How to Stop Teen Bedwettingкод для вставки
How to Stop Teen Bedwetting End the Embarrassment Now В© Copyright 2013 By L. C. Laughlin Introduction Hello and welcome! Allow me to express my heartfelt thanks for purchasing this eBook. If youвЂ™re reading this because you know someone who suffers from teenage bedwetting or youвЂ™re a parent of one, I commend you for not being ashamed or embarrassed. If youвЂ™re the teenager suffering from enuresis yourself, I applaud you for taking the first step to deal with this condition. Indeed, this is not an easy achievement вЂ“ success will only come to people who never give up and know that there is hope for treatment. Within these pages lie valuable information about teenage bedwetting as well as the ways to overcome the problem. If I cannot help you overcome this issue, then at least allow me to share important tips that will help you live with it on a daily basis. Before we delve deeper, let me first clarify some things for you. Definition of terms: Nocturnal enuresis вЂ“ Bedwetting that occurs beyond the age of six for girls and seven for boys. This is otherwise termed as nighttime incontinence. Self-limiting вЂ“ This term refers to a condition that is normally outgrown. Teen вЂ“ For the purpose of this eBook, teen refers to kids within the 13 - 18 age range. Accidents вЂ“ This refers to when the teen voids involuntarily after a period of dry days or nights. I cannot emphasize enough the importance of a broad understanding when dealing with delicate issues like this. Study the contents of this eBook well and broaden your mind. In the following modules, you will learn about teenage bedwetting, how it is diagnosed, and the options for its management. Module 1: What Is Teenage Bedwetting? вЂњYouвЂ™re too old to still be wetting your bed!вЂќ вЂњYou should have outgrown bedwetting by now!вЂќ вЂњStop acting like a baby!вЂќ Do these statements sound familiar? Does this sound like you? Or, maybe this sounds like your mother who constantly hassles you when you wake up morning after morning and find yourself wet. What you donвЂ™t know is that teenage bedwetting is a fairly common condition faced by many teenagers around the world. This means youвЂ™re definitely not alone. Did you know that about 2% of teenagers вЂ“ thatвЂ™s 1 out of every 50 вЂ“ deal with teenage bedwetting? ThatвЂ™s pretty normal if you ask me, but, because it is embarrassing for most people, they donвЂ™t talk about it. However, this does not mean I am advocating the вЂњnormalcyвЂќ of such a condition. I am here to offer whatever help I can in alleviating the emotional and psychological toll teenage bedwetting brings to you and your family. I will also provide ways вЂ“ options that you can take вЂ“ in dealing with the condition day in and day out. Below are some truths I have uncovered about teenage bedwetting, and I certainly hope by the end of this module you will have grasped the basics of the condition. 1.1: Overview Teenage bedwetting is one issue that most teenagers find very embarrassing. Often, they will keep it to themselves, which can result in feelings of insecurity and depression. However, there are some things that teenagers suffering from bedwetting must know. 1.2: Fast Facts вЂў At the age of two, children have generally attained bladder control, which means the child can remain dry during the course of the day. вЂў By three years old, the child can remain dry overnight, but even potty-trained children can fall short of this expectation. вЂў Bedwetting can be considered a developmental delay instead of being viewed as emotional or physical defect. вЂў It is also shown to run in a family (genetically related), since parents with teenage bedwetting problems have more than a 40% chance of passing the gene on to their child. вЂў Bedwetting can also be considered a neurological delay, and studies have shown that bedwetting can occur in teenagers 0.5% to 2.3% of the time. 1.3: Types of Bedwetting There are two types of bedwetting: primary and secondary nocturnal enuresis. Primary Nocturnal Enuresis (PNE) This occurs mainly in babies and younger children who have not attained full bladder control. This is diagnosed in children within the age bracket of 4 to 5 who have persistent bedwetting. By the age of 5, around 20% of kids no longer experience bedwetting. Each year cuts about 50% of the bed wetter population, and by the age of 7 only 10% remains, most of whom are boys. Secondary Nocturnal Enuresis (SNE) This is the type of bedwetting that occurs after a dry period of around six months. Medical conditions can actually trigger this type of bedwetting. An average of 2.5% of kids become bedwetters due to medical reasons such as urinary tract infections, too much bladder pressure, neurological reasons, and metabolic disorders, all of which must be evaluated medically. 1.4: Prevalence For many years, nocturnal enuresis has affected many people and this problem can be traced as far back as 1500 B.C. Studies have been conducted with a focus on nocturnal enuresis in children and persistent primary enuresis (which is also referred to as teenage bedwetting). There has been very little study of adult onset secondary nocturnal enuresis (SNE). 1.5: Basics of Teen Bedwetting They donвЂ™t go through it alone. Teen bedwetting is not a rare condition considering that millions of teens from all over the world experience the same issue. The issue ranges in severity from occasional bedwetting to bedwetting every night. Deep sleepers experience вЂњnormalвЂќ bedwetting episodes. Even though not all teenagers experience bedwetting, it might be вЂњnormalвЂќ for some teenagers who are deep sleepers. Deep sleepers are those that sleep so soundly that their body cannot identify the signs of a full bladder during the course of the night. Deep sleepers may also вЂњdreamвЂќ about going to the toilet and then wake up with a wet bed in the morning. Bedwetting can be outgrown. There are cases when teenage bedwetting can be outgrown without any intervention at all. However, it is always a good idea for teenagers to discuss the condition openly with their physician as well as their parents if it is creating problems for them. 1.6: Medical Background In order to understand more about bedwetting, it is important to give you a brief overview of the anatomy and function of the bladder. The kidneys process water, and the excess water becomes urine and travels via the ureters (tubes that carry the waste fluid from the kidneys) into the bladder for storage. As a muscular sac, the bladder stores the urine until it is full and then releases the urine into the urethra вЂ“ a tube connecting the bladder to the outlet. The bladder is like a balloon that expands when fluid is being stored until it is full. When the muscle of the bladder contracts in a squeezing manner, it will empty the urine from the body. The urinary sphincter (the muscle that acts as a valve at the outlet of the bladder) relaxes along with the bladder contraction, which serves as a portal allowing the fluid to pass and be excreted. For the efficient process of urination, both the bladder muscle contraction and relaxation of sphincter must occur at the same time. This happens when the sensory nerves on the bladderвЂ™s muscle walls release a chemical called acetylcholine, which sends a signal to the brain telling it that the bladder must be emptied. The process is autonomic, meaning it is something that you cannot control voluntarily. After all, the communication between the brain, the nerves, and the muscles are complex. As a side note, there are times when the signal that the bladder sends to the brain doesnвЂ™t wake you up, so the bladder is emptied even while youвЂ™re asleep at night. There are instances in daytime, though, when this signal is so fast that it doesnвЂ™t give your body enough time to react, so you donвЂ™t reach the toilet in time. Therefore, you may experience accidental daytime wetting too. Obviously, the bladder must be emptied on a regular basis. The process is something that only the brain controls, but, in time, bladder control is achieved and learned through repeated action and communication. It is physiological, therefore, that children under the age of six or seven will urinate anytime and anywhere they need to. Beyond this age range, it becomes what we call enuresis. Module 2: Causes of Teenage Bedwetting вЂњI donвЂ™t know why I still wet the bed when IвЂ™ve done everything I could!вЂќ It is a bit depressing, donвЂ™t you think? Why should anyone bear the brunt of something they donвЂ™t even have control over? If youвЂ™re the teen, it is somewhat disheartening to know youвЂ™re suffering from something that not everybody faces. If youвЂ™re the parent, it is heartbreaking to see your teenage son/daughter face something that can deeply impact their adolescent period. Teenagers face many things. вЂњI just want to belong,вЂќ is the typical statement of a teenager whoвЂ™s still looking for something that will make him/her part of the in-crowd. Add to this the problem of bedwetting, and teenagers may feel different and isolated. Before you despair, it is important to know what really causes teenage bedwetting. In children, it is somewhat normal to just dismiss the idea of bedwetting as a natural part of growing up. Everybody will go through it at some point. But when it comes to teens, it becomes another story. Nonetheless, you have to understand that bedwetting is not a disease and is often merely a symptom of a secondary disease. It is not a psychological or behavioral issue either. Many of the causes of enuresis are not absolute science; rather, these are factors that may explain why teens would urinate without intentionally doing so. If you are a parent or the one suffering from bedwetting, it is worth it to know that when you understand what causes bedwetting, it is relatively easier to find a solution and handle it correctly. So, what are the possible causes? Stress. When people get into stressful situations, it could trigger very unpleasant feelings that will make them involuntarily wet the bed. Whatever stressful situation someone is in (being in a new home, sleeping out in an unfamiliar place, or losing someone you love) can bring him/her out of his/her comfort zone. Unbalanced hormones. There are rare cases where the body produces insufficient amounts of the anti-diuretic hormone (ADH), which means urine production at night is not regulated. When ADH is not adequately produced, the production of urine is relatively high. ADH is a hormone that decreases or slows down the urine production at night so itвЂ™s not necessary to wake up just to urinate. Failure for the body to recognize a full bladder. There are some teens who are deep sleepers. Sensory nerves of deep sleepers function slowly, which makes them fail to recognize that they need to empty their bladder and that they need to wake up. вЂњSmall bladder.