management of bedwetting in children and young people’- Nocturnal enuresis.
More information about nocturnal enuresis
Nocturnal enuresis is involuntary wetting during sleep. It is generally considered to be normal in children younger than 5 years of age [National Clinical Guideline Centre, 2010].
Bed wetting is defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth Edition (DSM 5) as an involuntary wetting during sleep, at least twice a week, in children older than 5 years of age with no congenital or acquired defects of the central nervous system [American Psychiatric Association, 2013].
Enuresis causes in children
If after a few weeks there has been no change you might want to consult your doctor about having enuresis diagnosed. The affected child can be given a physical examination to assess the bladder and bowel are functioning correctly.
Urinalysis, urine culture tests for signs of disease and ruling out any physical causes of enuresis such as:
Urinary tract infection – Urinary tract infections (UTIs) in children are fairly common, but not usually serious. They can be effectively treated with antibiotics.
Lower urinary tract infection – lower urinary tract function in children and adolescents: lower urinary tract symptoms can be cystitis and urethra, lower abdominal or suprapubic pain, dysuria, urinary frequency and urgency. Older children may present with signs and symptoms suggesting the site of infection.
Overactive bladder – Bladder overactivity can cause urinary incontinence and dysfunctional voiding. Small functional bladder capacity may mean poor bladder control as the full bladder needs to be emptied more frequently. Usually bladder dysfunction corrects itself by age 5, as your child learns to empty the bladder more frequently.
Sleeping too deeply – Many parents report that when their child has wet the bed they sleep straight through. This could point to sleep disorders or sleep apnea especially if your child has a functional bladder capacity, but it might just mean that your child has an amazing imagination. The dreams that your child is having are so amazing that they remain there instead of waking up.
Psychophysiological treatment for enuresis
Using the lens of psychophysiological dis-ease we may be able to have a positive affect on both primary monosymptomatic enuresis and nonmonosymptomatic enuresis, which opens the door to what western medicine describes as complementary and miscellaneous interventions.
As you have read earlier, the anti-depressant drugs are a front-line treatment for enuresis. Hopefully that will cause you to search for another way to help your child and it’s probably the reason you have read this far.
Enuresis in children is a natural process that each of us has been through on our journey to adulthood. For some, there maybe a troublesome EMI that creates a psychological barrier to learning, which continually prevents the next step in development.
Urinary incontinence presents with larger social and psychological stigmatism as the child grows older, therefore a fast solution to enuresis in children is called for.
Using the psychophysiological model to treat enuresis creates a therapeutic experience for the child’s subconscious mind to use. This intervention aims to clear the negative EMI, which may help to relieve behavioral disorders that have developed as a result of the EMI firing overtime.
Interestingly, bladder capacity, neurogenic bladder, overactive bladder, dysfunctional voiding and behavioural disorders may all be improved with a psychophysiological approach to helping your child.
There is a paucity of research into what is classed as alternative therapy in this area. The hypnotherapy study has shown us that there are effective treatments, which work within a short period of time. If it’s been over one month and your child doesn’t seem to be benefiting from what you are currently trying, then do something different.
Your child learns quickly and needs to be curious about whether they can succeed, which, with a little help, they definitely can.