Treatment of Bedwetting in Children

Treatment of Bedwetting in Children

Most children outgrow bedwetting by the age of 5 years. However, 7% of boys and 3% of girls take longer to stop bedwetting. By the early teen years fewer than 2% of children still experience this problem. Medical causes of bedwetting include urinary tract infections, constipation, and diabetes.

Most of the time, children report that their bedwetting has occurred throughout their lives. When it persists after early childhood this is likely because of slow maturation of the ability to remain dry at night. Often this is related to genetic factors and one or both parents will report that they had difficulty with bedwetting in later childhood.

On infrequent occasions, when children report a period of at least several weeks of nighttime dryness at some point earlier in their lives, the problem likely is related to a psychological difficulty rather than delayed maturation.

When I first meet a child who is dealing with bedwetting, I reframe the issue using a positive approach. The child’s issue is that he or she needs to learn how to keep the bed dry, rather than how to not wet the bed. Through focusing on the goal of keeping the bed dry, the child’s mind is better set to improve its control over the bladder.

If a child is less than 8-years-old I suggest that difficulties with keeping the bed dry are normal at a young age, and that the child and his or her parents remain patient, as the child is likely to outgrow the issue in short order. In other words, the child and family should remain calm rather than feeling that something is wrong and needs to be “fixed.”

Usual treatments for keeping the bed dry including moisture alarms that are triggered as soon as the child start to urinate, which gives the child an opportunity to awaken and use the restroom. Such alarms typically take 1-3 months to start being effective. Alarms work with a majority of older children. Short-term use of medications for bedwetting should be a last resort because of their potential side-effects. These include medicines that decrease urine production or calm the bladder. Use of hypnosis is another viable alternative.

Before I start teaching how to use hypnosis to achieve a dry bed we review the child’s history. I ask whether the child has any daytime accidents. If so, this suggests that there may be a physical abnormality leading to the issue. I ask if the child always uses the restroom before bedtime. If not, I recommend this become part of their bedtime routine. If the child is constipated this can cause the stool inside the abdomen to push on the bladder that can lead to nighttime difficulties. In such a case I recommend that the child increase fiber and fluid in the diet to allow for regular bowel movements.

I encourage children to use a calendar to keep track of the state of their bed or Pull-ups every morning. They score a 0 if the bed is as dry as the desert, while they score a 10 if the bed is soaking wet and overflowing like Niagara Falls. I explain that by using a calendar they can track their improvement more easily as the bed becomes drier. When children are aware of their improvement they remain more enthusiastic about following through with their treatment plan.

Also, I recommend that the children be responsible for changing and washing any wet sheets, as well as remaking the bed. In this way, the children can take ownership of the solution to their issue, and also have an extra incentive to overcome it.

With younger children we discuss that the bladder holds the urine until it is ready to come out. I suggest that every night, before they go to sleep, that they talk to their bladder in hypnosis and tell it to stay “Tight, tight, tight, all night, night night.”

With older children I ask them to draw their artist conception of the connection between the bladder and the brain. The children usually explain that when the bladder tells the brain that it’s full, they go to the bathroom. I ask what happens at night. They respond that their brain is asleep. I then tell them this story:

“Did you know that part of your brain is always awake when you’re asleep? When I was young, I could tell my brain at night what hour I wanted to awaken in the morning, and that’s when I would wake up. This can only work if part of my brain was able to keep track of the time when I was sleeping.

“I learned more about the awake part of the brain when my first child was born. He would awaken in the middle of the night and cry until my wife awakened to nurse him. I used to stay asleep during these times. On the other hand, at the same time I was on-call as a physician and would receive phone calls in the middle of the night from the hospital. When the phone rang I always woke up immediately to answer the calls, but my wife would sleep through them. Each of our brains decided what we needed to do even while we were asleep!”

The children then figure out that in hypnosis they can tell their bladder to talk to the awake part of the brain at night, so that the brain can either tell the bladder to hold it, or it can awaken them and they can go to the restroom.

When children report a period of dryness earlier in life, hypnosis treatment can be focused on uncovering and dealing with the probable underlying psychological stressor. For example, children can start having difficulty with keeping their bed dry because of worries about whether their parents’ arguments might lead to divorce.

Usually, children demonstrate improvement with their bed drying within a few weeks of their use of hypnosis, and in many cases they become completely dry within 3 months.

Treatment for bedwetting involves considering whether the problem is caused by a physical abnormality, psychological problem, or because of slow maturation of the body. Therapy is based on addressing the underlying cause of the bedwetting, for which age-appropriate hypnotic suggestions often are useful.

Copyright Ran D. Anbar

Ran D. Anbar, M.D., FAAP, is board-certified in both pediatric pulmonology and general pediatrics. He is the author of the new book Changing Children’s Lives with Hypnosis: A Journey to the Center.

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