вЂќ Having a small bladder does not mean that you have an anatomically smaller bladder than your peers. It just means that you have a smaller volume of urine for its functional bladder capacity or FBC, which is actually the volume of urine that the bladder can hold before it sends the signal to the brain to empty it. In this case, the bladder muscles are overactive, thus it is not completely relaxed. Therefore, the capacity of the bladder to hold a regular volume is smaller compared to your peers. Medical problems involving the neurological or urinary systems. Enuresis is rarely caused by this kind of condition, but it could happen--especially in teens. My own son had something called urethral meatal stenosis which put back pressure on the bladder causing bedwetting. Urinary tract infection or UTI. If someone has a UTI, he/she will have the feeling of urgency вЂ“ which makes him/her unable to control urine release. Along with enuresis, UTIвЂ™s could demonstrate other symptoms, including painful urination, accidental urinating in the daytime, and an increased frequency in urination. Irregular bowel movement or constipation. If you are unable to have regular bowel movements, this causes water to be retained in the body, and that could increase the chances of bedwetting. Sleep Apnea. Bedwetting may be demonstrated in patients with sleep apnea вЂ“ a condition where normal breathing is disrupted either because of swollen tonsils or adenoids. However, sleep apnea could also manifest other symptoms like dizziness, snoring, sinus and ear infections, and sore throat. Diabetes. You should be evaluated for diabetes if you usually have dry nights but bedwetting starts. You should watch out for other symptoms including fatigue, increased thirst, weight loss, and excreting large amounts of urine. Genetic Predisposition. Enuresis tends to run within families. So, if someone in the family suffered from bedwetting during childhood beyond the age of five, there is a high chance that his/her child may also acquire the gene. Genetic linkage is not always the cause of enuresis in all people although studies have shown evidence that the condition is hereditary. One of the studies conducted showed that a patient whose parents both had histories of enuresis during childhood will have more than 70% chance of inheriting the same. The probability is high that the condition is likely to carry over into adulthood вЂ“ or in this case, the teenage years. If the teenager can talk with his/her relatives about it there is a pretty fair chance that one or both of their parents had the problem also. Consumption of certain beverages. There are some beverages that can cause excessive urine production; these are called diuretics. Examples include alcohol, coffee, and tea. Psychological reasons. Being emotionally distressed can predispose teenagers to bedwetting. If the teen has recently undergone trauma вЂ“ physical or otherwise -bedwetting may normally be experienced following the stressor. Medically-induced enuresis. There are medications that have been reported to cause teenage bedwetting as one of the side effects. These include medications for insomnia, hypnotics, and those that are utilized for psychiatric purposes. Considering that there are multiple factors involved in teenage bedwetting, it is highly likely that someone might feel overwhelmed. It is important to start by accepting the fact that the condition is there. This is not to say that there is nothing that can be done вЂ“ you just have to open up and discuss the options, the details of which we will be looking at later on. 2.1: Relationship of Bedwetting and Stress Teenagers have different coping mechanisms when it comes to the changes in their environment and social interactions as a whole. These changes can either be major or minor, but this still puts teens in a stressful situation nonetheless. Stress can be caused by many things, and reactions to it differ from person to person. The severity and response may not be directly proportional in some teens. Stressors can be anything from having an additional member of the family or moving to another place, to bullying at school, parental quarrels leading to divorce, and even the death of a loved one. Bedwetting is sometimes caused by stress, and, other times, it can be related to emotional neglect. If parents constantly neglect the emotional needs of their teenager, this can cause major bedwetting accidents as the teenвЂ™s response to the feelings of anxiety and stress. If after evaluation, you have identified that stress is the cause of persistent primary bedwetting, the issue may not be corrected or eliminated if you are not going to address the issue. If stress is the reason, you should talk to a medical expert on whether it is appropriate to see a psychologist or whether the process can be reversed through emotional support. However, it is not a good idea to assume immediately that the teenager is wetting the bed because of stress, even if there are incidents both in school and at home. This may not be the reason at all. Therefore, it is always recommended to consult your family doctor first so that underlying medical conditions are ruled out before you decide that stress is really the reason. If, after the evaluation, stress is indeed the primary cause of bedwetting, then other members of the family must cooperate and collaborate so that the issue of bedwetting can be controlled. This way, the teenager will feel the support and emotional attention he/she might be seeking. It is important to realize that there are social impacts in the life of the teenager as well, which we will discuss in later modules. But for now, let us be content knowing that the effect of bedwetting on the teenagerвЂ™s social activities is real. Nonetheless, it is equally important for the teen to participate in overnight activities because this will encourage him/her to be an active participant in eliminating bedwetting. Some experts say that bedwetting may be a vicious cycle, wherein stress becomes the reason the teenager wets the bed, and that will cause major stress for the parents. When parents are stressed out, they will trigger stress in their kids, which will make the condition even worse. Studies conducted have demonstrated that punishing and blaming the kids for bedwetting is actually a major stressor that will increase the frequency of wet beds. An increased frequency of bedwetting will also increase the shame and punishment, and the cycle goes on and on without realizing that the teenager is already having problems with his/her self-esteem and confidence. As you can see, the vicious cycle starts when parents cannot respond appropriately to the stressful situation of bedwetting. Module 3: How is Teenage Bedwetting Diagnosed? вЂњCan anyone help me?вЂќ It is not uncommon for teenagers to feel that theyвЂ™re alone in the fight. Sometimes in their desperation, the solutions seem so far away from their grasp that this results in false acceptance. However, parents and the teen themselves should understand that there are ways to alleviate or even cure the problem. It starts with careful planning and diagnosis. Consulting a medical professional doesnвЂ™t mean youвЂ™ve lost control over the problem. It is just that you need to rule out any underlying medical problems as mentioned in Module 2. Healthcare professionals often utilize useful tools that can help them recognize nocturnal enuresis. But nothing beats getting a lot of information about general habits and manifestations. For Parents: Encourage your teenager to keep a diary of symptoms containing his/her daily routines and habits for at least two days before you make a medical appointment with your physician. For Teens: Write your symptoms and daily activities in a medical diary, which must be at least two days before you see your doctor. The contents of this diary must be shared with your doctor, which will help in identifying the underlying cause as well as the severity of the condition that you are suffering from. 3.1: What should you include in your diary? вЂў Times when you void both daytime and nighttime вЂў Time of accidents вЂ“ which is the involuntary urinating following a dry period вЂ“ during the day or night вЂў Approximate volume of urine voided during these times вЂў Patterns of your drinking. For instance, drinking a lot of fluid late in the afternoon or evening. вЂў What kind of beverage do you drink? It could be water, caffeinated, artificially sweetened, carbonated, alcoholic, or sugary beverages. вЂў Characteristics of voiding: Is the stream constantly strong? Or, was there initial difficulty when voiding or continued dribbling? вЂў Do you suffer recurrent urinary tract infections? вЂў Quantify how many wet nights versus dry nights вЂў Note any significant symptoms associated with bedwetting including the presence of night sweats. The information stated above will help your physician to identify the primary cause of the problem and to make specific suggestions to alleviate or entirely cure the teenage bedwetting. 3.2: What to do during the medical appointment? When your appointment day arrives, you should prepare whatever information will be needed by your health care professionals, such as personal and family-related medical history. You should also try to remember all medications you have taken, including what you are taking at the time, if any. Your medications are important to rule out the possibility of drug-induced enuresis, which means that bedwetting occurs only as a side effect and is usually a reversible process. 3.3: What will you expect during your appointment? Your doctor will perform a physical examination and neurological assessment. To further study the case, he may ask you to submit urine samples for urinalysis and a urine culture. Urinalysis is the analysis of urine content while a urine culture determines the kind of bacteria present in your urine. In other cases, your doctor will order tests such as Uroflowmetry. This is a test that will determine the amount of urine you excrete, the rate at which it is excreted, and how long the voiding takes. Another test may also be performed, which is called the post-void residual urine measurements requiring an ultrasound. The test is non-invasive, which determines the amount of urine left in the bladder following urination. When healthcare professionals suspect other problems, further testing may be necessary for diagnosis. Of course, you will be given the options on the best course of action related to the condition. 3.4: What kind of health professional should you consult? If what youвЂ™re suffering falls under the persistent PNE, Primary Nocturnal Enuresis, you might want to see your primary care physician first or a nurse with similar expertise. But for teenagers who only suffered bedwetting recently or ones with SNE, Secondary Nocturnal Enuresis, you would usually be referred to specialists such as a sleep disorder specialist or an urologist. 