Natural Enuresis Treatment

99 Ways To Stop Bedwetting

99 Ways To Stop Bedwetting

53 Minutes From Now, You'll Know Exactly How To Stop Your Child From Wetting The Bed...Without Drama Or Discipline. It's one of the hardest problems families face and can be very tough on a child's self esteem. When one of your children is a bed wetter, it can be a very sensitive topic. Even though it's a normal part of growing up, siblings can still give them a hard time.

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Stop Bedwetting Today

Here Are Just a Few Examples of What You'll Discover Inside: The 6 important warning signs that most parents completely overlook. How your behavior can actually be causing your child's bedwetting problem. What to tell your child to make him or her feel better about their problem. How to know for sure that it's time for your child to see a doctor? What you can do to make bedtime less stressful for your child. The easy way to tell whether or not your child has a more serious problem. The single most important thing you can do to make it easier for your child to tell you about an accident. 10 warning signs that you need to seek more aggressive treatment. Click Here to Purchase Stop Bedwetting Today. Why making your child go to sleep earlier can actually help him or her to stop wetting the bed. 6 vital steps that you must follow to prevent your child from developing skin irritations. The single most harmful thing you can do when trying to stop bedwetting. Discover how to give your child hope. How to use night lifting to keep your child dry. 3 bladder control exercises guaranteed to help your child. Click Here to Purchase Stop Bedwetting Today. Which liquids to keep your child away from in the evening. Note: They aren't what you think! The 3 single most effective medications to stop bedwetting fast. Discover the 10 things you should write down every time your child wets the bed. Doing this one simple thing can have a huge impact on your child's problem. What your pediatrician absolutely needs to know, and when you should think about getting a second opinion. 7 amazing resources that can give you incredible information on your child's specific problem. The 5 all-important questions to ask before attempting any bedwetting fix.

Stop Bedwetting Today Summary

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Contents: EBook
Author: Shannon Miller

My Stop Bedwetting Today Review

Highly Recommended

All of the information that the author discovered has been compiled into a downloadable book so that purchasers of Stop Bedwetting Today can begin putting the methods it teaches to use as soon as possible.

As a whole, this book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

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Enuresis

Enuresis, or incontinence, may persist due to motor and mental difficulties. In the severely impaired child, as with infants, urinary tract infections should be considered in the uncomfortable, ill-appearing child without clear evidence of other infectious sources. An increased incidence of urinary tract infections has been observed without evidence of urinary tract abnormalities. This has been ascribed to hygiene issues in the past, although a neurogenic bladder with urinary retention should be ruled out. A urinalysis should be done, with care taken to limit external contamination. Contractures of the hips and tight adductors make it difficult at times to clean the vaginal and perineal areas. Referral for radiologic studies to rule out anomalies of the urinary tract is recommended. Most urinary tract infections can be managed on an outpatient basis. If pyelonephritis is suspected, a urology consultation and hospitalization should be considered.

Empirical Studies

Arousal training has been shown to be extremely effective in the treatment of enuresis, provided it is maintained for a sufficient period of time, and implemented appropriately by parents. Clearly, if the enuresis is due to a physiological condition, the problem needs to be treated using appropriate medication. These medications, and their effectiveness, will not be considered in this chapter, for this discussion focuses primarily on the treatment of enuresis due to a psychological etiology. Van Londen and colleagues demonstrated that arousal training obtained a 98 success rate with nonclinical boys and girls with nocturnal enuresis between the ages of 6 and 12 years. Even 2V2 years after the initial training, 92 of children were continent. This compared with a success rate of 84 where reward reinforcement only was used, and 73 percent where the urine alarm was used without any rewards. The 2V2 year success rate for these two approaches was 77 and 72 , respectively. The majority of...

Ethical Implications

Principles of operant conditioning, with desired behavior brought about without the moral tags of praise and blame. His work also provided the theoretical and technical foundations for various behavior therapies applied to disturbances ranging from bed-wetting to catatonic withdrawal. Considered ethically, these methods would seem to be neither more nor less coercive than those arising within other theoretical contexts and employed for the benefit of consenting patients.

Complications Of Penile Rings

Penile strangulation can occur from pressure around the entire penile circumference by rings, hair, or other devices. Since delay in relief of strangulation can lead to vascular compromise and other serious consequences, these devices must be removed rapidly. Penile-strangulating objects have been placed for masturbatory purposes, as adjuncts to vacuum erection devices, to prolong erections, enhance sexual performance, and often by children during experimentation. Such devices have also been used to prevent enuresis and nocturnal emissions. In the pediatric population, the possibility of child abuse must also be considered.

