Bedwetting

Bedwetting (nocturnal enuresis) is the involuntary loss of urine during sleep. The condition affects approximately 10 percent of six-year olds, 5 percent of 10-year-olds, and 1 percent of 15-year-olds.

Nocturnal enuresis means bedwetting only. Urinary incontinence means wetting both day and night, or isolated daytime wetting. Primary enuresis means that a child has never been dry for at least six months straight. Secondary enuresis means that the child has had a dry spell for at least six months. Secondary enuresis is usually associated with other psychological conditions.

Fifteen per cent of 5-year-olds are still not dry in the morning; 10 per cent of 6-year-olds, and 5% of ten-year-olds are also not dry in the morning. Unfortunately, one out of every 100 fifteen-year-olds also suffers with this problem. Most experts do not consider this condition a problem until children are 8 years old, as long as they are dry during the day. If they are having daytime accidents as well, then referral to a pediatric urologist is appropriate.

If one parent had this problem, there is a 44% chance that the child will have this issue. If both parents had this, there is a 78% chance.

The evaluation of primary enuresis is pretty simple. It is based on the patient’s history, physical examination, and a urinalysis. The physical examination is extremely important as there are many medical conditions that can contribute to this problem. The urinalysis rules out urinary tract infections and diabetes.

Ineffective treatments for bedwetting include: punishment, waking the child at night, and fluid restriction. Treatment options include: (1) tincture of time. There is a 15% spontaneous resolution per year of age. So, if 100 ten-year-olds are not dry in the morning, the following year, 15 will be dry and the other 85% will still not be dry. The following year, 15% of the 85 children will be dry, etc. (2) The alarm/buzzer system has a 36 to 70% cure rate but it may take 6 months to work. The parents and child must be very motivated for this to work, and, often it wakes up everyone in the house except the patient! (3) ddAVP, or vasopressin. This is a hormone that increases water reabsorption in the kidneys, thereby causing more concentrated and lower volume of urine. Side effects can include nausea, headaches, and rarely, seizures. It is only up to 25% effective, which is not much different than the 15% spontaneous cure rate. And, when the medication is stopped, the relapse rate is 95%. (4) Clinical hypnosis. In clinical hypnosis, we use guided imagery to create an experience that allows patients to realize that they are able to do things that they did not previously know that they could do. It is effective only in patients who are motivated. If the parent is motivated and the child is not motivated, it is not effective. Dramatic improvement is usually seen after only two or three visits, plus, there are no side effects.

A note about motivation: Sometimes children wake up at night in a wet bed, and then spend the rest of the night sleeping with the parents in their bed. As long as parents allow this, there is no incentive for the child to stay dry and the bedwetting will likely continue.

Joe's story
Joe is a 10-year-old boy who had never been dry at night. At the first meeting, he talked with Dr. Lazarus and received some “homework.” When he returned the following week, he had been dry five out of seven nights! At the second visit, he learned self-hypnosis-and he has been dry ever since. He chose not to return for a third visit because he had cured himself.

Jason's story
Jason is a 19-year-old young man who had never been dry at night. His first visit was during the summer and he was concerned because he was starting college in the fall. He wanted Dr. Lazarus to send a letter to the housing office explaining that he needed a single room in the dorm because he was embarrassed about wetting the bed. He got the letter and the single room-but he didn't need it. After the second visit, he was dry!

In the initial visit, Dr. Lazarus talks with the child to put him or her at ease, uses pictures to illustrate how the brain and bladder work together, and assigns “homework” for the child to work on. Typically, there is improvement after only two or three visits.

Dr. Lazarus recently wrote the chapter on bedwetting for a new book on hypnosis designed to help clinicians treat children with this condition. (See CV for details).

Download the Enuresis Questionnaire (PDF)
Download the Imagery Discomfort Questionnaire (PDF)

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