3.5 How to prepare for your medical appointment? The importance of seeing a family-trusted health practitioner cannot be stressed enough. When you do, here are some tips to get ready for your doctorвЂ™s appointment: 3.5.1 List all of your symptoms, including those that you think are unrelated to your condition. As a patient, your responsibility is to provide as much information as you can about your habits and activities so that the medical practitioner can accurately make a diagnosis. Include in this list the times when you go to the toilet and whether there is a sense of urgency to void. Also, include the amount of fluid consumed, especially after dinner. 3.5.2 List relevant personal information such as recent changes experienced and major stresses. 3.5.3 Write down medications youвЂ™ve taken, including vitamins and supplements. 3.5.4 Make a list of questions or clarifications you want to ask the physician. When youвЂ™re seen by a medical doctor, the time spent could be limited so a list of questions would be especially helpful. Some of the basic information you might want to get from your doctor includes вЂў Causes of bedwetting вЂў When will you outgrow bedwetting вЂў Treatment options and recommendations вЂў Side effects of any bedwetting medications вЂў Alternative approaches in bedwetting treatment вЂў Any dietary changes or fluid and food restrictions of which you need to be aware вЂў Generic alternatives to recommended or prescribed medications вЂў Further information related to bedwetting in print, such as flyers or brochures вЂў Recommended websites for more details Do not hesitate to ask questions during the appointment so that all your concerns will be addressed and properly dealt with. 3.6 What to expect during the doctorвЂ™s appointment? There are a number of questions that your doctor would most likely ask you during your visit. The things you prepared above will help you get the general picture of what the doctor wants. If youвЂ™re ready to answer any of the doctorвЂ™s questions, your appointment would be well-spent and there will be more time for clarifications or concerns. Doctors may need the following information from you: вЂў Family history, especially related to bedwetting вЂў Medical history вЂў Time that bedwetting started (whether persistently over time or just recently) вЂў Frequency of bedwetting вЂў Any related foods, activities, or drinks affecting bedwetting вЂў Daytime dryness вЂў Major life stresses or changes, if any вЂў Any complaints during urination such as pain or other symptoms 3.7 What to do before your medical appointment? Whether youвЂ™re the patient or the parent of the bedwetting teenager, it is important that you try to stretch your patience and widen your understanding. As much as it causes anxiety and is frustrating for you, it does affect people surrounding you too. You just have to remember that bedwetting is not intentional, so while youвЂ™re waiting for your appointment, you might want to reduce fluid consumption at night. While you may be embarrassed to discuss teenage bedwetting with other people, rest assured that the medical professional will give you options in dealing with bedwetting. Most cases of teenage bedwetting can be cured. If not, there are ways to alleviate the problem, which will be discussed in the latter part of this eBook. Module 4: Facts versus Myths вЂњI am so confused why this is happening to me. My parents say bedwetting is common, but why donвЂ™t my friends deal with it? They said it can be cured, but why am I still suffering when IвЂ™ve already done everything!вЂќ Some information on enuresis may be true, but other remains hearsay. Bedwetting, medically known as nocturnal enuresis, is fairly common for schoolaged children and rare in teenagers. This module discusses briefly what we should believe and what we should not in order to avoid confusion вЂ“we will separate this information into facts and myths. 4.1: MYTHS 4.1.1: Teenage bedwetting is the result of laziness in the lack of controlling urination. To assume that teenage bedwetting is a result of laziness is not only incorrect, it is also downright destructive to the teen. It would make him/her feel bad about the condition. The truth is that urinating is involuntary, which means that the nervous systemвЂ™s communication is the one that controls the emptying of the bladder. The bladder sends a signal to the brain that it needs emptying. Also, at night, there is a hormone that regulates the production of urine. If the bladder fills up at night, the signal to empty is supposed to wake you up вЂ“ when this becomes impaired, bedwetting occurs. Therefore, teenage bedwetting is not a result of laziness. 4.1.2: Teens who wet their bed are always emotionally or mentally disturbed. The connection between psychology and bedwetting has been attributed to the fact that autistic kids usually wet their beds. But, not all teens suffering from enuresis are emotionally or mentally disturbed. Even though there is a connection between psychological issues like low self-esteem and bedwetting, these issues usually are not absolute. Teens who previously had dry nights may experience bedwetting if they undergo emotional trauma, such as the death of a parent or loved one. If a teenager wets his/her bed, this doesnвЂ™t necessarily mean that they are emotionally or mentally disturbed. There are various factors that cause teenage bedwetting (as discussed in Module 2). 4.1.3: Wearing diapers during the night slows down the process of eliminating the habit. Most experts will agree that wearing diapers cannot prevent teenagers from eliminating the habit. In fact, adult diapers can actually provide benefits to the teen. Many teenagers claim that it prevents them from experiencing the embarrassing situation of waking up wet and cold. For parents, this is also one of the practical ways to deal with the condition, making it unnecessary to change bed covers or linens frequently. 4.1.4: Taking fluids before going to bed cause bedwetting. Limiting the fluid intake before going to bed can reduce the amount of fluid produced at night. But, this does not mean that drinking a lot of fluid at night will cause bedwetting. If you remember from the previous sections, there is such a thing as the anti- diuretic hormone, which is produced to regulate the production of urine at night. This means that the body will still be able to cope with the high amount of fluid intake before going to bed. Fluid restriction before bedtime can certainly lessen the workload of the bladder at night. However, the bladder will still work even if youвЂ™ve increased fluid consumption at night. 4.2: FACTS 4.2.1: Bedwetting has a tendency to run in families. Heredity is one of the many possible causes of bedwetting. If the parent has faced enuresis in his/her childhood or teenage years, the child will most likely suffer the same. In fact, 3 out of 4 kids who face teenage bedwetting --which is 75% -- come from a positive family history of bedwetting. 4.2.2: Some teen bedwetters have functionally (not anatomically) small bladders. As discussed in detail in Module 2, some teenagers have a lower threshold when it comes to the volume of fluid that the bladder can hold. This means that the bladder fills faster, so the process of emptying the bladder is also more frequent than normal. 4.2.3: There are cases of bedwetting where the teen finds it hard to wake up. The difficulty to wake when the bladder signals the brain for emptying is a fairly normal cause of bedwetting. This is called the вЂњdeep sleep stateвЂќ when the person is so asleep that everything else вЂ“ even the bodily signal вЂ“ is being ignored. This makes it hard for the person to respond to the signal to void. 4.2.4: Insufficient production of the anti-diuretic hormone can cause bedwetting. We have seen the possible causes of bedwetting in Module 2, and one of them is hormonal imbalance, which is the bodyвЂ™s insufficient production of anti-diuretic hormone (ADH). This hormone, as previously discussed, will lessen the generated urine at night. There are people that suffer from low production of ADH, and as a result, their body cannot regulate the production of urine while they are asleep. This means to say that they produce more urine even when they are asleep вЂ“ which could cause accidental voiding. 4.2.5: Bedwetting may be caused by an underlying medical condition. Bedwetting may be just a symptom secondary to an underlying disease or condition. It could be diabetes, a UTI, spinal cord conditions, constipation or even sleep apnea. In some teenagers, it may be a combination of two or more issues. Now that youвЂ™ve learned what you should believe and what you should not, it is important that you seek medical help so that you can have the condition checked. This paves the way for treating or alleviating the bedwetting condition. 4.3: SNACK MYTHS AND FACTS The facts and fallacies do not stop with the things mentioned above. It even reaches the realm of food, and youвЂ™ve probably heard many rumors regarding nutritional solutions for bedwetting. LetвЂ™s get everything straight in the following sections. Statements like the following may be all too familiar to you already. вЂњYou should limit fluid intake after 6 oвЂ™clock in the evening.вЂќ вЂњOrange juice is not encouraged.вЂќ вЂњDo not eat spicy foods.вЂќ Well, I guess youвЂ™ve probably heard them all. In an effort to correct teenage bedwetting, you might be tempted to just try them out, all at once. But before you do, bear in mind that unnecessary dietary changes can make things worse, especially in terms of stress and anxiety. The truth is, there is little evidence to back up these food-based claims. In fact, most of them are merely fallacies. Here, we shall uncover the truth about dietary strategies in controlling teenage bedwetting. 4.3.1: Spicy Foods Have you banned spicy foods in your home? If so, it is time to correct this assumption because it is merely that: an assumption. Most experts say that there is no evidence showing that spicy foods can cause bedwetting. This misconception is based on the fact that spicy foods have the tendency to become a bladder irritant in some people. Therefore, physicians would recommend patients with urinary incontinence to completely avoid spicy foods. However, studies conducted did not show any significant relationship between spicy foods and nocturnal enuresis. 