Archive for the ‘Urinary system’ Category

Alarm clocks

Tuesday, February 10th, 2009

T.S. writes to ask about using an alarm clock to wake his 9 year old son to urinate. He’s been setting an alarm clock for 2 am for the last month. Sometimes his son does hear it and gets up to go to the bathroom. Sometimes it’s too late and he has already wet. He doesn’t seem to be making progress. Why?

When you set an alarm clock, you are picking an arbitrary time to alert your son. His body doesn’t necessarily work on this schedule. Some nights he may not need to urinate at all, some nights it might be midnight and sometimes it may be 3:30. There is no way for you to predict precisely when his bladder needs to empty.

A bedwetting alarm, which senses moisture, is able to pinpoint when the wetting is occurring. It will alert your son exactly when his bladder needs to empty. Behavioral conditioning works to help him learn to wake up to the sound that occurs when the wetting happens. Over time, his body will be able to make the connection that a full bladder means get up and go to the bathroom.

Parents often ask, “Isn’t it too late to be alerted if the urine is already coming out?” In the beginning, the bladder may completely empty before the child or parent can respond. Over the first few weeks, however, the usual response is that the urine flow stops at the sound of the alarm. Instead of a large wet spot on the bed, the spot is reduced to a quarter sized spot on the underwear. Urine remains in the bladder and can be emptied in the toilet. Ultimately, the brain alerts the child to wake up before urination happens.

Daytime Wetting

Friday, January 9th, 2009

I want to share some effective strategies for school aged children with daytime wetting or leaking.  Daytime wetting is a little more common in girls, and nighttime wetting is a little more common in boys, but both sexes can be affected. The children often describe that they don’t feel like they need to go to the bathroom until the last minute. Then it’s too late and urine begins to come out in their underwear. Parents describe the frustration of noticing that their child is fidgeting or reminding them to go to the bathroom, with their child responding “I don’t have to go”. Five minutes later, urine is leaking out or they are urgently trying to find a bathroom.

Making sure that the urine/urinary tract is normal is always prudent when noticing this behavior. You can consult with your pediatrician about this. Also, constipation and infrequent stools can contribute to daytime wetting problems. Address these factors first. If neither of these things is found to be contributory, you can move on to some behavioral techniques.

It seems that when these children’s bladders become overly full, they sent a very urgent message to the brain and begin contracting before the child has a chance to get to the bathroom. Parents describe this as “waiting until the last minute” or being so interested in play that they “ignore needing to go to the bathroom”. You and I receive messages from our bladder well in advance of actually needing to use the bathroom. We have time to finish what we’re doing and leisurely make our way to the toilet. Children with daytime wetting often don’t have this luxury.

We know that “timed voiding”, which is emptying the bladder on a schedule, rather than waiting for internal messages, is very effective in preventing overfull bladders from sending urgent messages. It’s almost impossible for a child, who has little comprehension of time, to remember to “Go to the bathroom every 2 hours”. A discreet, independent reminder can make all the difference.

Using a vibratory wristwatch is a great way of fostering the independent behavior of going to the bathroom on a regular schedule. Usually around every 2 hours is a good amount of time to begin with. For school age children, I prefer watches in which you can set specific times. That way, you can coordinate with the teacher the times that would be less disruptive but allow him/her to start p.e., recess or lunch with an empty bladder. Voiding at the end of the school day allows your child to begin the trip to home with an empty bladder, eliminating accidents on the bus or running to the bathroom when entering the house.

The Vibrowatch offers 12 independent times and vibrates about 20 seconds, making it difficult to ignore. The Medose and WobL watch each offer 6 independent alarms, and vibrate for 20 and 5 seconds, respectively. You can watch these videos to get a better idea of how these watches work. Most of my patients are amazed at how well their children do once they’re given a simple tool to help.

What is a weak bladder?

Monday, December 8th, 2008

I’d like to discuss the question that a grandmother poses about her 9 year old grandson. His mother was told by his doctor that he has a “weak bladder” and that was the reason for his nighttime and occasional daytime wetting. She wonders what this is and what they can do to help him.

First of all, I don’t think that “weak bladder” is a description for any specific medical condition. Your grandson’s doctor may have used this as a generic term for an uncoordinated urinary system. The urinary system is quite complex, with several components innervated by different sets of nerves. In order to be completely dry during the day and night, quite a lot of coordination needs to take place. A good thing to know is that in the majority of children with nighttime wetting, the urinary system is completely normal. It’s the coordination of the different components that takes time and in some cases, some “nudging”, through the use of a timed voiding program or the use of bedwetting alarm in the nighttime. The actual bladder capacity (the amount the bladder holds before it perceives that it is full) varies from person to person and may necessitate your grandson getting up to use the bathroom in the nighttime or go a little more frequently in the daytime.

In the nighttime, children with bedwetting release the urine at a time when they are still asleep. The coordination between the brain and bladder hasn’t quite developed to the point where they “hold it” until morning or until a time when they can be more easily alerted. Bedwetting alarms work to alert the child and parents when the wetting is occurring. Over time, the sound helps the brain make the association between a full bladder and getting up to urinate. Bedwetting alarms harmlessly speed up this natural progression so that children can become dry over a few weeks or months rather than a few years.

Children with occasional daytime wetting often receive “urgent” messages from their overfull bladder. If there isn’t immediate access to a bathroom, the urine is released into their underwear. A successful strategy to help avoid this embarrassment is to empty the bladder on a regular basis, before it gets overfull. A vibratory wrist watch with programmed times (about every 2 hours) can be a helpful, discreet reminder to the child that they need to take a break and go to the bathroom. A watch also takes the parent or teacher out of the loop, so they don’t have to be the ones always doing the reminding. Of course, a child can choose to ignore the reminder, but in my experience, once a child is given the tools to make a change, most would gladly go to the bathroom than wet themselves.