Enuresis 

Definitions:

Primary Nocturnal Enuresis

Nighttime wetting in a child who has never been dry for any extended period

Secondary Enuresis

Bedwetting in a child who had established a pattern of nighttime continence

Nocturnal Enuresis Statistics:

Occurs in 77% of children when both parents had wet the bed

Only 1/3 parents consult a physician

Girls will gain control of urination by age 5 and boys, by age 6

• > 1/2 children are emotionally distressed
• > 2/3 of the parents are concerned

In 1986 a large study (x = 1753)

14 % of children 5-18 years (boys 16% > girls 12%)

15 % of bedwetters resolve spontaneously

Etiology - Nocturnal

Simple maturational delay

Decreased bladder capacity

Sleep disorder

Stress

Autonomic dysfunction (i.e. vasovagal episodes)

Etiology - Day and Night wetting

low levels of antidiuretic hormone

urinary tract disorders

neurologic disorders

Treatment

Bladder stretching

Behavior Modification (below)

Bed alarm is the most commonly recommended regimen

$ 40-55

prescribed 3%, 70% effective

Meds (prescribed 30%)

Imipramine is effective in about 50% of patients

Cheap

High side effect profile

Relapses

DDAVP is effective in about 50% of patients

Oral form available

Nasal DDAVP no longer needs to be kept refrigerated

Expensive

Intermittent use OK (i.e. sleep-overs)

Suggestions for Overcoming Enuresis (Bedwetting)

1. Drink water freely during the day until 6:00 p.m. (No tea, coffee, cocoa, soft drinks. No milk after lunch.)

2. Only 1/2 glass water at evening meal

3. Visit bathroom at bedtime and again in the middle of the night, being sure you empty bladder and are aware of your dry bed when you return to it in the middle of the night. (you may need a parent help you wake up, or set alarm clock)

4. Meditative exercise for relaxation and building your self-image on going to bed and before sleep (see below). 

Meditative Exercise for Enuresis:

Make yourself comfortable in a quiet room. Lie on your back - hands to your sides. Spine straight. Close eyes, relax all your muscles. Breathe deeply through your nose, hold briefly and exhale. Continue breathing deeply, more and more slowly until you are conscious of your breath. When you are thoroughly relaxed, speak to yourself something like the following in your own words: "I am becoming more and more relaxed, as relaxed as an old rag doll. I like myself. I like my family, my school, my classmates. I am thankful to be where I am. I will relax each part of my body." (Consciously go over each organ of you body, brain, head, eyes, nose, and throat, etc. and "speak" to it lovingly.) Feel the tension go out. Be sure and keep the muscles of the body relaxed and continue to breath slowly and rhythmically.When you reach your urinary system, visualize each part in health and with gratitude. Be thankful for a good urinary system that works well. End your meditation by saying, and believing: "I will awaken with a dry bed." Repeat 3 times, each time putting the emphasis on a different word. Try also saying "I will wake up to use the toilet" again repeating 3 times.Do the above treatment nightly. Never miss. Apply to any problem or health difficulty. It works.Good luck!