4.3.2: Citrus Fruits Lemons, limes, and oranges--these are citrus fruits that many people thought would cause bedwetting because of their acidic nature. While it is true that acid can irritate the bladder, there is no medical research that proves that citrus foods can trigger bedwetting. There are some cases, however, where people are allergic to citrus fruits and that causes bedwetting вЂ“ but these cases are extremely rare. 4.3.3: Foods Causing Allergic Reactions While there is some truth that food allergies can cause bedwetting in some people, this link is still very weak. You cannot make the direct assumption that if other teenage bedwetting cases are the result of food allergies then it is whatвЂ™s causing yours too. A single case does not cover all other cases. In the large population of teenage bedwetting cases, food allergies do not play a major role. 4.3.4: Caffeine It doesnвЂ™t matter where the caffeine comes from вЂ“ beverages or food вЂ“ it will still be a diuretic. A diuretic is a substance that will trigger the bladder to produce more urine. So, most experts would agree that one way of preventing bedwetting is to avoid caffeinated foods or drinks, especially in the afternoon and evening. Caffeine is not just found in coffee alone. Other beverages like teas, energy drinks, and colas contain caffeine as well; therefore, it does not follow that if you donвЂ™t drink coffee youвЂ™re not consuming caffeine. Also, chocolates and related foods like brownies and ice cream contain a caffeine-like chemical, which acts similar to caffeine. It isnвЂ™t necessary to completely ban these foods at home, but there is a need to be cautious. These foods should be eaten early in the day so the effects of caffeine have worn off before going to bed. 4.3.5: Fluid Intake at Bedtime Drinking water at bedtime alone is not enough to cause bedwetting. Bedwetting does not just occur because the bladder holds too much fluid. To be blunt, drinking a gallon of water at bedtime will cause anyone to need to empty his/her bladder -- the question is whether they will wake up to use the toilet. Nevertheless, liquid restriction at bedtime still makes sense because youвЂ™re limiting the fluid that the kidneys will process, therefore delaying the filling time of the bladder. This gives teens extra time before the bladder completely fills up, and when it does, theyвЂ™re already awake to empty it. Furthermore, you should also consider other foods that produce fluid. Water is not your only source because foods like yogurt, fruits, soup, and vegetables have high fluid content. 4.4: How to find food triggers in bedwetting Each one of us is different вЂ“ if you are a parent or a teen, you might want to determine what kinds of foods trigger bedwetting episodes so that you can deal with it accordingly. Becoming an active participant in treating the condition is one of the most efficient ways of coping with it. As I have mentioned previously, it is important that a bedwetting journal is kept in order to record bedwetting incidents and the activities surrounding it. This is one way of identifying the patterns and other habits related to the bedwetting incident. Being involved in finding the solution can get teenagers all hyped up, so they should be included in the planning and the diagnosing process. As much as possible, it is important that all involved parties know the truth вЂ“ whether youвЂ™re the parent or youвЂ™re the one facing the condition. Some teenagers are quite interested in crafting their own hypotheses as to why they are having this problem. For instance, they will make their own theories on what affects staying dry throughout the night. If teenagers are left to identify any personal triggers for bedwetting, this could prove to be beneficial for them in two ways. a. Teenagers would feel a sense of control over their problem and a sense of responsibility to find a solution that works for them. If they could identify possible triggers, they would feel confident and boost their self-esteem. b. Once they have identified any food, drink, or activity that actually causes their bedwetting episodes, avoiding such things would be much easier, even if it is only based on the placebo effect (anything that has no direct medical but nonetheless makes the patient feel better. In other words the beneficial effect is psychological). 4.5: How to Make the Diet Approach Work If you are about to make decisions regarding any dietary changes to control bedwetting incidents, ensure that these decisions are not based on punishment or negative reinforcement, which will only create a vicious cycle. Many teenagers who wake up wet and cold are embarrassed and ashamed about their condition. Parents who are consistently angry and frustrated вЂ“ not to mention stressed вЂ“ over the endless clean-up will instill negative feelings in their kids. Their anger and frustration will cause anxiety both emotionally and mentally, which can be distressing to the worsening condition. Before you start with the diet approach, make sure that the involved parties (parent and teenager) understand the strategy. This is the only way to make this approach work. Remember: Do not start something as a consequence of misbehavior. Bedwetting is not misbehavior but rather a problem that must be faced and resolved in a positive way. Module 5: What is the Impact of Bedwetting on Teens and Their Family? 5.1: For Teens: вЂњI donвЂ™t want to go to the school acquaintance party.вЂќ вЂњI donвЂ™t feel welcomed at all. They all think IвЂ™m a freak.вЂќ вЂњWhy me?вЂќ Perhaps, IвЂ™m just exaggerating a bit on what teenagers think or feel about themselves, but letвЂ™s face it, sometimes the statements above do ring a bell. As previously mentioned, bedwetting has a significant impact on the teenвЂ™s life, and, more specifically, on their self-confidence and self-esteem. Various debates regarding the relationship between bedwetting and teenвЂ™s self-esteem have occurred. Nonetheless, several medical studies have been done which show a significant improvement in the teenвЂ™s self-confidence upon proper management of bedwetting. Teenagers know that bedwetting can cause stress and anxiety in the family. It is often related to major life changes, such as constant parental fighting, divorce, or even death. In some teenagers with enuresis, any form of punishment and teasing from relatives, siblings, or even friends can contribute to the fact that they donвЂ™t want to talk about the condition any more for fear of embarrassment and shame. There are also studies that show bedwetting teenagers develop behavioral problems in conjunction with low self-confidence and stress. They feel guilty and often try to isolate themselves from the rest of the world, which affects their social life as well. This effect is worsened when the problem is not controlled, leaving them to feel that they are no longer in control of their lives. In some cases, these behavioral problems could manifest themselves in school settings, and bedwetting teenagers may fall into one of two extreme categories: вЂў Aggressiveness вЂў Self-pity Many times, these same kids have problems focusing while in class, which results in poor school performance and low academic marks. Teenagers who have nocturnal enuresis may consider this condition as the biggest hurdle they have encountered in their lives. Therefore, parents and other family members play a very important role. It is important to downplay the impact of bedwetting in the family so as not to create the vicious cycle I have mentioned. Bedwetting can cause stress which, in turn, can cause even more bedwetting incidents, and then the cycle begins again. Parents and family members must constantly reassure their kids that they are not alone in this difficulty. By giving them constant emotional support, family members can help prevent any negative behavioral problems from developing. If teenagers feel theyвЂ™re alone, remind them that some other kids experience the same problem, but itвЂ™s just something people donвЂ™t normally talk about at school or in social gatherings. Constant reassurance is the key. Help bedwetting teenagers feel and think well about themselves because this condition is something that is out of their control. Do not make them feel isolated; in fact, it would be generally helpful for teens to participate in regular social activities. 5.1.1 Emotional Impact of Teenage Bedwetting Despite the fact that bedwetting is not their fault, teens often feel embarrassed about their condition. This can lead to a significant emotional impact, such as anxiety, depression, low self-esteem, and decreased self-perception. They may lack the ability to appreciate their skills, talents, capabilities, and physical appearance because they think they just donвЂ™t measure up. Above all, the major effect of teenage bedwetting is just one word: shame. We have been brought up thinking normal people donвЂ™t pee in their beds at night because thatвЂ™s what the majority experience. When someone experiences something thatвЂ™s contrary to our notion of вЂњnormal,вЂќ we tend to cower, feeling ashamed. This is what happens to teenagers who wet their beds almost every night. They would feel the full impact of shame because they think their condition determines their value and is not something their peers have to deal with. They tend to forget that nocturnal enuresis is something they do not have full control over. If youвЂ™re the teenager whoвЂ™s facing this kind of problem, just remember youвЂ™re not alone. Someone out there bears the same burden as you do вЂ“ you just donвЂ™t know it because it is not something people often talk about. 5.1.2 Social Impact of Teenage Bedwetting The emotional impact is not the only effect of teenage bedwetting. We should also consider the social impact, which includes вЂў Lack in interpersonal skills that makes it hard to maintain social relationships вЂў Significant reduction in the quality of life вЂў Low or poor performance in school and other social-related activities In other words, bedwetting teens often experience the full impact of isolation and social difference. We will take a look at how avoid this later in the module. 5.1.3 Looking at bedwetting from another perspective There are teenagers who only wet their beds occasionally, but there are also others who never experienced having a dry night. However, for those affected by bedwetting there are some things that can be done in order to prevent, or minimize, the emotional and social impact of bedwetting in the teenвЂ™s life and that of their family. Look at bedwetting from another perspective. The teen is the only one who can make things better by doing things such as refusing to give in to the negative feelings and impact of bedwetting. The teen can stay motivated and feel positive as they put their effort into making treatment options work. Mind over matter. Refrain from negative thoughts, such as, вЂњIвЂ™m going to have an accident tonight.