How To Stop Bed Wetting - Nocturnal Enuresis

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Hi, I'm Dr. Paul. This is Live On Purpose TV. A thing from my past that you might not

know, I did my doctoral dissertation on bedwetting. I'm going to share some tips

with you today about how to help kids stop wetting the bed.

Those of you who know me, may be

surprised that I'm doing a video about bedwetting but I gotta give you a little

bit of the history of this to become a doctor, to receive my PhD, I had to do

what's called a doctoral dissertation. My dissertation, got it right here.

My dissertation is basically everything you never wanted to know about

bedwetting. Yeah, this is part of my history and I used to work a lot with

kids who wet the bed and it came up that there was a missing piece of information

out there in literature. All of the parents that I talked to could have told

you this, kids who wet the bed sleep more deeply, they're harder to wake up than

kids who don't. The parents could tell you that but it was nowhere in the

psychological or the pediatric or the urological literature, wasn't anywhere,

that had never been shown or demonstrated until Dr. Paul shows up and

proves it with his doctoral research on bedwetting, that's basically what I did.

You probably don't want to read this but I'm going to share with you a few of the things

that I learned about bedwetting so that we can get on top of this thing.

My dissertation, by the way, was also published in the journal of Children's Health Care,

which shows that it was a significant contribution to the field of

knowledge in this area we didn't know. Scientifically proven that kids slept

more deeply wet the bed. Now this leads into two of the things that I want

to talk about here, there are two primary causes for bedwetting. Now first of all,

there's different kinds of enuresis or or bedwetting, I'm talking about the kind

where it's limited to nighttime bedwetting, it's called

Nocturnal Enuresis and Primary Enuresis, which means that there's never been a

period of dryness for more than six months.

Secondary Enuresis, which is where they've been okay for a while and then

they go back to wetting the bed, that tends to have some other components

that we're not gonna address in this video. So I'm talking about primary nocturnal

enuresis, the kind that has never had a period of dryness and it

happens just at night, not during the daytime too, okay?

Just to be clear about what we're talking about, primary nocturnal enuresis.

There are two causes, one of those causes is what I just shared with you, what I

found in my doctoral research, that they sleep more deeply than other kids who

don't wet the bed. The other cause, and you have to have both of these by the

way in order to have bedwetting occur, the other cause is a deficiency in a

particular hormone, it's called antidiuretic hormone, ADH for

short, which in a normal functioning person causes you to dry up at night,

that's why you don't have to get up all night and go to the bathroom. Well, some

people do, usually older people, pregnant people, right? They've got some hormonal

changes where that hormone isn't serving them and so they have to get up and

relieve themselves. Well if you have sufficient of the hormone on board, even

if you're sleeping deeply, it dries you up and you don't have an issue. If you

don't have enough of the hormone, like in a pregnant woman for example, who's got a

lot of different hormonal changes going on, maybe that's interfering and some

people say, "Oh I've got this baby pressing on my bladder."

Really? The baby is this big. How much is it gonna press? Anyway, it's a hormonal

thing but they don't sleep so deeply so that they can pick up those cues that

are coming up through the nervous system that tell them, "Hey get up and go take

care of business." So you gotta have both of those in order to have enuresis

or bedwetting. Now that's important to know because how we're going to treat it

is going to address those factors. One of the common treatments,

if you go to your pediatrician for example, they may suggest some kind of a

synthetic form of the hormone that cause them to dry up at night.

So if your kid is wetting the bed, you can give them a dose of this hormone

or the synthetic hormone usually, it's in the form of a nasal spray which causes

them to dry up for that night, so it's a symptom treatment, it doesn't address the

cause and most kids will grow out of this by the time that they're 18.

You're thinking, "18, really? Do I have to wait that long?" Yeah, but only a small percentage of

bed wetters are still wetting the bed at 18, I think it's 2% or 3% so it's

not very high, sometime between the age that your kid is right now and 18,

they're probably going to clear up on their own and that's because their brain and their

body start to adjust and create the hormones that they need to take care of

the problem. Well, what are we gonna do in the meantime? The best interventions that

we're finding and what I found in my own research of this topic, our behavioral

approaches that trained kids to wake up and go to the bathroom, you know what?

I don't even care if they wake up, quite frankly, they can do it in their sleep if

they want, as long as they do it appropriately, I'm good with that, right?

So we want to train them to respond to the signals that are already

coming up from their bladder and from their body, we want their brain to start

handling that differently than it has been. See up until now, if the brain just

stays asleep and it's like, "Don't bother me." The signals are coming through

but they're not triggering anything so what we've done is, designed a behavioral

program that conditions and trains the brain to respond differently to those

signals and it's more than we can cover in this particular video but I've

created an e-book that addresses that and you can get that in the links in the

description of the video. What it does is, it takes you through a behavioral

training program. Now let's put a

little context around this because think about it, there are things that you

easily wake up to and there are things that you sleep right on through.

