Dry Bed Training (part 3)
Treatment Options # 1-4
1.Habit Changing
– reduce fluid intake after supper may be a reasonable start
– reduce fluids containing caffeine
– ensure the child “completely” voids before bed
– using rewards and punishments for a behaviour while
sleeping us usually a no win situation
– rewards MAY have a place but there will be no greater reward
for the child than to wake up dry in the morning
– there is absolutely no place for punishing a child for doing
something in his sleep
3. Night Lifting (getting the child up to go to the bathroom)
– frequently done by parents before they go to bed
– there is no reliable evidence to support night lifting (that I can
find) and considerable research condemning it
– passes responsibility onto others- it should belong to
the child
– creates tension between child and parent – the child
usually does not want to get up – not a good to
engage in a battle
– reinforces wetting wile asleep because the child may
appear to be fully awake but more likely to still
be asleep
4. Bladder Training (N.B. – the child should be examined by a doctor to ensure there are no structural problems in the urinary organs or urinary tract infection before attempting bladder training)
There are 2 physical problems that may respond to bladder training:
a) weak sphincter muscle at base of bladder
b) small “functional” bladder capacity
The sphincter muscle at the base of the bladder is sensitive to pressure. Initially the slightest pressure of urine triggers the reflex action in a baby and he/she expels urine immediately. However, as the child matures and develops, the neurological and urinary systems are conditioned to retain urine for longer periods.
Bladder training means to systematically exercise the sphincter muscle in hopes of developing it faster. We want it to move past the reflex stage so it will be able to retain using longer and come under conscience control.
The second part of bladder training involves conditioning it to hold more – in essence increasing the bladder capacity which reduces the frequency of urination. In reality we do not change the actual size of the bladder but we can train it to hold more releasing it. Doctors tell us that a developing child will naturally pass more using with each voiding as he gets older. The actual size of bladders from one child to another varies little however the FUNCTIONAL CAPACITY can vary enormously.
Bed wetters typically urinate small amounts with each voiding. Their bladders are roughly the same size as non bed wetters but they have not been conditioned to hold more – the enuretic child passes about 50% of the volume of urine with each voiding as the non bed wetters.
The experts suggest a procedure that is designed to address both problems at once. The process is simple but, but at first may sound counterproductive – DRINK WATER , LOTS OF IT. When the child feels the need to void, encourage him to hold on as long as possible. Two good things happen if the child cooperates and does this over a period of time;
1) the sphincter becomes conditioned to withstand increased
pressure before responding to ref;ex and opening
prematurely
2) the amount of urine the bladder will accommodate between
voidings will increase
When these two things happen sufficiently, the child will be dry at night – guaranteed!
To be continued