вЂќ Instead, you should think that you are going to wake up to use the toilet so you can be dry all night. Otherwise, you are only telling yourself that youвЂ™re going to get wet or fail. If you will it, you can do it. ItвЂ™s just mind over matter. Prepare your bladder. Before you go to bed, always go to the toilet first. You have to anticipate that during the course of night your kidneys will still process any remaining fluid and your bladder will be filled. To prepare your bladder for extra volume, empty it before you retire for the night. This means extra room for fluid processed by the kidneys. Set up an alarm. If you are able to predict the time you usually wet the bed each night, you might want to set up an alarm to wake you at least 10-15 minutes early. Once the alarm sounds, you should get up and empty your bladder again in order to stay dry. Drink more fluids during the daytime. It is best to drink fluids during the day, especially water. If you donвЂ™t drink enough fluid, your bladder may be used to storing only limited amounts of urine. This means, it might not be strong enough to store the fluid processed by the bladder overnight. However, you should increase fluid consumption in increments so your bladder can adjust accordingly. Avoid alcoholic beverages and those that contain caffeine. Alcoholic beverages will only make matters worse because it acts as a diuretic. Since alcohol and caffeinated drinks are diuretics, it makes your kidney produce more urine, and, as a result, your bladder could become overactive. When this happens, bedwetting can occur. If you suspect that some drinks are causing you to wet the bed, try to reduce or eliminate those drinks for about two weeks and see if there are some improvements. Prevent constipation. As you may well know, constipation is one of the major culprits of bedwetting. Why? Because when your bowel movement is slow it can create pressure on your bladder. When this happens, not only will your bladder have limited room to expand, but it will also cause your body to вЂњsense that it is filled upвЂќ making you void more often. This is also true during nighttime. It is best that you increase fluid consumption, try to exercise, and eat a balanced diet to help with constipation. If you have persistent constipation, you might want to seek advice from your physician to help with your bowel movement. 5.2: For Parents: Desperation: вЂњWeвЂ™re at a loss for this teen bedwetting problem.вЂќ вЂњItвЂ™s so stressful trying to monitor my teenagerвЂ™s situation that sometimes I completely lose myself in the process.вЂќ Anger: вЂњDoing my teenagerвЂ™s laundry reeking with urine is very frustrating and embarrassing at times.вЂќ вЂњWhen will this end?вЂќ Frustration: вЂњI canвЂ™t think of anything else upon waking up in the morning other than the possibility that my teenager has wet his bed.вЂќ Are these familiar? The teenagerвЂ™s family is often faced with a wide-range of emotions regarding bedwetting. Some of these emotions include desperation, frustration, as well as outright anger. At other times, they experience denial that their teenagers are even experiencing an embarrassing condition. Some might find it embarrassing to have a full-grown teenager wet his/her bed at night. This can lead to a feeling of shame, thus making parents hesitant in discussing the condition even with their family doctor, who can perhaps provide some sort of help and some recommendations about available bedwetting treatment options. At times, when parents become outright angry, they will punish their kids for bedwetting, thinking that the condition can be controlled merely by willpower and avoiding laziness. They often think that the punishment (i.e. not allowing the kids to attend overnight trips at their friendвЂ™s home or other social activities so as to avoid embarrassment) would lead their teenagers to outgrowing the condition. Unfortunately, this kind of reaction will not get bedwetting to stop. In fact, more than 30% of teens with enuresis who are punished in one way or another have worsening conditions because of the extra stress the punishment brings them. This is a typical development of a vicious cycle. Teenage bedwetting is NOT a disease and we should stop treating it as such. If youвЂ™re a parent or the teenager, it is often helpful to treat bedwetting as a symptom. Since bedwetting is not an issue that parents usually talk about, the feeling of shame and embarrassment is often worse because there is nothing helpful to turn to. However, this is something for which we must seek medical attention. We cannot assume a teenager will eventually outgrow the condition, otherwise we will be faced with all the negative impacts that accumulate over time. There was a study conducted in Japan, where parents, specifically mothers, who often suffered the full brunt of stress over their teenвЂ™s bedwetting found that they scored relatively low when it came to quality of life. The relationship between bedwetting and the motherвЂ™s low quality of life was proven when they found there was a significant improvement in the score once enuresis had been controlled or treated. Furthermore, the results seen by parents who provide enough support, patience, and encouragement for bedwetting teens have found that it helps downplay emotional impact. 5.2.1 How can you help your teenager maintain his/her self-confidence? As parents, it is often frustrating to try bedwetting solutions with your teens only to find out that the promising solution youвЂ™ve found is not working. Fortunately, there have been several management options to help teenagers stay dry throughout the night. Talk to your family doctor. A medical professionalвЂ™s opinion is extremely important and is unparalleled, especially when the problem of bedwetting has been persistent until young adulthood. It is always a good idea to talk to your family doctor in order to make sure that there are no physical abnormalities and other medical-related conditions that are causing the bedwetting. Once the abnormalities and medical conditions are ruled out, this could at least help ease your teenagerвЂ™s mind about bedwetting. There are many cases where bedwetting is a symptom of an underlying medical problem. When teenagers understand that something is wrong with their bodies, this could alleviate the feeling of embarrassment or shame. Otherwise, this could help them understand more about bedwetting, so it is important that you discuss with your teen how you can deal with the problem. If teenagers think that they are doing something wrong, you and the doctor can reassure them that itвЂ™s not their fault. Explaining to teens what their condition is, especially when itвЂ™s about the development of their bladder, can help them understand the situation more. You could also point out the fact that some teens who sleep very deeply can wet their beds because they donвЂ™t wake up in time to use the toilet. Point out that bedwetting is a common condition. The problem with bedwetting is that it is not something people talk about normally each day, so your teenager may feel like he or she is the only teenager who is wetting the bed. Make sure to point out that there are millions of teenagers across the globe who are wetting their beds just like your teenager does. Furthermore, make sure that your teenager is aware that bedwetting is often hereditary, which means that the teen may have inherited the condition through their genes. There are even teenagers who donвЂ™t have bedwetting parents and still have more than 10% chance of becoming a bed wetter. It goes up to more than 40% when one parent has experienced bedwetting and will hit 70% when both parents have wet their beds during their childhood. So, be honest with your teenager and tell him if you or your spouse has experienced bedwetting before. If you tell your teen that you had the same problem as they do when you were young, it can significantly reduce the embarrassment or shame that he or she feels. This will give the teenager some hope that there is a solution to a problem. Avoid getting angry and frustrated. There is a significant chance that teenagers are already feeling upset and ashamed, especially when waking up wet and cold. We have to remind ourselves again that it is not the teenвЂ™s fault because it is not under his or her control. No matter how angry, mad, or frustrated we become, it is important that we try to control our tempers and stay positive and calm. Getting angry will only promote a more stressful environment and will not be helpful. Anger and frustration can create more damage, by hurting the teenвЂ™s self-esteem and making matters worse вЂ“ not to mention the chance of ruining your good relationship with your teen. If we want to help a teenager get over the feelings of shame and embarrassment, donвЂ™t make them feel like theyвЂ™re guilty for being wet. Instead, we must encourage them and give them hope that soon the struggle will end. In the same manner, donвЂ™t forget to give them recognition for staying dry after they wake up the following day. Also, do not tolerate any teasing from other members of the family. Make nighttime toilet more convenient. We might want to make it easier for the teenager to go to the toilet at night. Therefore, make sure that it is more convenient and comfortable. We can allow them to keep their bedside lamps on and have night-lights installed in the hallway so it is easier for them to see at night. If it is possible, wake them during the early days of bedwetting management so they will feel supported and see effort in helping them to stay focused on the goal of being dry until it becomes their second nature. Instill a sense of responsibility to teenagers for bedwetting. We shouldnвЂ™t overemphasize the issue of bedwetting, but we shouldnвЂ™t ignore it entirely, as if it is not happening, as well. If you instill responsibility in the teenager, it can empower him or her to minimize the impact of bedwetting to the their self-esteem. Encourage the teen to help clean up the mess. While it is true that instilling responsibility in your teenвЂ™s mind is important, make sure that your approach in making him or her feel вЂњresponsibleвЂќ is not because youвЂ™re blaming him or youвЂ™re implying that bedwetting is something he does on purpose. There is a big difference between the two scenarios. Being a teenager means being responsible, and this is what you should make him or her feel. DonвЂ™t make them bear the burden of responsibility just because you want them to know what вЂњthey are doingвЂќ even if itвЂ™s not their fault. Give teens a sense of control over their condition. A lot of teens reach the point of desperation when it comes to getting over bedwetting. Their self-esteem could go downhill if we do not give them an outlet to vent their frustration. We can achieve this by giving them a sense of control over their condition. In most cases, a medical expertвЂ™s opinion matters to teens, especially in giving them enlightenment that thereвЂ™s hope for their condition. If we allow teens to have ownership over their condition, the recovery will be based on their commitment, which can greatly improve their confidence and self-esteem in the process. Allow them to hypothesize about their condition without feeding them information. Let them realize what food, drink, or activity is leading them to wet their beds, if any. If we allow them to make their own hypothesis regarding their condition, they will end up experimenting with what works and what does not in relation to their food and fluid consumption as well as their activities. Teenage bedwetting is not something that requires disciplinary sanction. It was often thought that bedwetting teens were not taught well, delayed in development, or were poorly disciplined. Many parents today are still under the impression that bedwetting is an act of rebellion, a way to вЂњpunishвЂќ their parents, or a way to get вЂњnoticed.