When Vicki and I were first married, we moved into a little basement apartment,

this place was so small, seriously, I could touch my nose to the

ceiling in the bedroom and I know that's not even up to code but this particular

basement apartment was dug out by hand, by our landlord who wanted to be able to

move some students in there.Well that's where we lived and in this apartment we

were about two blocks from a major railroad and those trains would

come rumbling him through and they would shake the whole place and sometimes

they'd sound their horns and it's just loud and so when we first moved in

I'm like, "Wow, we got a lot of train traffic here." And my wife is like,

"Yeah, I know. I can hardly sleep." After a few months, we got used to it,

I wasn't waking up to it anymore, I didn't even know that they were still

coming through. When we had our first baby, we would wake up to the slightest

little sniffle from the crib because our mind is attuned to what's important and

what's not. I commented to my wife, I said, "Wow it's interesting that they don't

have the trains running at night anymore." And she's like, "Oh yeah they do." She was

getting up to nurse the baby and she could still hear the trains cause she's

awake, I'm sleeping right through it. So our mind has the ability to attune to

certain things and to ignore other things, it's like the feeling of your

shoes. Oh, you can feel them now and that's because I called your attention

to i, right? Told your brain it's important, pay attention to that.

That's basically what we're doing with a behavioral approach to bedwetting.

We're saying, "Hey pay attention to that signal that's coming up from your bladder."

And quite frankly, even if they don't wake up, as long as we can get them to respond to

that in an appropriate way, then we're gonna solve the problem

and eventually, they're gonna grow out of the hormonal part of what's causing the

bed. So there is hope, there is hope, you guys.

And it works quite well but it's a lot of work to program and train the brain

to respond differently and that's why it's good to have something to help you

walk through it, that's why I've designed the program so you can get that in the

description. Short version, there's hope, okay?

Understand that this is something that happens pretty regularly, oh and by the way,

I wanted to make that point too because how you approach this matters, a lot of

kids are so embarrassed by this problem, they don't want to tell their

friends about it and they're not eager to talk about it with you either.

So taking this on is kind of a challenge, it's kind of hard, it's so important to

stay positive, to use a very positive, affirming approach and I also want to

empower your child to be in charge of this and we're going to do this with

smiles and a good attitude. If we don't have those on board, it's just going to be

hard and difficult and that's the part that you're going to expect from me because

I'm the positivity guy, right? But positivity is important in treating

bedwetting as well because of the difficulty that's entailed but as we

change the way we look at things, the things we look at change and this can

become a challenge and a task that you can take on together with your child.

It could actually help to build your relationship instead of tearing it down

the way that sometimes it will. So have fun with this, keep a positive

perspective and know that there's some hope. So let me give you a little example

of what I mean by behavioral training. Basically, we're going to condition and

train the brain to respond differently to the signals that are coming.

One of the mistakes that a lot of people make if their kid is wetting the bed is,

they start to restrict fluids in the evening hours. In my behavioral training program

that we talked about in the e-book, I actually encourage plenty of fluids. Why?

Because we want that signal from the bladder to be very clear. You see what I'm saying?

We don't want to reduce that at all because we're going to train the brain

to respond to it differently, to notice, like my baby crying. That "Oh this is

important, pay attention to that." Instead of tuning it out like we did with the

trains. So we're not going to restrict fluids, we're actually going to

encourage fluids and then an example of the behavioral process,

we might go in during the night time for example and wake up the child, not even

wake him up but get them enough aware to answer a question "Do you need

to go to the bathroom?" And then there's a yes or a no to that. If there's a no,

it's like, awesome I'll be back in an hour. You can tell this is pretty

intensive for parents. Then you check again in an hour, do you need to go to

the bathroom? Yes. Okay then get up and go to the bathroom. So we're gonna do some

behavioural training that's connected to the to the feelings but here's where it

gets really powerful. Usually we'll encourage the use of an alarm system,

the one that I typically use has an alarm that's built into the underwear that the

child is wearing, it's connected to a hundred decibel alarm. A hundred

decibels is like a fire alarm, this is loud. It will not wake them up,

that's what my doctoral dissertation proved. They sleep right through it,

a lot of the kids in my study group slept right through a hundred decibel

alarm. I know but it will wake up the parents. This alarm is set off by

moisture. So this alarm is going off because they just had a bedwetting

incident, okay? Now some people will think, "Oh, but we were trying to avoid."

No, we're not. We're not trying to avoid that, we're trying to reprogram that, okay?

So it's a good thing that this is happening and it's okay that it only

woke up mom and dad down the hall or upstairs. Mom and dad

respond, they're the ones that get the kid to now get up and perform a series

of tasks and this is all outlined in the book, but it's a series of tasks called

nighttime cleanliness training. Our goal is not to to avoid bedwetting incidents,

our goal is to stay clean and dry and this is how we emphasize it with the

kids, clean and dry. That's what we're going for, right? When the alarm goes off,

it suggests that we are neither of those things right now so we're going to go

through a series of tasks in the middle of the night that get us back to clean

and dry. The child has primary responsibility for that. Here's what

happens, that's not fun, okay? The child wants to do what? they want to

keep sleeping, they're out cold. They have to get up in the middle

of the night and go through this whole retain to get back to clean and dry and

that includes changing the sheets, it's kind of intensive, that's the whole point

because the brain will do more to avoid pain than it will to seek pleasure.

And in this training program, behaviorally, we're training the brain to

respond to "Oh my gosh, I don't want to get up and go through all of those tasks.

I wonder if there's any signals coming in that would warn me that that's going

to happen." We're training their brain to respond differently to the signal coming

from their full bladder. See, this is how we get the brain to get that kid up

instead of mom and dad having to do it. It takes a little training process but

that's an example of where we're gonna go with the behavioural part and again

you can get the full program in the e-book, Finally Dry. So that's in the in

the description on the post. Hopefully, you got some good ideas about this

bedwetting thing. I mentioned in the video today that there's an e-book

available, it's called Finally Dry. You can get that at my website, the link is

in the description below. Share some questions too, open a discussion, I'm happy

to respond. This is Live On Purpose TV.