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BED WETTING TREATMENTS |
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Occasionally
a doctor will determine that the problem is serious enough to
require treatment. Standard treatments for bed-wetting include
bladder training exercises, motivational therapy, drug therapy,
psychotherapy, and diet therapy. Bladder training exercises are based on the theory that those who wet the bed have small functional bladder capacity. Children are told to drink a large quantity of water and to try to prolong the periods between urinations. These exercises are designed to increase bladder capacity but are only successful in resolving bed-wetting in a small number of patients. In motivational therapy, parents attempt to encourage the child to combat bed-wetting, but the child must want to achieve success. Positive reinforcement, such as praise or rewards for staying dry, can help improve self-image and resolve the condition. Punishment for "wet" nights will hamper the child's self-esteem and compound the problem. The following motivational techniques are commonly used: Behavior modification. This method of therapy is aimed at helping children take responsibility for their nighttime bladder control by teaching new behaviors. For example, children are taught to use the bathroom before bedtime and to avoid drinking fluids after dinner. While behavior modification generally produces good results, it is long-term treatment. Alarms. This form of therapy uses a sensor placed in the child's pajamas or in a bed pad. This sensor triggers an alarm that wakes the child at the first sign of wetness. If the child is awakened, he or she can then go to the bathroom and finish urinating. The intention is to condition a response to awaken when the bladder is full. Bed-wetting alarms require the motivation of both parents and children. They are considered the most effective form of treatment now available. A number of drugs are also used to treat bed-wetting. These medications are usually fast acting; children often respond to them within the first week of treatment. Among the drugs commonly used are a nasal spray of desmopressin acetate (DDAVP), a substance similar to the hormone that helps regulate urine production; and imipramine hydrochloride, a drug that helps to increase bladder capacity. Studies show that imipramine is effective for as many as 50% of patients. However, children often wet the bed again after the drug is discontinued, and it has some side effects. Some bed-wetting with an underlying physical cause can be treated by surgical procedures. These causes include enlarged adenoids that cause sleep apnea, physical defects in the urinary system, or a spinal tumor. Psychotherapy is indicated when the child exhibits signs of severe emotional distress in response to events such as a death in the family, the birth of a new child, a change in schools, or divorce. Psychotherapy is also indicated if a child shows signs of persistently low self-esteem or depression. In rare cases, allergies or intolerances to certain foods--such as dairy products, citrus products, or chocolate--can cause bed-wetting. When children have food sensitivities, bed-wetting may be helped by discovering the substances that trigger the allergic response and eliminating these substances from the child's diet. Alternative treatment A number of alternative treatments are available for bed-wetting. Massage According to practitioners of this technique, pressure applied to various points on the body may help alleviate the condition. Acupressure or massage, when done by a trained therapist, may also be helpful in bed-wetting caused by a neurologic problem. Herbal and homeopathic remedies Some herbal remedies, such as horsetail (Equisetum arvense) have also been used to treat bed-wetting. A trained homeopathic practitioner, working at the constitutional level, will seek to rebalance the child's vital force, eliminating the imbalanced behavior of bed-wetting. Common homeopathic remedies used in this treatment include Causticum, Lycopodium, and Pulsatilla. Hypnosis Hypnosis is another approach that is being used successfully by practitioners trained in this therapy. It trains the child to awaken and go to the bathroom when his or her bladder feels full. Hypnosis is less expensive, less time-consuming, and less dangerous than most approaches; it has virtually no side effects. Recent medical studies show that hypnotherapy can work quickly--within four to six sessions. |
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