Medical Hypnosis for Bed-wetting
important to give the brain and bladder lots of practice working together to help your child stay dry and so the child is not thirsty at bedtime.
2. Predictable bedtime schedules: Doing things in the same order each night makes it easier for kids to anticipate and settle into sleep-time. Even if your child has urinated earlier in the process, it’s good to void one more time just before lights out to be sure the bladder empties completely and has plenty of room to fill up over night. 3. Praise success and avoid punish-
By Eileen M. Poulin, MD
at a typical 2-4 years of age. When night- time success has never been achieved, this is called “Primary Nocturnal Enuresis (PNE).” Between the laundry and the dread- ed or often unthinkable sleepovers, this problem can be frustrating for parents and discouraging and even humiliating for the child. It can be embarrassing to talk about enuresis, even with the child’s own doctor, because so many people don’t know that they are not alone. Actually, 15% of 5 year- olds, 10% of 6-year-olds, 5% of 10-year- olds, and 1% of 15-year-olds still wet the bed at night.
B Bed-wetting often runs in families. A
child is more likely to wet the bed if a par- ent or other close family member has a his- tory of this problem. As inconvenient as it can be to families, PNE becomes a treatable problem when it starts to bother the child. If a parent pushes a child to be dry before he or she is motivated, it can actually prolong the problem because of stress and negative feedback from the parents. All treatments work best when the child shows interest in having dry beds. This readiness usually happens around 7-8 years of age. Some children are motivated earlier and others are content to wear pull-ups at night a bit longer, depending on the child.
Possible Causes Now that you realize how common
PNE is, you can feel comfortable discussing it with your child’s doctor, as it’s important to consider the following possible causes:
edwetting is a common condition in pediatrics. The typical child who wets the bed has achieved daytime dryness
1. Constipation: The most common cause of nocturnal enuresis in children. This is largely because the hard stool in the lower intestine compresses the bladder from the outside and decreases its capacity to hold urine. Because parents and chil- dren may be unaware that constipation is an issue, your child’s physician may order an abdominal X-ray to rule this out prior to initiating other treatments. If constipation is present, increasing fluid and fiber in the form of whole grains, fruits and vegetables as well as increasing daytime water intake are generally advised. Often a laxative is prescribed.
2. Sleep apnea: Can cause nocturnal
enuresis. This is usually due to enlarged tonsils or adenoids, in which case snoring or daytime sleepiness might be present. Be sure to inform your child’s doctor if this is a concern.
3. Urinary tract or bladder infections: Are unlikely causes of long-standing bed- wetting, but it is wise to have your child’s physician check a urinalysis before starting medical therapy. 4. Habit: Many children with enure-
sis have developed a habit of decreased awareness of the signals from their bladders during the night. It’s important to know that most children are able to retrain their brains to pay more attention to the bladder when they learn self-hypnosis skills and learn to have dry beds.
In Primary Nocturnal Enuresis, consider the following:
1. Fluid restriction: This will help decrease the urine production during the night. Drinking more during the day is also
20 Essential Living Maine ~ July/August 2014
ment: Unless there is a significant behav- ioral issue, assume that your child desires dry beds as much if not more than you do and is not wetting the bed on purpose. For this reason, punishments are generally ineffective and may prolong the bedwetting problem by increasing the stress and shame that some children experience with bedwet- ting.
Treatments for Primary Nocturnal Enuresis:
1. Medications: The most common medication used to treat PNE is DDAVP or Desmopressin. When taken at bedtime, this derivative of the body’s antidiuretic hor- mone works by increasing water reabsorp- tion by the kidneys, decreasing the volume of urine produced during the night. When effective, the family may choose to use this every night or to use only when the child is planning on sleeping away from home. This medication can be expensive and there is a high rate of relapse or recurrence of the PNE when the medication is discontinued. 2. Wet alarms: These electronic devices are frequently recommended. They work by snapping the wetness-detector to the child’s underwear. On the other end, positioned near the child’s head, is an alarm that buzz- es loudly when wetness completes a con- nection as the child starts to void. In theory, the buzzer trains the child to wake up and go the bathroom when the voiding starts. They can be effective, but unfortunately, many parents have the experience that the buzzer wakes up everyone in the house but the sleeping child, and alarms can take several months to work. The relapse rate after stopping alarm use is lower than with medications. 3. Self-hypnosis: Unlike medications and alarms, this mind-body approach empowers the child to develop internal control over the process rather than relying on external means to control the problem. By using a playful and imaginative process, the child can retrain the brain and bladder
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