When Dr. Lazarus sees patients who are motivated and have no other medical or psychological problems, they typically have significant improvement in keeping the bed dry after only 2 to 3 visits!
Bedwetting, medically known as nocturnal enuresis (NE), is a common pediatric issue that can follow children into their early teens. Bedwetting can have significant impact on a child or adolescent’s life. He may feel sad, ashamed, and embarrassed. She may worry that she might have an accident while sleeping at a friend’s home or while away at overnight camp. Some “feel like babies” because they still have to wear pull-ups at night.
BEDWETTING INFORMATION:
WHY IT OCCURS / WHICH AGES IT TYPICALLY OCCURS / IMPACT ON A CHILD’S LIFE
Causes of Bedwetting
Nocturnal enuresis may be due to:
- Constipation: the leading cause of bedwetting is constipation.
- Sleep apnea: this is occasionally related to enlarged adenoids and tonsils.
- Children not being able to recognize when their bladders are full while they are sleeping.
Before considering medical hypnosis for treatment, your child should be evaluated by his or her primary care clinician, including having a urinalysis. When other biological causes have been eliminated, it is not clear why bedwetting occurs and may simply be an unconscious habit that some children develop.
Bedwetting is usually not a problem until it becomes a problem for the child
If the parent wants the child to be dry, and the problem doesn’t bother the child, then the child is not ready for this, or any other, type of treatment.
There is often a family history for nocturnal enuresis (NE). If one parent has had NE, then there is a 44% chance that the child will. If both parents had NE, then there is a 78% chance that the child will also have NE.
It is important to realize that just because the parents used to have NE, this does not mean that the child will not benefit from medical hypnosis. Medical hypnosis techniques to control bedwetting have been effective for many, many children whose parents had NE.1
Bedwetting Age:
Which Ages it Typically Occurs
The prevalence of bedwetting reveals that 15% of 5 year-olds, 10% of 6-year-olds, 5% of 10-year-olds, and 1 out of every 100 15-year-olds is still wetting the bed at night. Sadly, many children are so embarrassed by this problem that they don’t even want to mention it to their primary care clinician!
In general, Dr. Lazarus doesn’t consider this to be a problem until children are around 8 years old. Of course, there are younger children who are motivated to become dry at night, and older children who still don’t care about it.
Hypnotherapy for Bedwetting:
How to Stop Bedwetting
The largest study regarding the use of medical hypnosis for bedwetting was a series of 257 children conducted by Dan Kohen, MD, (1984). Most had previously tried the bedwetting alarm or bedwetting medication. After learning medical hypnosis, 45% were completely dry, defined as 30 nights in a row and 1 year later without relapse. An additional 32% were dry more than 50% of the time. Importantly, it was found that successful patients usually demonstrated improvement after only 2 or 3 visits. Unsuccessful children were either not motivated or had parents who were too involved.3
Before Dr. Lazarus sees patients in his office, he screens them by talking with the parents first, over the telephone, for about 30 to 40 minutes, at no charge. He is mainly interested in knowing the following:
- Is the child motivated?
- Is the child constipated?
- Does the child have any other significant psychological or psychiatric problems?
About Jeffrey E. Lazarus, MD, FAAP
Dr. Lazarus is a board certified pediatrician. He received his training in pediatrics at Stanford University Medical Center. He wrote the chapter on nocturnal enuresis, or bedwetting, for a recent pediatric hypnosis textbook. He has also had the privilege of teaching the workshops on this subject at the last few meetings of the International Society of Hypnosis, where he taught clinicians from around the world how to use these techniques to help their patients attain dry nights.
Dr. Lazarus combines more than 25 years in general pediatrics with a 20-year medical hypnosis practice.
Statistics on Hypnosis for Bedwetting Children
Medical hypnosis has been found to be effective as a nocturnal enuresis treatment, even after traditional approaches, including the bedwetting alarm, medication, drinking less before bedtime, and having someone wake the child during the night, have failed.
Karen Olness, MD, (1975) taught self-hypnosis (SH) to 40 children with nocturnal enuresis (NE). Thirty-one were dry, usually within the first month.4
Stanton (1979) had a similar series of 28 children: 20 were dry within 1-3 visits, 15 of those were still dry 1 year later.5
KEEPING THE BED DRY
Bedwetting Video
Dr. Lazarus has also developed a new bedwetting video to help families manage bed wetting in children and adolescents. View the Keeping the Bed Dry video at its dedicated website and help your child control the bed wetting problem with the use of self-hypnosis.
Alternative Bed Wetting Solutions & Studies – ddAVP & Alarms
The most common approaches in the treatment of nocturnal enuresis, or bedwetting, include medication (most commonly desmopressin, also known as ddAVP) and the bedwetting alarm.
It is important to note that these alternatives to hypnotherapy give the message that the patient relies on an external locus of control instead of an internal locus of control. This means that the patient learns to be dependent on someone else, or something else, rather than on his or her own internal resources. Medical hypnosis teaches internal locus of control so the child feels empowered and in control!
