| Drybed (Enuresis/Bedwetting) Treatment: Sale of the Dry Bed Manual has been discontinued
so that I can concentrate on the Clean Kid Manual. I will leave informational
text below. See and use hyperlinks on the right for more information.
DrC. |
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Additional Information: Bedwetting Alarms List
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Do
not limit your reading to this page. See the hyperlinks above, top right-side.
We have the most extensive list of bedwetting alarm manufacturers and
guidelines on the internet. WE DO NOT SELL ALARMS! You will also find
an overview of available medications and their mechanisms for action on
bedwetting further below on this page. |
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MEDICATION OVERVIEW: Another medication that has been used to treat enuresis is an antidepressant, Tofranil (imipramine). This is an old "tricyclic" antidepressant, which has been around for over thirty-five years. It is typically prescribed in low dosages, below antidepressant therapeutic benefit levels for bedwetting (eg. 25, 50 or 75mg with higher dosages being more effective). Its mechanisms of action for a beneficial effect in a child's getting through the night are various (one is to relax the bladder and somewhat tighten up the resting level of the sphincter). It is quite cheap, but its use has been associated with some deaths because children may locate the medication and overdose on it without parental supervision. Finally, there is Ditropan (oxybutynin) and other more recent antispasmodic medications for children who tend to show a lot of "urgency" associated with sudden voiding urges at fairly low volume thresholds. They may have "hair triggers" so to speak, and I suspect that this could be more typical of daytime wetters. Basically, it relaxes the bladder and possibly lowers the sensory threshold for voiding, which would allow for more accomodation of urine in the bladder. All
of these medications are only effective for the length of time that the
child is on them and the most frequent recommendation from major research
institutions is that they should be used and reserved for limited use,
eg., going camping, overnight stays, etc. A learning or conditioning approach
is more effective for the longer run with lower relapse rates, but it
does indeed require time, effort, and a likely loss or interruption of
sleep. Yet it is also an excellent investment in your child's well-being
and pride in his finally gaining control over a basic function of his
body. He or she will sleep much easier for the rest of his or her life! |
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THE NEW DRY BED MANUAL: The new easy to read and follow Dry Bed Manual is now available. Here is a preview of its 77 pages. Preface: Conditions and Conditioning to Achieve Success for Dryness Night and Day
Table of Contents for the New Dry Bed Manual No.
1: Achieving Daytime Bladder Control (Pg 16 ) No. 3: Bathroom Volumetric Voiding Record 34 (Pg 34--not available here, proprietary information) No. 4: Bedside Bedwetting Alarm Arousal Record (Pg 49--not available here, proprietary information) No.
5: Recent Scientific Abstracts on Enuresis (Pg
64 ) No.
7: Problem Behavior Checklist (Pg 76--not available here, proprietary
information)
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| THE FIRST FEW PAGES OF THE NEW DRY BED TREATMENT MANUAL
Loss of bladder control at night, bedwetting, is technically known as nocturnal enuresis. A daytime failure to reliably hold and release urine in an appropriate place is called diurnal enuresis (see Appendix No. 1). In the course of normal development we gain control over our bodily functions in a typically reliable sequence. First, we gain bowel control overnight in sleep and then in the daytime. Bladder control comes next for the day and, finally, over the course of the nighttime while asleep. Bladder control in sleep is typically the last eliminative function to come under control and it is diagnosable from age 4 years on. It occurs with surprising frequency. The pediatric community usually assumes and assures parents that their child will grow out of it. I strongly disagree with this passive and even cavalier attitude. I advocate for applying a rational treatment as soon as possible, which beats the natural cure or growing out of it rates of only 1 in 4 to 1 in 7 odds of becoming dry in any given year after age 4. The chances of drying up in the next year actually decrease as children grow older. Why live with it? Maybe your pediatrician will let him/her sleep over at his/her house! The reader is invited to examine a much broader and historical review of enuresis in Appendix No. 2. This How To manual will stick to being a practical recipe book for treating enuresis in what follows. Many bedwetters get through the earlier stages of eliminative control and only get hung up in the last stage of bladder control in sleep. This really should not be surprising since learning automatic control while asleep should be more difficult to achieve. Learning with awareness is much more effective and more likely during the daytime while awake. Also, we have to pee much more often than we have to poop, so getting through the night without having to empty the bladder may not be very easy. Adding having to awaken and leave your warm comfortable