Procedure Modifications

The schedule of alarm presentation refers to the percentage of nighttime wets that will activate the alarm system. In the traditional protocol, referred to a continuous alarm, each bedwetting episode activates the alarm. A 70 variable ratio schedule indicates that on average 70 of the wets triggered the alarm. In some cases the percentage of wets triggering an alarm can increase or decrease during the period of treatment. In general the continuous alarm was more effective in terms of the duration of treatment and percentage of children achieving continence. The overall relapse rate, however, seemed to be somewhat less when the alarm was programmed on a more intermittent basis.

Correlates of Success and Failure

As in any type of therapy it is important to identify those factors that seem to be associated with success and failure. It seems logical to assume that the acquisition of control over pelvic floor musculatures involved in the inhibition of voiding would be associated with successful treatment. Such muscular activity can be evaluated by the use of surface electromyographic studies (sEMG). In fact, children who were successfully treated for nocturnal enuresis were found to have a higher peak voltage when compared to those that failed. Furthermore, when measured prior to treatment, successful children had lower peak voltage (1.9 microvolts versus 2.7 microvolts). This observation encouraged The use of DDAVP in conjunction with the urine alarm may help to reduce the dropout rate and therefore increase the number of children that are successfully treated. The effect of adding DDAVP to the urine alarm tends to occur in the first 3 weeks of treatment. Beyond this there appears to be no...

Summary And Recommendations

The urine alarm has assumed and maintained a position of prominence in the treatment armamentarium for nocturnal enuresis. The apparatus generally consists of some type of sensing device activated by the presence of urine. The device is placed on the bed. The child is awakened by a bell, buzzer, or some other stimulus designed to initiate involuntary or voluntary suppression of voiding until the child reaches the

Cruelty Toward Animals And Human Violence

The belief that one's treatment of animals is closely associated with the treatment of fellow humans has a long history, but despite the long history and popular acceptance of this concept, until recently there have been few attempts to systematically study the relationship between the treatment of animals and humans. In the early 1900s case studies by Richard Krafft-Ebbing and Sandor Ferenczi began to explore sadistic behavior toward animals associated with other forms of cruelty. However, single case histories do not provide much insight into the origins of animal abuse and its connections to other violent behavior. In 1966 Daniel Hellman and Nathan Blackman published one of the first formal studies of animal cruelty and violence. Their analysis of life histories of 84 prison inmates showed that 75 of those charged with violent crimes had an early history of cruelty to animals, fire setting, and persistent bed wetting. Several subsequent studies looked for this ''triad'' of symptoms...

Overview Of Contingency Contracting

Successful completion of the respective target behavior. Significant others are usually persons who are of higher authority status than the patient (e.g., parent, employer, supervisor). An example of this method of contracting would be a parent permitting his bed-wetting 6 year old to view television from 5 to 7 p.m. if the child evidences continence during the preceding night.

Posttraumatic Stress Disorder Ptsd

In the initial stage, the child generally reacts to the trauma with separation anxiety, and in more severe cases with regression (e.g. bedwetting at night). Regression can at times be to very early stages of childhood. A 10-year-old child who arrived at our clinic about 6 years ago, whose classmates introduced a pencil into his sexual organ, regressed to a developmental stage of 2 years old for a period of a year and only regained speech 4 years after the trauma. Difficulties with falling asleep and waking up in the middle of the night appear. A lower stimulus threshold is present, as well as expressions of unexpected aggression. The most important element in the diagnosis is the change that takes place in the child's behaviour. This change, when compared with previous behaviour, must bring the clinician to suspect a traumatic event.

Development Of Continence

Enuresis is defined as the involuntary discharge of urine after the age at which bladder control should have been achieved, in most cases 5 years of age. Enuresis can occur at night (nocturnal enuresis NE ) or daytime (diurnal enuresis), or both. NE can be further subdivided as primary (continuous), and secondary (discontinuous). The term primary NE is applied to children who have never achieved urinary continence for at least 6 continuous months. Secondary NE refers to those children who achieved dryness only to later relapse to wetting. The majority of NE cases, some 90 , are primary enuretics. (higher than normal episodes of voiding), and or urgency (persistent urge to void). Children evidencing nocturnal enuresis in the absence of any other such symptoms are referred to as monosymptomatic. Approximately 10 to 20 of all 5-year-olds wet their bed at a frequency sufficient enough to be considered as NE. In most cases this involves wetting the bed one or more nights per week or at a...