вЂќ However, it is imperative вЂ“ as a parent вЂ“ not to treat bedwetting as something that requires disciplinary action. It doesnвЂ™t work because the stress resulting from the disciplinary efforts will only make things worse for a teenager. No teenager in his right mind would want to wet their bed. The teenager needs empathy and help, not our discipline. He or she will understand the situation better if we are supportive and emotionally there for him or her. Give them a sense of hope. There will always be hope for bedwetting teens, and we should reinforce this fact by constantly reminding them that bedwetting isnвЂ™t going to be forever. If there are episodes of dry nights, remind them of this improvement so they will look forward to staying dry for the rest of their life. Anyone who will not believe that bedwetting is going to improve will only have a hard time making treatment efforts work. As a result, the teenager will think that the problem is actually bigger than they ever thought it was. A parentвЂ™s responsibility is to make the teenager see that help is available for the problem to be resolved. Module 6: How to Start Controlling and Managing Bedwetting Is there a way to control and manage teenage bedwetting? The answer is absolutely yes. However, the success of your efforts depends on your response, commitment, and other factors. I have identified three major categories in the control and management of teenage bedwetting, which we will be discussing in detail later. They are: вЂў Early identification вЂў Medications вЂў Alternative approaches 6.1 Early identification If you and your family are in denial of the situation, this will only worsen the issue. The first step would be to identify the condition early and accept that the condition exists in your home. Teens will hide this even from their parents because they think they are different, and that could lead to bullying and other social problems. Early identification is important because you can craft a course of action right away. In this sense, the emotional and social impact of bedwetting in the teenagerвЂ™s life can be minimized. Along with your attending medical doctor, you can choose which mode of treatment is appropriate for you and your family. 6.2 Medications There are a number of medications that can also help, such as Desmopressin, which is a synthetic replacement for the naturally occurring Vasopressin that regulates the production of urine during the night. Desmopressin is usually one of the medications given to patients suffering from Diabetes Insipidus, but some doctors use it in the treatment of teenage bedwetting. 6.3 Alternative Methods This is usually what parents and teenagers can use to make significant improvements in collaboration with their medical professional. These alternative methods may be used in conjunction with medications so that the treatment and management will become even more effective . Information, expert advice, and brochures are all resources that can help you in your fight against bedwetting. You may need to try various approaches to the problem until you find the one that works for you. Module 7: Medical Treatment of Teenage Bedwetting As I have previously mentioned, there are different modes of treatment, and, in this case, I have separated the medical methods from alternative methods for treatment and management of teenage bedwetting. 7.1 Pharmacological Treatment I have mentioned before an example of medications for nocturnal enuresis, otherwise known as bedwetting. These pharmacological treatments can be used alone or in combination with alternative methods such as behavioral therapy and other management options. Generally, when the treatment is combined with medications and alternative methods, it is more effective. However, a number of studies have shown that medications may be effective initially in reducing the frequency of bedwetting incidents, but they are only effective provided they are taken on a regular basis. You should know that medications, when used alone, have the tendency to increase relapse once the treatment has been abruptly stopped because only the symptoms are being treated and not the condition or causal factor itself. Before you start with any of the treatments given below, it is important that you first seek the opinion of your medical doctor. 7.1.1 Desmopressin By far, the most popular medication for nocturnal enuresis is Desmopressin, otherwise known as DDAVP. As mentioned, it is comparable to the naturally occurring hormone, Vasopressin or ADH (anti-diuretic hormone). This synthetic drug mimics the function of ADH, which results in the kidney producing less urine. It is usually taken at night before bed. In many cases, bedwetting teens respond well and experience dry nights. This medication is available in two forms: oral tablets or nasal spray. When used in conjunction with the alternative methods, this pharmacological treatment is a great option, especially when spending the night with friends or participating in other social activities. According to research conducted, this mode of treatment is more efficient if the drug is tapered вЂ“ wherein the medication is slowly stopped вЂ“ and then restarted after a period of time without it. You should know that Desmopressin will lose its effectiveness over time, but can usually be useful again after a period of time of non-use. For that reason, it is often recommended that it not be used continuously, but rather, only in intervals. Some reported side effects include sleep disturbances, mood swings, and dry mouth. It is not recommended for people with electrolyte imbalance since it can cause fatigue, dehydration, and dizziness. 7.1.2 Imipramine Imipramine is a tricyclic-antidepressant with off-label usage of decreasing the frequency of bedwetting; however, the reason for decreased urination from this drug has yet to be discovered. It is important to note that this medication should only be used under medical supervision and with extreme caution. In fact, it is only given to individuals who are not responsive to other medications. Extreme caution must be used since it has more serious side effects, including those that could affect the heart: вЂў Decreasing blood pressure вЂў Increased risk for suicide Other common side effects noted include gastrointestinal disturbances, sleeping problems, loss of appetite, and, in rare cases, personality changes. 7.1.3 Anticholinergic drugs Anticholinergic drugs are prescription medications which are effective in treating bladder wall muscle hyperactivity and show a success rate of anywhere from 5% up to 40% of bedwetting cases. The common side effects noted include blurring of vision, dizziness, and dry mouth. The anticholinergic drugs available today include, but are not limited to, the following: вЂў Oxybutynin: This drug will relax the bladder wall muscle. It can significantly decrease the frequency of bedwetting episodes, and can be combined with alternative modes of treatment such as bladder volume training. It comes in the form of transdermal patches and immediate as well as time-release pills. вЂў Solifenacin: This is a recently introduced drug for bedwetting and is more selective with lesser side-effects. вЂў Tolterodine: This drug is available in short and long acting doses, and it functions similar to Oxybutynin. вЂў Darifenacin: This drug relaxes the bladder muscle and can treat bladder spasms as well as hyperactive bladder. In other words, it lowers bladder contractions while increasing the capacity of the bladder to hold urine. вЂў Trospium Chloride: This drug treats the unstable bladder by blocking the receptors found on the bladder wall muscles. Hyperactivity is eliminated because the bladder can relax through this process. 7.2 Surgical Approach There are cases when the bladder wall muscle is so hyperactive that it becomes necessary to use surgery to correct it. But, even then, it should only be considered when other non-invasive or less invasive options have failed. The surgical procedures mentioned here have risks that must be evaluated and adequately discussed with your attending medical doctor. 7.2.1 Clam Cystoplasty This surgical method is done by cutting the bladder open and placing an intestinal patch between the two halves to enlarge its size. The procedure is done in order to reduce the instability of the bladder which increases its capacity to hold more urine. 7.2.2 Detrusor Myectomy This procedure is otherwise known as auto-augmentation, which will remove a portion or all of the muscle surrounding the bladder. Its purpose is to strengthen the bladder contractions and lessen the contraction frequency. 7.2.3 Stimulation of the sacral nerve The roots of the sacral nerve are under neurologic modulation. This is a process where the neurotransmitters are controlling several neuron groups. This will increase the external sphincter tone, which will cause the bladder muscle wall neurons to stop their activity. When this happens, there will also be a decrease in the bladder muscle activity which causes contractions not to happen constantly. Eventually, the voiding episodes are decreased and become less frequent. This procedure is ideal for individuals with moderate and severe urge incontinence, as well as for those who have tried all other treatment options and found that they failed. 7.3 Experimental Treatments There are also experimental treatments that are still undergoing some testing today including 7.3.1 Laser Acupuncture This is the recently introduced branch of acupuncture that utilizes lasers to target specific parts of the body painlessly. This treats various medical problems, including bedwetting. In fact, research has shown that laser acupuncture has a success rate that is equal to the effects of Desmopressin following three months of therapy. 7.3.2 Botulinum Toxin A This method of treatment utilizes an injectable bulking agent, which is given through the means of a flexible cystoscope, on various areas of the muscular wall of the bladder. A cystoscope is a thin instrument utilized in the examination of the bladder interior. This can be done as an outpatient surgery but may only last between 6-9 months, and it is important to note that a few adverse side effects have been reported. This is an off-label use that is currently undergoing clinical trials and must only be considered as a last option. Module 8: Alternative Approaches to Treating Teen Bedwetting There are several alternative methods that can treat teenage bedwetting as well. The following sections list various options that bedwetting teens and their parents can explore. 8.1 Behavioral Therapy 8.1.1 Monitor Your Fluid Consumption One of the best alternative methods used to treat bedwetting is fluid restriction, especially late in the afternoon and before retiring to bed. Often, this will lessen the amount of urine being produced during the night. It is also helpful to reduce the intake of caffeinated or alcoholic drinks. Monitoring your fluid consumption does not mean reducing daily fluid intake. It just means changing the time of consumption (i.e. drinking water in the early morning and mid-day but not so much late in the afternoon until bedtime). It is still important that you take in adequate fluid to ensure general well-being, especially when it comes to water consumption. 