Tricyclic Antidepressant Concerns
Imipramine is a tricyclic antidepressant. One of its side effects is urinary retention. That is why it used to be used for bedwetting. As it happens, a more serious side effect is a cardiac arrhythmia! So, my question is: Why would you treat a non-life-threatening condition with a potentially life-threatening medication?
Bedwetting Medications
In 1993, Banerjee, et al, compared hypnotherapy with imipramine. After 3 months, both the hypnotherapy and medicated groups were about 75% improved. At this time, the imipramine was stopped and the self-hypnosis group was encouraged to continue doing the hypnosis exercise. Six months later, only 24% of the imipramine group participants were still doing well compared with 68% of the hypnotherapy group.6 Imipramine is a medication that used to be used commonly to treat nocturnal enuresis. In general, this medication is no longer used due to side effects.
Lister-Sharp et al (1997) found that the use of most medications provided one more dry night per week during treatment, and most patients relapsed after the medication was discontinued.7
Hjalmas et al’s study (1998) of 399 children using DDVAP for one year revealed that 37% were dry on or off the medication, and they concluded that this was probably due to spontaneous cure, meaning that the children had become dry on their own, having nothing to do with the medication.8
Bedwetting Alarms
Bedwetting alarms and buzzer treatment systems may take up to six months to work, and we have all heard stories of the alarm waking everyone in the household…except the patient! In addition, for this approach to work, both the child and the parents must be very motivated, and it requires a great deal of parental involvement and supervision.9
Vermandel et al. studied 34 patients with NE in 2005, all of whom had had prior treatment, including medication. All had undergone cystometry, a very invasive procedure. They used bladder training, oxybutynin (a medication that can help for daytime accidents but not night-time accidents), and a bedwetting alarm. They concluded that nighttime dryness is obtained mainly from increase in arousal sensitivity, and not from medication or the alarm.10
To date, there has been only one study comparing hypnotherapy to the bedwetting alarm. Patients in the hypnosis group who were motivated, experienced success more quickly than those using the alarm.11
Previous research has documented a strong placebo effect for medication in the treatment of NE. This ranges from 59% at four and eight weeks to 37% long-term (Rombis, Triantafyllidid, et al, 2005; Humphreys and Reinberg, 2005; Smellie et al, 1996). The strong placebo response for NE can actually be an indicator that hypnosis would be an effective treatment. It supports the value of the power of the mind over the body in resolving this issue.12-14
References:
1. Lawless MR, McElderry DH. Nocturnal enuresis: current concepts. Pediatr Rev. 2001;22:339 – 407.
2. Caldwell PHY ,Deshpande AV ,Gontard AV. Management of nocturnal enuresis. BMJ 2013;347:f6259.
3. Kohen, D.P., Olness, K.N., Colwell, S., & Heimel, A. 1984. The use of relaxation/mental imagery (self hypnosis) in the management of 505 pediatric behavioral encounters. J Dev Behav Pediatr, 1: 21-25.
4. Olness K. 1975. The use of self-hypnosis in the treatment of childhood nocturnal enuresis. A report on forty patients. Clin Pediatr (Phila) Mar;14(3):273–279.
5. Stanton, HE. 1979. Short-term Treatment of Enuresis. Am J Clin 22:103-107.
6. Banerjee, S., A. Srivastav, and B. M. Palan. 1993. Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy. Am J Clin Hypn 36:113-119.
7. Lister-Sharp, D., et al. (1997). A systematic review of the effectiveness of interventions for managing childhood nocturnal enuresis. Research Report. York: University of York.
8. Hjalmas, A. et al. Nocturnal Enerusis : An International Evidence Based Management Strategy. The Journal of Urology 2004;171:2545-61
9. Glazener CMA, Evans JHC, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002911. DOI: 10.1002/14651858.CD002911.pub2.
10. Vermandel, A., de Wachter, S., and Wyndaele, J-J. (2005). Refractory monosymptomatic nocturnal enuresis: A combined stepwise approach in childhood and follow-up into adolescence, with attention to the clinical value of normalizing bladder capacity. BJU International 96: 629-633
11. Seabrook, J., Gorodzinsky, F., Freedman, S. 2005. Treatment of primary nocturnal enuresis: A randomized clinical trial comparing hypnotherapy and alarm therapy. Pediatr Child Health 10(10): 609-610. (Personal communication – Drs. Gorodinsky and Freeman, 2013)
12. Rombis, V., Triantafyllidis, A., Balaxis, E., Kalaitzis, C, and Touloupidis, S. (2005). Nocturnal Enuresis in Children: A four-year experience in outpatient clinics of pediatric urology. Folia Medica, XLVII.
13. Humphreys, M. R., and Reinberg, Y. E. (2005). Contemporary and emerging drug treatments for urinary incontinence in children. Paediatr Drugs 7:151-162.
14. Smellie, J. M., V. S. McGrigor, S. R. Meadow, S. J. Rose, and M. F. Douglas. 1996. Nocturnal enuresis: a placebo controlled trial of two antidepressant drugs. Arch Dis Child 75:62-66.
13. Glazener CMA, Evans JHC. Desmopressin for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002112. DOI: 10.1002/14651858.CD002112.