Heterocyclic Antidepressants Hcas

Although tricyclic antidepressants (named for their three-ring structure) were first synthesized in the nineteenth century, their antidepressant properties were not recognized until the late 1950s. Since that time, other cyclic antidepressant agents have been formulated thus creating need for the more general term heterocyclic (Table., .282-3). The therapeutic effect of HCAs is believed to be related to secondary downregulation of norepinephrine and serotonin postsynaptic receptors after initial blockade of presynaptic reuptake of norepinephrine and serotonin. HCAs are primarily indicated for major depression but may also be effective for dysthymic disorder, panic disorder, agoraphobia, obsessive compulsive disorder, enuresis, and school phobia. As previously advised, initiation of HCA therapy in the emergency department is not routinely recommended.

Behavioral Analysis

A behavioral analysis of nocturnal enuresis focuses on the role of environmental conditions and appropriate learning experiences or conditioning. Treatment A behavioral analysis does not ignore the potential contribution of psychological abnormalities such as childhood depression or anxiety Rather, the behavioral analysis emphasizes the application of behavioral theory and principles of conditioning learning to the treatment of nocturnal enuresis in place of more traditional verbal psychotherapy. The latter has not been found to be a very effective approach in treating nocturnal enuresis. In addition, behavioral analysis assumes that there is no underlying medical pathophysiology causing the nocturnal enuresis that would interfere with the use and potential effectiveness of behavioral therapies. Some theories have been put forth to explain nocturnal enuresis and the outcome of urine alarm or bell-and-pad treatment. One such theory utilizes a classical conditioning paradigm. In this...

Basic Tenets And Philosophy

Relative to other treatment approaches, CBT for children has received strong empirical support. Today CBTs are applied to a wide range of childhood problems and disorders including anxiety and phobic disorders, depressive disorders, aggressive and disruptive behavior problems, substance abuse and eating disorders, as well as pediatric or medical concerns (e.g., coping with painful medical procedures, enuresis, and irritable bowel syndrome). Although reviews clearly highlight the need to develop more and better empirically supported treatments for youth, CBTs for children and adolescents stand out in that they have led the way in doing so. For example, a recent review of the empirically supported treatment literature finds support for CBTs in the treatment of anxiety disorders and phobic disorders, conduct disorder oppositional defiant disorder, chronic pain, depression, distress due to medical procedures, and recurrent abdominal pain (Chambless & Ollendick, 2001). In addition,...

Pharmacological Treatment

Reported in children as young as 3 years of age 94 . Common lithium side effects in children include weight gain, nausea, diarrhoea, tremor, enuresis, fatigue, ataxia, leukocytosis and malaise. Less commonly seen side effects are renal, ocular, thyroid, neurological, dermatological and cardiovascular. Changes in growth, diabetes and hair loss have also been reported 95,96 . Younger children may experience more side effects than older children 97 .

Urine Alarm Plus Medications

Doleys, which was referred to earlier, several medications including dex-amphetamine sulfate (Dexadrine), methamphetamine hydrochloride (Methadrine), and imipramine (Tofranil) were used in the treatment of nocturnal enuresis. When dexamphetamine, methamphetamine, or imipramine was combined with the standard urine alarm protocol the duration of treatment was shorter although sometimes by a very small number of nights. However, the relapse rate was higher. In an analysis of the data, Gordon Young and Keith Turner indicated that the shorter duration of treatment was probably not clinically significant and amounted to perhaps one or two trials. This fact, combined with the indication of the possibility of misuse of the drugs by children in the absence of proper safeguards, resulted in the conclusion that there was little distinct advantage to adding these preparations to the urine alarm procedure.

Use of psychotropic drugs in specific childhood disorders

Nocturnal enuresis This is quite a common condition affecting some 7 of 7 year olds who continue to wet the bed at least once a week. The cause of nocturnal enuresis is complex and beyond the scope of this volume. It is evident, however, that various treatments are available including retention control, dry-bed training, enuretic night alarms and waking the child to urinate The efficacy of imipramine has been repeatedly demonstrated in controlled trials about 85 of children treated within a week of the start of medication, but tolerance frequently develops after a number of weeks and relapse is high after discontinuation of the treatment. Relatively low doses of imipramine only are needed, but the typical side effects of tricyclic antidepressants limit the prolonged use of the drug. The mechanism of action of imipramine in the treatment of nocturnal enuresis is unclear but one possible action is through a direct anticholinergic action on the bladder wall. The synthetic vasopressin...

Lower Urinary Tract Symptoms

Rition symptoms (Abrams et al. 2002). Storage symptoms include frequency, nocturia, urgency, and urgency incontinence. It is important to differentiate a normal urge to void and urgency, and similarly nocturia from nocturnal polyuria. Voiding symptoms include hesitancy, poor stream, intermittency, straining to void, incomplete bladder emptying, and UR. A case can be made for considering enuresis secondary to chronic retention - overflow incontinence - as both a storage and a voiding disorder. Postmicturition symptoms include terminal and postmicturition dribbling.

