Written by: Dr. Cathy Moser
Once in a while I come up with an intervention that is so effective that my clients are wowed – and they look at me like I’m some kind of magician. I love it! But really, it is rare that an intervention is that effective immediately; and often, it works like magic for one person, but not another. I have a couple of tricks up my sleeve for bedwetting, and I will share them with you. Let me know if they work!
The first necessary condition for change is that you and your child believe that it is possible to stop the bedwetting… if you think that there’s no point in intervening, you’re right. If you don’t believe that it can be treated, you will wind up changing the sheets, not the problem. If you think that it’s possible to make a difference, AND that it is worth your effort to intervene rather than wait it out, read on. By the way, the waiting it out approach works – I don’t know too many adults that wet their bed. However, there can be secondary complications if you wait too long. NOTE: this article deals with children who have not yet achieved night-time control, not situations where a child has been dry at night for some time, but regresses. In either case, it’s a good idea to consult with your child’s Physician before intervening.
Most children acquire daytime control before they are dry at night. Nocturnal enuresis is the medical term for bedwetting that occurs beyond the developmentally appropriate stage. The criterion is a frequency of two or more times a week. One study showed that 15% of children who were 7 ½ years old wet their bed at least once a week, but only 2.6% wet their bed twice a week or more. So, don’t start interventions before the age of seven – unless your child shows signs they are ready (e.g., they ask you to take the pull-ups off and/or you find that the pull-ups are dry a few times a week). Personally, I wouldn’t start to even expect nighttime bladder control until your child is four or five (boys are often a little older than girls before they achieve control). Then, I would ask myself a few questions before starting to actively work on it. First, is there a history of nocturnal enuresis in the family? Interestingly, there’s some evidence that not only is it inherited, scientists have identified the specific gene. Many parents that I see tell me that they themselves wet their bed until they were 10 (or 12, or 14… and in rare instances… 16 or more). They don’t expect their children to be any different and assume that eventually, they will outgrow it on their own. In my mind – not a great approach. Regardless of what your child says, at some point, it’s not really o.k. for them. At some level, older children worry that they will have to face situations such as sleepovers, school retreats/trips, and overnight camp. And, even if they don’t admit it – self-esteem takes a hit.
Here are some of the other sources of enuresis (taken from WebMD): Delayed bladder maturation – like walking, reading, and other skills, children develop bladder control at different rates; Low anti-diuretic hormone (ADH) – ADH tells the kidneys to make less urine. Some children release less of this hormone while asleep, resulting in more urine; Deep sleepers - some children sleep so deeply, their brain doesn't get the signal that their bladder is full; Smaller ‘functional’ bladder - although a child's true bladder size may be normal, during sleep, it sends the signal earlier that it's full; Constipation - full bowels press on the bladder, and can cause uncontrolled bladder contractions, during waking or sleep.
Now… what to do about it. Here are some of the conventional interventions that parents often try before they come to see me. Some of them work for some but not all children, so it’s worth trying them out. The first thing that you should do is to make sure that your child has gone to the bathroom before they head to bed; and, if there is a time lag, get them to pee once more before they close their eyes. Second, encourage your child to drink more during the day, and limit their intake after supper. If they are thirsty, give them small quantities of water, ice chips, or miniature home-made freezies. Third, try one of the commercially sold bed-wetting alarms. These alarms sense urine and wake a child so that they go to the bathroom. Make sure that your child is not afraid of the dark, and use a nightlight if needed.
Although not a cure, medication can be used to stop wetting. This would be especially useful for overnights (there is an immediately effective nasal spray) or for trying to change up the pattern (there are also more long-term medications). But before you go to the medication alternative, I would try this one out.
First off, you have to assure your child that enuresis is a medical condition, and it is not their fault that they wet the bed. If you were a bed-wetter when you were a child, share that with them. However, you can let them know that there are some treatment options that they can try that may not have been available way back in the Stone Age, when you were a child. Also, if they are older, you should get them to change their own sheets and do their laundry. This way, you do not get frustrated with all the extra laundry, and it becomes their responsibility (as opposed to a punishment).
The basis for my intervention is twofold. First, I frequently use visualization and subconscious activation work in my practice. Second, I am a big fan of the power of incentives and rewards. They are extremely effective when the rewards are powerful and the behaviour to be rewarded is simple and short-term. Here’s the Moser Manipulation in a nutshell. First off, have a positive discussion with your child about how, sometimes, the subconscious part of their brain can help them out. What they have to do to access the subconscious is to think positively about achieving dryness for at least some of the night before they go to sleep. I have used a book with visualizations called Dry All Night by Alison Mack. In it, she reads stories about a camel (who holds it in when necessary) and a fireman (who has to open up the hydrant in order for the water to flow). There are other books that may be helpful – check them out. The next CRITICAL step is to offer the child the cost of a pull-up every time they wake up dry (what is it now - $1.00 or more?). You can tell them that they can save up for a specific goal (like a piece of clothing that they wanted or a toy or a bike). Once they realize that they can earn big bucks, the subconscious is definitely on board. And miraculously, some children become dry at night more frequently, and eventually – they pretty much get the situation under control. As I said, it definitely doesn’t work doesn’t work all the time or for all children. This is the same type of effect as is often found with hypnotherapies – it works for suggestible individuals and not for resistant ones. In one case, the parents used the intervention for my client – it worked partially for the client, and perfectly for their younger child that asked to do the same when she found out how much money she could earn.