bed is another difficulty to overcome. The use of the bedwetting alarm to arouse the child and instantaneously arrest the very act of wetting would appear to be a relevant approach then in treating this problem. I suspect that the natural alarm for many children in the normal course of development is the discomfort that comes with a filling bladder and the startle response to the very act of wetting oneself while asleep. However, bedwetters are so good at sleeping that they can overcome this disruption and continue sleeping. Actually, we must be very concerned with these children also learning to sleep through a bedwetting alarm, which is addressed in my treat-ment instructions. Complications with bowel control can affect bladder control both during the day or night. Most often the complication with bowel control comes from a backing up of stool into the colon when the child resists voiding stool normally into the toilet. This problem is often associated with soiling, overly large stools, constipation, and an enlarged colon (sometimes called a megacolon). Therefore, if there are any indications of soiling whatsoever (e.g., tire tracks in underpants, prune drops, or other accidents) or toilet clogging with large stools (even without soiling) this problem should be treated BEFORE using my procedures for bedwet-ting. Children holding their bowels in excess of three days show another indication of constipation and they should form a more normal daily or, at most, an every other day voiding habit. My Clean Kid Manual-III definitively addresses these issues. Occasionally, the successful control of soiling or encopresis can lead to bladder control without any intervention. You should be so lucky! However, if not, then proceed with this manual. If daytime enuresis is present it can be treated simultaneously with a treatment for bedwetting. That would be my recommended strategy, but if that is not possible or to exhausting, then you must focus your efforts on one or the other. I would recommend starting on the daytime bladder accidents first (see Appendix No. 1) followed by treating the bedwetting. In the unusual case where the daytime treatment is not showing any progress after a true sustained effort for two weeks then you should reverse the treatment sequence. There was a recent study that showed treating nocturnal enuresis can be helpful in dealing with diurnal enuresis when it persists. This special treatment package is temporarily being offered at a discounted price along with the special Urine Measurement Collection Device (UMCD or Specipan). Purchase also entitles you to access my personal consultation services described at the end of this treatment section. Demand for my consultation services, talks, writing, and the extraordinary success of the Clean Kid Manual for desperate families with children who are soiling has delayed this second printing of the Dry Bed Manual. The advantage of the present completely rewritten manual is that it is brief, powerful, and cheaper. Yet it covers more than the original Dry Bed Manual. This Packet Contains the Following Items: 1). This manual on Bottom Lines for Dry Beds. 2). A Urine Measurement Collection Device or Specipan (use cubic centimeters or ccs in recording your childs bladder capacity, please). No other bedwetting treatment uses this measure, which is essential to monitoring and adjusting treatment as necessary. 3). The instructions for treating daytime bladder difficulties are contained in Appendix No.1. 4). An inserted informational sheet for purchasing the very unique Malem bedwetting alarm (available on-line), which features sound, vibration, and flashing lights to promote awakening your child. An extensive listing of alarms is available on my website by going to the Dry Bed Treatment page and clicking on a hyperlink at the top right side of that page. This listing is the most extensive on the internet and is categorized by different countries. 5). Bathroom or volumetric recording sheets for measuring bladder capacity (see Appendix No. 3). Morning bladder volumes should increase over the course of treatment. Set aside a blank form to make more copies. This form should be completed faithfully throughout treatment. It is important to have it available should you wish to consult with me. No other treatment assesses bladder-voiding volumes at the proper times, although it is vital for successful treatment. 6).
Bedside diary sheets for recording the size of wet spots (using inches
is OK here), time, and to rate the degree of arousal immediately after
the alarm sounds (see Appendix No. 4). Wet spots should decrease in size
over treatment. Some degree of arousal from sleep is necessary for learning,
but total wakefulness after an alarm sounding is not required. Keep
in mind that most children learn to sleep through the entire night without
accidents and that occurs for about two-thirds of our children. Indeed,
that is a good sign, children who have to be awakened and void in order
to be dry are more likely to relapse. As noted in point 4 above, complete
the diary as you go. Set aside a blank form for additional reproduction
if necessary. No other treatment monitors these critical variables for
successful treatment. This form is also important should you wish to consult
with me. |
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Soiling Solutions
an End to Encopresis!