Theoretical Bases

Enuresis may have either an organic or a psychological etiology. This discussion focuses on the psychological explanation for development of the disorder and on the reason for the effectiveness of arousal training in its treatment. It has been proposed that the waking alarm described earlier works through classical conditioning. Repeated pairings occur between the sensation of a full bladder, the child wetting the bed, the sound of the alarm, and the child waking up. In time, the child learns to wake to the sensation of a full bladder prior to wetting the bed. Thus, the training is focused on the eventual association between a full bladder and waking up. Arousal training for enuresis also utilizes operant conditioning. Children may perceive the sound of the alarm, waking in the night, and cleaning up as an aver-sive condition, and so may learn to avoid this situation by learning to keep dry. Both of these behavioral approaches use the theoretical underpinning of conditioning to...

Characteristics of Manualized Interventions

Headache to childhood enuresis, sexual dysfunction to sex offenses. A detailed list of empirically supported treatment is provided by Hayes, Barlow, & Nelson-Gray in their 1999 book. Criteria have been developed for three levels of empirically supported interventions well-established treatments, probably efficacious treatments, and experimental treatments. These criteria were developed by a task force formed by Division 12 of the American Psychological Association whose mandate was to formulate both criteria for determining efficacious treatments and to identify treatments that have been established.

Summary

Arousal training is a therapeutic technique that uses learning principles to either decrease or increase levels of arousal in order to achieve an appropriate therapeutic outcome. This approach has been used effectively in the treatment of nocturnal enuresis among children. Interventions are most likely to be effective if both the child and the parent are highly motivated, and if the arousal alarm in combination with reinforcement is used in the treatment regime. It is also important to continue treatment for a number of weeks after the child has a dry bed in order to firmly establish the new learning processes. Arousal training also appears to be effective in the treatment of inorgasmia in women. Learning theory can be used to explain the development of this sexual dysfunction, and inorgasmic women have been shown to experience low levels of sexual arousal. Although further research is needed to determine other strategies to enhance arousal, preliminary research would suggest that...

Pathophysiology

With increased age, the problems with bladder emptying tend to progress. Some patients may develop problems fully emptying their bladder, with the development of increased residuals due to an encroaching prostate and worsening obstruction whereby the failing or tiring detrusor is unable to adequately compensate for the obstruction. This can culminate in acute-on-chronic UR, where the patient is unable to void despite a volume often in excess of 1.51 in the bladder. These patients also often have enuresis (so-called overflow incontinence), and in some cases the volumes retained may preclude full recovery of detrusor function (Chapple and Smith 1994). Others may have an episode of AUR, which typically presents as described in Sects. 11.2.2.2 and 11.2.2.4, and requires emergency treatment by catheterization (see Chap. 19, Surgical Techniques and Percutaneous Procedures). In some cases, prolonged BOO and the development of residuals will predispose to the formation of bladder stone(s),...

Other Parasomnias

The other parasomnias are disorders in which the phenomena of interest are not closely associated with a particular stage of sleep. Of the other parasomnias, features of three may suggest the possibility of epilepsy sleep bruxism, sleep enuresis, and nocturnal dissociative disorder. In the psychogenic nocturnal dissociative disorder, conscious awareness becomes dissociated from behavior, and patients perform complex activities for which they are amnestic. Patients are often young women with psychiatric conditions, and the episodes are sometimes accompanied by self-mutilating behavior and injuries.

Clinical Features

Sleep enuresis, defined as recurrent involuntary bedwetting that occurs beyond the age of expected nocturnal bladder control, is a common distressing disorder. The age at which continence is expected varies across cultures while the prevalence of continence is similar. In general, girls attain nocturnal continence earlier than boys. If continence has never been attained, the disorder is called primary sleep enuresis, while enuresis that recurs following a period of at least 3 months of bladder control is called secondary sleep enuresis. Primary sleep enuresis accounts for 75 of cases however, in older children, up to half have secondary enuresis. Because nocturnal seizures may be accompanied by incontinence, epilepsy is sometimes a part of the differential diagnosis. The majority of children achieve bladder control by age 4 with a 1-3 prevalence of enuresis at age 12 and a 1 prevalence in young adults (Schmitt, 1984 Klackenberg, 1987 Friman and Warzak, 1990). Daytime enuresis occurs...