8.1.2 Bladder Volume Training This method has an end-goal of increasing the capacity of the bladder to hold urine, especially in bedwetting teens with small functional bladder capacity. The individual must drink a lot of fluid during the day and refrain from urinating for as long as he/she can, which is usually up to 3 hours. Through this training, there will be a significant increase in the functional bladder capacity, thus making urination less frequent. This approach is especially helpful for people with hyperactivity of the bladder wall muscles вЂ“ otherwise known as detrusor hyperactivity -- which is known as a condition wherein the muscles of the bladder involuntarily and frequently contract. 8.1.3 Alarm System This is also called the вЂњbedwetting alarm system,вЂќ which can be any device that can awaken the bedwetter at the same time of the accidentвЂ™s occurrence. There are various alarm devices available today from vibrating to audio-capable alarms as well as those equipped with wet-detection sensors, which can be attached to the pad or underwear used by the individual. The control of urine flow is achieved once the individual wakes up and can finish urinating in the bathroom before returning to bed. The problem with them is that for many individuals once the urine flow starts it is next to impossible to interrupt it. The constant use of these devices can help condition the body to wake up whenever there is an urge to urinate, even before urinating begins. This method could take weeks or even months before it could work, so it requires commitment, motivation, and constant encouragement. It will probably not be effective in cases where the individual has to wake up several times at night because of more than one episode of bedwetting from inadequate functional bladder capacity. However, in other cases of bedwetting, the device will generally help overcome the condition. 8.1.4 Waking Up This option does not really treat the problem but it could prove to be helpful in the prevention of bedwetting. It works similar to an alarm system, only rather than attaching the alarm to the underwear or pad, it is just an ordinary alarm set to random times at night in order to wake the person up so that they can void. The random time is important so that the bladder does not get used to the schedule regardless of whether or not the individual is awake. 8.2 Other Management Options 8.2.1 Diapers Your teen may cringe at the idea of wearing diapers but diapers can greatly reduce the amount of clean-up work. If the teen is sharing the workload of the clean-up they might opt for the convenience of not having to change the bed (especially during the night when they would rather be sleeping) and be able to get over the idea that вЂ�only babies wear diapers.вЂ™ There are disposable products such as GoodNitesВ® (or generic equivalent) that list their sizing as up to 115 lbs. Above that there are products such as DependВ® briefs in various adult sizes. The disposable products are very convenient and no laundry is needed for them. On the other hand they sometimes donвЂ™t handle a вЂ�floodвЂ™ very quickly and tend to leak much more than cloth diapers. Disposables can be used with waterproof pants over them to reduce the leakage problem. Cloth diapers require the use a waterproof pant and can be obtained from a variety of sources. I suggest that you have a look at www.plastic-pants.com and www.plastic-pants.com/adult-cloth-diapers.htm The reusable (need to be laundered) вЂ�All in OneвЂ™ pants have cloth on the inside and a waterproof polyurethane layer on the outside but they tend to leak around the edges and the VelcroВ® closures can really irritate the skin if they come into contact with it. I donвЂ™t recommend them for those reasons. 8.2.2 Bed Protection There are a variety of available mattress covers on the market today that could protect your bed, including vinyl, absorbing mattress covers, sheet protectors, and waterproof mattress covers that will make the clean-up process more convenient and easier. 8.2.3 Skin Protection There are a number of products to choose from when it comes to skin protection. These will prevent skin soreness and irritation, which usually occurs when an individual suffers from bedwetting. You can choose from a range of soaps, cleansing cloths, and lotions for different skin types. 8.3 Bedwetting Advice From Other People Some of the methods mentioned in this section have been tried by other parents. Whether or not they will work varies on a case-to-case basis, since not all cases are the same. Still, I will emphasize the importance of consulting your attending physician or health practitioner first before you engage on any of the mentioned treatment methods. An expertвЂ™s advice will always be helpful вЂ“ more than you can imagine. 8.3.1 Hypnotherapy One of the alternative treatments that has not yet been extensively tried is hypnotherapy. The principle followed in hypnotherapy is similar to behavioral therapy in using the mind to control the bodily processes. In a hypnotherapy session, the individual will be hypnotized and active suggestions are instilled using the therapistвЂ™s voice. The hypnotherapist will suggest that the individual attain bladder control, so they can wake up and empty it in the bathroom. This method is safe and generally used for teens and older individuals, even though there are therapists who work with young kids. Results of hypnotherapy might be seen in just a few weeks. If you think that hypnotherapy is best for you or your teenager, you have to do your own research about credible practitioners since this kind of therapist is not required to have license to practice. You can get a referral for an enuresis-specific hypnotherapist, who has had successful therapies with other patients. You have to know that most health insurances will not cover this method of treatment, so you should research a good therapist, so you know that youвЂ™re spending your money well. 8.3.2 Honey Therapy The honey therapy is an inexpensive way of controlling teenage bedwetting. However, as previously mentioned, not all cases will respond to this kind of therapy. Nonetheless, it would be worth trying. Some teens who take a teaspoon of honey twice every day вЂ“ in the morning and the evening вЂ“ notice that it can prevent a bedwetting episode. This kind of therapy received mixed reactions from experts. Some are skeptical about its relationship and thus dismiss it as part of the treatment regimen. In some cases, however, teenagers are happy to say that it works. Research has been conducted to analyze the efficacy of honey in treating teenage bedwetting. It showed that active components found in honey are believed to be waterretaining and can help calm the nerves. More research must be conducted to test the honeyвЂ™s properties and their potential effect on bedwetting. Nevertheless, it is not harmful to take a teaspoon of honey both in the morning at night since this can also treat other common ailments. Before starting this treatment you must be sure that the bedwetter does not have diabetes or it could be very harmful. 8.3.3 Natural Remedies Included in the natural remedies section is homeopathy. Nowadays, homeopathy, or alternative medicine, has been widely accepted and might be worth a try. There are a number of accredited practitioners who claim success in treating bedwetting. If you find one of them that seems promising make an appointment with them to discuss the problem. Ask them for examples of cases that they have successfully treated and also ask what their success rate is. In line with this, there are also a number of natural medicines that can be used in controlling bedwetting problems, which you can easily and inexpensively purchase at any natural health food shops. Before you buy anything, it is best that you consult with an alternative medicine practitioner over which products or natural medications are best for bedwetting. A lot of people have succeeded using this method in the past, and you could too. If you buy over-the-counter homeopathic remedies, you should read the active components of each product you purchase to ensure safety, specifically when talking about hypersensitivity or allergic reactions, which could be potentially fatal. If there is something you donвЂ™t understand, you can ask the pharmacist specifically about the ingredients that can interact with anything that you are currently taking. Even though the label says вЂњnatural,вЂќ it may contain components that may cause harmful effects like an allergic reaction. Many teens found significant relief from bedwetting when they take natural pills, tablets, and other products вЂ“ you just have to proceed with great caution. 8.3.4 Chiropractic Medicine Some teenagers who have tried chiropractic medicine have noticed significant improvement in their bedwetting problem. However, it is important that you find only an accredited, qualified, and recommended chiropractor, especially someone who has had experience dealing with teenage bedwetting. Chiropractic medicine works by the manipulation of joints and the spinal cord. The manipulation is believed to help relieve various conditions, including bedwetting. Recently, a study was published in a well-known medical magazine that indicated bedwetting episodes have been reduced up to 50% using chiropractic medicine. This study showed that more than 20% of the subjects made significant improvement in bladder control. The chiropractic method must be performed only by a qualified practitioner, is generally safe, and can be used by many people вЂ“ bedwetting or not. Be careful whom you select as many chiropractors will try to sell you a very expensive series of treatments when only a few may be needed. Buyer beware! Module 9: Final Advice to Parents of Bedwetting Teens Your teenager is in a critical period of his or her life. They will face many stresses such as school, relationships, and other burdens. If you add bedwetting into the equation, the stress would increase and the teen would need an outlet to vent his or her anger and frustration. Make sure youвЂ™re always there for them. Apart from you, there are actually many people that can help your teenager overcome this problem and make him or her see that there is hope. 9.1 Team This is a group of people who play a significant role in a teenagerвЂ™s life, and it includes teachers, doctors, therapists, and specialists. 9.1.1 Teachers There is no need to tell the teachers that your son/daughter is suffering from a bedwetting problem. However, you should maintain an open line of communication with them to make sure that your teenager is still performing well in school and his or her social maturity is not compromised. A teacher whoвЂ™s given an alert sign about your teen will often notice any sign of bullying or teasing at school. 