Bedwetting: More Behavioural Modification Options

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• Bedwetting: How to Help Your Child

If your child is still bedwetting beyond the age of six, you may have explored options such as the urine alarm system or medication as a way of helping him stop. However, most literature supports an approach that includes some behaviour modification - either on its own or in conjunction with other methods. Teaching a child new skills and techniques that support his staying dry, along with employing other interventions, often has longer lasting effects than when only one approach is employed at a time.

In a previous article, Cleanliness Training, Positive Practise, Reinforcement for Dryness and Retention Control Training methods were explored. This article will look at other options to modify your child's behaviour - Avoidance Contingency, Overlearning, Waking Schedule, Intake Schedule and Stop/Start Training.

Avoidance Contingency sounds like a pretty radical approach to changing your child's behaviour and should be considered with great caution. It involves exposing your child to a noxious stimulus or removing a pleasant stimulus following a wetting episode. Although punishment-based treatments such as this were used quite commonly for early treatment of enuresis in the early 1950's, they are not usually considered, let alone used, today.

Overlearning techniques are only implemented once a child has attained some criterion for dryness. For example, if a child has been using the Urine Alarm device to achieve dryness and has been dry for two weeks (the amount of time recommended prior to beginning Overlearning), Overlearning may be introduced as a way of reducing the chance of the child relapsing. This is done by giving the child a large amount of liquid prior to bedtime so that they further learn to retain the liquid until waking.

Waking Schedule means that the child is woken at least once, but often several times at prescribed intervals, during the night and either taken or asked to go the bathroom to try to urinate. It is recommended that this approach be used in conjunction with others since it is not very effective when used on its own.

Intake Schedule means that the child is not allowed to drink anything for about an hour prior to bedtime. Immediately before going to bed the child is encouraged to urinate. According to the Child Clinicians Handbook on Elimination Disorders, this method works best "if the child is encouraged to drink plenty of fluids about 2-3 hours before bed and if the child is restricted from salty or spicy foods in the evening." The reason that plenty of liquids are encouraged a few hours before bed is so that urination just before going to bed will be easier for the child. It may also mean that the child will be less thirsty during the hour immediately prior to going to bed. The reason for restricting spicy or salty foods is to avoid the child being thirsty after ingesting same. This approach is probably one of the easiest to implement but may not be all that successful with children who have significant issues with enuresis.

Stop/Start Training is less commonly used and not that effective. It is based on the belief that bedwetting results from a weakness of the bladder sphincter muscle. This method is employed by asking children to stop and start their flow of urine during regular intervals during daytime urination. Each time the child stops his flow of urine, he is asked to count to three. This exercise is assumed to strengthen the sphincter muscle.

As with all treatment options, great care should be exercised when considering and executing any of these approaches. You may consider working with a professional who has experience with these methods to help you in the process. As well, please keep in mind that the above mentioned are all brief outlines of much more involved plans and each needs to be researched more thoroughly before implementing.