Putting Bed Wetting Out to Dry by Dr. Wayne Terai, D.C.
B
ed-wetting (aka: nocturnal enuresis) is a common concern for many parents, and it’s an uncomfortable and inconvenient event for both parent and child. It’s normal for children to make “mistakes” while they’re learning any new skill, but at what point is wetting the bed considered inappropriate? According to the Canadian Pediatric Society, primary nocturnal enuresis is the involuntary discharge of urine (bed-wetting) by children old enough to be expected to have bladder control - typically by the age of five. The American Academy of Pediatrics states that nocturnal enuresis “affects one out of every four children at age five, one in five at age seven, and about one in twenty at age ten. Boys make up two-thirds of this group, and often there is a family history”. Secondary enuresis occurs when a child who has exhibited proper bladder control (for at least six months) begins again to wet the bed. Most commonly, wetting the bed is simply a sign of developmental delay, not an emotional problem or physical illness. The physical size of the bladder itself may be small. Chronic constipation can cause pressure on the bladder when the bowels are full, and make it difficult to hold through the night. Some sleep disorders may make the transition from sleep to wake cycles difficult and may also create problems with the child recognizing the feeling of having a full bladder. Because the bladder and its sphincters are controlled by the nervous system, neurological problems can also affect either the ability to hold a full bladder, or for the child to recognize when the bladder is full. Bed wetting, especially secondary enuresis, may be a sign of more serious things going on. A few things to watch for are: • discolored or cloudy urine (may show as staining on the underwear/pajamas at night) • weak stream or difficulty/painful urinating during the day • daytime wetting • redness or rash in the genital area If any of these are present, consult your family doctor. Another condition that would require medical attention is an imbalance of the hormones that regulate the kidneys to produce urine, specifically at night. A report in the American Family Physician (May 2006) reviewed research literature on the pros and cons of bed-wetting alarms, drywww.okanaganchild.com
bed training, and medications. It appears that the combination of bed-wetting alarms plus dry-bed training was the best combination. There was insufficient or, at best, limited evidence that medications worked. Short and long-term side effects of the medications were not discussed, but should be thoroughly investigated and understood before undertaking any medication program. A promising study has shown another treatment option which addresses the nerve system’s involvement. Fourty-six children with classic enuresis took part in a randomized clinical controlled trial (J Manipulative Physiol Ther. 1994 (Nov-Dec);17 (9): 596-600). Over a 10 week period preceded by and followed by a 2 week nontreatment period, 31 children underwent chiropractic care, and 15 were placed in a control group. The results: 25% of the treatmentgroup children had 50% or more reduction in the wet-night frequency while none of the control group had such reduction. There is plenty of literature on the psychological impact of bed wetting. Due to its impact, it is highly recommended not to punish, scold or embarrass the child. The outcome is often a downward spiral, making the problem worse, and adversely affecting the child’s self-esteem. In fact, talking with your child, ensuring he or she understands that it isn’t anyone’s fault, can help alleviate a great deal of anxiety and stress. Since most children will out-grow bed wetting with time, most pediatricians and urologists recommend delaying any kind of intervention until the child is at least 6 or 7 years old. During that time, you should discourage the child from drinking any fluids during the two hours before bedtime. Make voiding the bladder as part of the bedtime routine – just like getting into pajamas, brushing the teeth and reading a bedtime story. You can also try dry-bed training – waking up your child and walk them to the bathroom to void, and gradually increasing the length of time between wakings. Celebrate the dry nights; don’t punish the wet ones. Most of all, try not to get too stressed about the situation. Your child’s anxiety and stress will directly reflect your own. As a parent myself, my biggest advice to you: Enjoy your children, while they are children. They grow up far too fast. This information is provided by Dr. Wayne Terai, B.Sc., D.C., a family practice chiropractor, Advanced Proficiency Rated in Activator Methods. He has practiced in Kelowna for 15 years, and has practice includes the new Kelowna Laser Therapy Clinic, implementing the BioFlex Low Intensity Laser Therapy (LILT). LILT is used to effectively treat injuries and chronic and inflammatory conditions.
Summer 2010 l 27