9.1.2 Family Doctor Make sure your teenager understands that your family doctor is an important part of the treatment process. The doctor must know all things related to the bedwetting condition. Some tests will be conducted to determine the root cause of this condition and will treat the underlying cause accordingly. Therefore, total honesty is needed so that the doctor can determine which course of action to take. 9.1.3 Therapist If you noticed some changes in the teenagerвЂ™s social interaction, grades, or selfperception you might want to introduce the teen to a therapist, especially when these changes are related to the bedwetting condition. You want to help him or her overcome this problem and give the teen back the confidence he or she may have lost in the process. Discuss this with your teenager first and see whether it is something he or she is interested in. There are times when seeing a therapist would only worsen the condition because the teen will think youвЂ™ve run out of options and thatвЂ™s why youвЂ™re giving him or her over to a therapistвЂ™s care. However, if your teen says itвЂ™s a good idea to try, then you should allow him or her to open up to a therapist. Reinforce this by talking to your teen so that both of you can develop strategies that can help him or her overcome the condition and help cope with any emotional burden, such as bullying and teasing. 9.1.4 Specialist You can also opt to see a specialist, like a nephrologist or urologist, who might have an opinion about the bedwetting condition of your teenager. In some cases, inadequate functioning of the urinary sphincter will cause bedwetting, and this requires medical help. A specialist can help identify whether the urinary system is functioning well or there are underlying conditions that must be treated first before the bedwetting problem is resolved. 9.2 Teamwork Teamwork is important once you have identified the key persons involved. The specialists you go to must be chosen carefully. All of you must be on the same page so the progress can be a success. The treatment options must be amenable to all and everyone must cooperate вЂ“ including the teenager. When youвЂ™re still in the process of choosing medical professionals, make sure that you find people who are genuinely concerned about the condition and have worked with similar cases before. Make sure they are highly qualified considering it is the well-being of your son/daughter that is at stake. In cases where licensing is not required, you should choose only the highly recommended professionals in your locality. You want to choose those who will listen to your concerns, as well as those of your son/daughter. As soon as your team is put together, teamwork is the next thing you need to arrange with them. This ensures that all treatment regimens and other management options will work as effectively as planned. This means you should follow their recommendations and instructions carefully (or seek out clarifications, if needed). You should also give voice to all of your concerns regarding the treatment procedures or management options you choose, and tell them honestly whether the treatment regimen works or not. 9.3 Educate Yourself Your team can only do so much when it comes to the treatment of bedwetting. You can augment this by educating yourself regarding the condition so you can help professionals in their efforts to alleviate or cure the condition. Because of the recent advancements in technology, new research, and information discovered, it is important that you do your own research. The internet can be a great source of highly relevant and reliable information regarding bedwetting. Just beware of those who have their financial interests ahead of you or your childвЂ™s health. 9.3.1 Flyers, Brochures, Pamphlets Most of doctorвЂ™s clinics, medical offices, and even pharmacies provide flyers, pamphlets, and brochures about different conditions such as bedwetting. These printed materials can give you a general overview about bedwetting as well as an outline of the common treatment and management options, which can help you to understand bedwetting better. 9.3.2 Educational Videos Some doctors or specialists, and even pharmacies, have videos related to bedwetting, which are clear and concise. These videos utilize the simplest form of explanation, reinforced with visual data, to ensure quick understanding about how the urinary system works in relation to bedwetting. Most often, it is very useful to see images of the urinary system and watch actual or simulated bedwetting treatment options so that you can understand how the entire process works. 9.3.3 Pharmacists Currently, pharmacists are equipped with knowledge about various conditions and their treatments. If your son/daughter is taking some medications intended for bedwetting purposes, like herbal or alternative medicine, you should ask the pharmacist about possible drug interactions with other medications. This reduces the chance that the medication your son/daughter is taking will cause additional problems. 9.3.4 Health Articles There are a lot of health articles written all the time, and there is no reason for you not to pay attention to them, especially when you want to know more about bedwetting. These health articles may contain news about breakthrough treatments or discoveries that can help your son/daughter overcome bedwetting. It may also be helpful if both you and your teenager read these health articles together in order for you to be on the same page, and to let your teen know that others face the same problem he or she is facing. 9.3.5 Online Communities There are various online communities you can find that are related to bedwetting. However, you must proceed with caution when youвЂ™re using online resources or become members of online communities. Nonetheless, there is written information online that is provided by professionals and experts. Therefore, it is important that you know which sites are reliable and which are not. You should only trust online information in which you have confidence in the source. There are also plenty of online resources from membership sites, which are helpful in your bedwetting problem. You just have to find the sites that are genuine and have members that are in the same boat as you. Many parents find forums and chat rooms helpful in the treatment process because they will be able to encounter other members who are facing the same problem, whether they are the bedwetting teens or the parent of a teen. In these online communities, parents are able to discuss their bedwetting concerns and explore healthy and safe solutions together. Many parents find that other people from these online communities can empathize with them and their problems. Teenagers can also find the support they need. But, again, you must treat all the information you get from these online channels with caution. There are also various online speakers who can give you ideas and can make suggestions for specific concerns, such as the best tools that can save you money and time in the cleanup process. Use the online chat with caution and common sense. The same is true with online forums. 9.3.6 Parents or Relatives There are many families that have bedwetting teens. If you are open to other parents, or your own relatives, you might find that they have had the same problem as you do. Often, this brings a lot of useful information, tips, and advice, as well as support for teenage bedwetting. However, you should never discuss your teenвЂ™s bedwetting problems with another person or relative without his/her knowledge. This could result in other problems later on. But, if the entire family already knows the problem, you can work alongside them to discuss what methods are appropriate for your teenager and who is the best professional in your area that can deal with teenage bedwetting. Many times, other parents or your relatives know information that you have not yet uncovered, so donвЂ™t dismiss their importance. They can make suggestions on which alarm is best for teenagers or which absorbent materials are best to use to protect the bed. These extra details can give you great insights on what to buy or who to trust. Module 10: Closing Words Now that we have seen most of the basic information to help parents and teenagers deal with bedwetting, the next step is for you to take action and choose the methods that you think will work best. There are methods that have already been put into practice and have succeeded, while there are also those that are undergoing a вЂњtrial and errorвЂќ phase. It is up to the teenager and his/her parents which methods to adopt at first. There are several things I want you to remember in closing: 1. No matter what kind of method you choose, it will always require your patience and time. This means if a method doesnвЂ™t seem to work at first, that doesnвЂ™t mean it wonвЂ™t work ever. You just have to wait until the body can adapt to the changes, and eventually, bedwetting will stop. Often, this results in frustration and desperation, but if you truly want to outgrow bedwetting, time and patience are needed. 2. Adopting better behavior is also a great way to teach the body how to respond to bedwetting. One way is to think about waking up in time so you can go to the bathroom. 3. Reduce the mess that bedwetting generates, thus lowering the stressful impact of bedwetting. Teenage bedwetting is messy, and unlike the mess of bedwetting children, the stress is more severe or extreme because teenagers are in the stage of their lives when they should have attained that independence. Teenagers should be involved in the mess reduction and cleanup process. If this means buying absorbent products or disposable underpants, then you should. The qualities of a good method of dealing with a bedwetting problem include many things. 1. It must be well accepted and personally initiated by the teenager. This allows them to stay in control of the situation, considering that they are the one who will have to deal with any bedwetting episode that may occur. 2. The method should also not make matters worse, must be safe and effective, as well as budget-friendly. This means that the options should be discussed with the whole family. 3. It must also be accepted by other members of the family so as not to cause disruption in relationships. In addition, the method chosen must not compromise other responsibilities in terms of money and time. In as much as the method must be comfortable to the teen, it should also be comfortable to the rest of the family and not interfere with any social activities. There are a lot of treatment methods mentioned in this eBook that possess these qualities. The only thing you have to remember is how to make it work. The method must make sense, and in many ways, it could help you and your teenager reduce the mess and show significant improvement in the following days or months.