Generalized Epilepsy

The parasomnias refer to clinical disorders consisting of undesirable physical phenomena that occur predominantly during sleep (DCSC, 1990). They have been classified based on the stage of sleep from which they originate. They include both normal and abnormal phenomena. Included in the category of NREM parasomnias are hypnic jerks and hypnic imagery, considered to be normal, in addition to confusional arousals, sleep terrors (pavor nocturnus), and sleepwalking (somnambulism), referred to as disorders of arousal. These all originate from deep NREM sleep, stages 3 and 4. They are all common in childhood and decrease in frequency as age increases. These individuals tend to have a family history of similar disorders. REM parasomnias include nightmares and REM behavior disorder (RBD). A third group consists of disorders that may occur during any or all sleep stages and includes bruxism, enuresis, rhythmic movement disorder (including head-banging), sleep talking (somniloquy), and...

Postictal Sleep

Postictal sleep is a common phenomenon after a generalized tonic-clonic seizure. The patient may pass through several stages from sleep to delirium to drowsiness before awakening. During the late postictal state, the heart rate begins to normalize from the typical ictal tachycardia. There is a decrease in muscle tone with bladder sphincter relaxation and incontinence that typically occurs in the early postictal phase. In the immediate postictal phase, there is partial obstruction of the airway resulting in stertorous respirations. Deep tendon reflexes are diminished and the plantar responses are sometimes extensor. The patient then may pass into sleep. If the seizure occurs during the night, the patient may sleep through the postictal period and awaken with complaints of tongue soreness, muscle aches, or nocturnal enuresis. Patients may often experience postictal morning headaches or unexplained bruises.

Nematodes Roundworms

ENTEROBIUS (PINWORM) Adult Enterobius (pinworm) resides in the cecum, appendix, ileum, and ascending colon after its eggs are ingested. The gravid female migrates to the anus, especially at night, where it causes intense pruritus. Autoinfection with hand-to-mouth transmission is possible after scratching. A host of problems from vaginitis to enuresis have been attributed to Enterobius infection without good evidence. It is most prevalent in temperate climates during the winter and fall. The diagnosis is confirmed with a cellophane tape swab of the anus. All family members should be examined. Treatment is with pyrantel pamoate, albendazole, or mebendazole and should be repeated after 2 weeks.

Marita P McCabe

Arousal training is a technique that is used in the treatment of a number of clinical conditions. The essential aspect of the treatment involves training individuals to detect their levels of arousal, which are then the focus of treatment. Patients are trained either to further enhance arousal levels or to reduce levels of arousal, depending on what is required for a successful outcome. This article focuses on two quite different conditions that utilize arousal training enuresis and inorgasmia in females. These two conditions have been selected because (1) there is a reasonable body of literature that relates to the use of arousal training with these conditions and (2) the treatment of enuresis involves training the individual to lower arousal levels, whereas the treatment of inorgasmia involves training to increase arousal levels. Arousal training among children with enuresis generally involves teaching the child to use a waking device to prevent them from wetting the bed. Parental...

Biological Basis

Genetic factors may play a role in some cases. Enuresis is more common in children of enuretics than in the general population, and in some families, the pattern of involvement is consistent with an autosomal dominant inheritance with greater than 90 penetrance. Linkage to markers on chromosome 13 has been reported (Eiberg et al., 1995). Primary sleep enuresis is caused by a combination of genetic, maturational, psychosocial, and endocrinological factors the relative importance of each of these varies across individuals. Anatomic abnormalities of the genitourinary system and other sleep disorders such as obstructive sleep apnea are uncommon in enuretic children although they may contribute to enuresis in some (Friman, 1995). Psychosocial factors that may contribute to or exacerbate enuresis include marital discord, parental separation, sexual abuse, and birth of a sibling. Maturational factors may also contribute because enuretic children tend to have lower birth weight, delayed...

Wetting

Wetting in children can be caused by anatomic incontinence (ectopic ureter, bladder obstruction, extrophy), neurogenic incontinence (spinal dysraphism, trauma, tumours), functional incontinence (urge syndrome, fractional voiding), enuresis (nocturnal, diurnal), and other conditions (urinary infection, polyuria). Incontinence is characterized by failure of voluntary bladder control and incomplete emptying whereas in enuresis emptying is complete and the child is often unaware when wetting occurs. Primary nocturnal enuresis (defined as wetting 2 times per week for 3 months in a child 5 years) affects 15-20 of 5 year old children. The natural course is spontaneous resolution, at a rate of 15 of patients per year. Even though enuresis causes no physical harm, adverse psychological consequences may be sustained. The diagnosis of primary nocturnal enuresis is achieved by exclusion, starting with a good history including psychological evaluation, and proper physical examination. The child...