Friday, January 31, 2014

Children and Bedwetting -- Popular Parents’ Mistakes and Misconceptions by Dr. Jacob Sagie and Tal Sagie

Even though bedwetting is one the most common problems in children, very few people truly understand it and how to treat it or react to it. As a result, parents of children who have a bedwetting problem often receive advice from professionals that is not very helpful or that is downright misleading. Unfortunately, this is due to a general lack of understanding regarding enuresis in children.

Some more common misconception include:
     That children who wet the bed are lazy because they do not get up to use the bathroom when they need to at night, thus resulting in wetting the bed.
     That a child must wake up in the middle of the night to use the bathroom in order to avoid bedwetting.
     That parents should be the ones to wake a child up from sleeping and make him use the bathroom.
     That children should not be allowed to consume drinks before bed; otherwise, they will wet the bed.
     That punishing a child for wetting the bed or belittling him in front of others for his problem is a good way to handle it.
     That bedwetting is a problem that, if ignored, will eventually be overcome by the child of his own accord.
     That buying pull-ups for the child to wear to bed to prevent an accident is a good way to solve a bedwetting problem.

Of course, there is some logic behind this advice that should be understood:

Waking the Child
Some parents believe that the child cannot sleep through the night without waking up to the use the bathroom at least once. They think that this is what causes bedwetting. However, this is not the case. A child needs to learn how to train the sphincter to contract when the body feels the urge to urinate. By waking the child at night to go to the bathroom, he can never learn to train the sphincter. Not to mention, waking the child to use the restroom at night takes the responsibility of overcoming the problem away from the child and puts it on the parents instead, which is not right.

Restricting Fluids Before Bedtime
Some parents think that if they keep the child from drinking fluids before bed, they will teach the child to stop wetting the bed. Actually, all that fluid restriction accomplishes is making the bladder even more dependent on being empty. In order to overcome bedwetting, the bladder must learn to function while full. Therefore, keeping a child from having a drink before bed will not only keep him from being able to overcome the problem, but may actually make it worse.

Punishment and Embarrassment
Scenarios such as the following are unfortunately quite common: A child runs to his father crying because some other children have somehow learned of his bedwetting problem and have made fun of him for it. Instead of making the child feel better, the father decides to belittle the child in front of the other children, thinking that embarrassing him will further motivate him to want to stop wetting the bed.

In actuality, embarrassing the child or punishing him for wetting the bed will only make him feel even worse. He will feel as though he is a failure and a disappointment, which is not going to motivate him but instead will make him feel helpless. Punishment and embarrassment should never be used as a solution to any problem.

Forcing Children to Wash Bedding and PJs
Many parents of children who wet the bed may also punish them by requiring them to wash their own sheets, bedding, and pajamas after wetting the bed. Parents believe that, by doing this, the child will have no choice but to learn how to quit. However, the reality of this situation is that making the child wash his own bedding and pajamas is another form of punishment that does not encourage the child to overcome enuresis. Instead, it makes him feel even more upset with himself and as though he is not supported by his own parents. This is not the solution to a bedwetting problem but will only be sure to perpetuate the issue.

Overprotection of the Child
Parents, especially those who initially had trouble getting pregnant or those who have children with other medical problems, often make it a point to overprotect their children. Therefore, when a child begins to develop a problem when it comes to wetting the bed, the parents want to take the pain and stress away from the child by taking on the burden themselves.

The issue with this is that, by overprotecting the child, he does not learn to take responsibility for his own problem. Instead, he feels as though it is up to his parents to solve it for him. Unfortunately, parents cannot fix enuresis; it must be overcome by the child himself with plenty of support from his family. Overprotection is never a good solution to bedwetting. It is as simple as that.

Ignoring the problem
A lot of parents find themselves in denial over a child’s bedwetting problem. They may feel like the incidents are just a coincidence and not a recurring issue. By ignoring the problem, however, this will not make it go away. Quite the opposite, really. The child will end up feeling alone in his battle against enuresis and will have a hard time overcoming it as a result. This is a problem that should be addressed by parents and children alike.

Comparisons Among Siblings
Some parents, upon finding that a younger sibling has learned to not wet the bed before an older sibling, will try to use this against the older sibling in an effort to get him to stop wetting the bed. Such parents may say things like, “Why are you still wetting the bed all the time when your younger sister has never wet the bed in her life?” While parents may make such comments with good intentions, the fact remains that doing so will only lead the child to feel more frustrated and even more like a failure. Furthermore, this can lead to animosity between siblings, which is never good.

Having the Child Wear Pull-Ups
Finally, many parents think that making the child wear pull-ups until he overcomes his bedwetting problem is a viable solution. However, all this does is make the issue worse by showing the child that the parents have given up on the issue. This leads the child to feel as though wetting the bed is acceptable and something that he must simply live with forever. In the long run, the child may never learn to not wet the bed and will suffer emotionally as a result.





Friday, August 2, 2013

The causes for bedwetting by Dr. Sagie

The conventional train of thought among both parents and many pediatricians is that bedwetting is a medical or psychological problem. Often, the patient undergoes a comprehensive and unnecessary medical assessment with no findings. However a medical, neurological or urological, problem is only the primary diagnosis among 2% of enuretics. A psychological cause, such as family problems, social adjustment, or fears is a factor among an additional 20-25% of the patients.
In fact, the majority of enuretics (75-80%) do not have either anatomical or psychological problems. For most enuretics the primary source of the issue is unusually deep sleep.  These are normal, healthy children who have not learned to activate the appropriate reflex system during sleep. Typically, when a person sleeps and pressure is built up inside the bladder, a signal is sent to the brain. Among enuretics, the signal is not recognized by the sub-conscious reflex system and instead of contracting the sphincter muscle, the circular muscle that keeps the bowel closed, the child relaxes the muscle and urinates during sleep.

Wednesday, July 31, 2013

Understanding the Enuretic child by Dr. Jacob Sagie and Tal Sagie

Knowing the causes for bedwetting is not enough. It is essential that the parents will understand what it is like to be a child with a bedwetting problem. Since it is a genetic issue, many parents have suffered from bedwetting themselves. Even this is not enough of a preparation to deal with their child's issue.
What is going in an enuretic child's mind? The following story will illustrate the typical situation;
I received a phone call from an ex-patient who is 25 years old. He told me that when he was 9 years old he came with his parents to my bedwetting clinic. His parents accused him of not trying hard enough to deal with the problem and then he reminded me of my response to his parents: "What do you want from him? Why do you blame him? He does not wet the bed on purpose; he doesn't feel when he is wetting the bed". The young man said, “For the first time in my life, I felt that someone understood me". Although many years passed since this meeting, he remembered every single detail from this session and was so grateful. By the way, he outgrew bedwetting after only 3 months of treatment.

If parents will realize what is going on in their child's mind they will certainly act differently by showing understanding, sensitivity, empathy and support.