Tag Archives: bladder control

Bedwetting in the Older Child:

5 Oct

Punishable by death?

In August of this year, the Dallas Morning News reported that a 10-year old boy died in late July of dehydration after his parents deprived him of water to discipline him for wetting the bed. The boy’s father, Michael Ray James, 42, and his wife, stepmother Tina Maria Alberson, also 42, were arrested and charged with injury to a child causing serious bodily injury. Depending on the outcome of trial, sentencing and punishment, they could be imprisoned for up to 99 years for the crime.

The charge stems from the death of the boy after an autopsy revealed the child died from dehydration while being punished. Alberson’s bond is set at $150,000; James is $100,000. According to online reports, both are currently being held at the Lew Sterrett Justice Center. While the two had previously encountered problems with the child custody authorities, nothing had been proven to warrant removal of their children from them, according to reports.

Their son, Johnathan James, died on July 25. He wasn’t tied up or beaten as we often hear in child abuse stories. Instead, it seems the boy was forced to stand still for long periods of time, and not allowed anything to drink—not even a teaspoon of water, for five long days during the intense heat wave gripping Texas and The South throughout the summer. The James’ home does not have central air conditioning. And the child was forced to eat peanut butter, found stuck in his throat because of insufficient beverages upon his death and discovery by health care personnel upon autopsy.

At the time, Alberson told police the boy had complained of being hot and she had tried to cool him by putting him into a tub of cold water. Authorities initially thought the boy had died from heat exhaustion, but his death went unexplained until his autopsy revealed foul play. The boy’s grandmother is very concerned for the twin brother who saw his brother collapse and now wishes he had been able to sneak him a drink.

It’s not the first time we at the National Association For Continence (NAFC) have heard of a grandmother’s concern. In fact, I have personally spoken to grandmothers who telephoned our headquarters expressing serious concern about the physical and emotional abuse their grandchildren were being subjected to because of bedwetting. I have referred them, on occasion, to social services and other local authorities including the police.

It happens to be the #1 search term that brings people to our website, not for babies but for unresolved problems in older children and even young adults. Read what we have to offer in the way of guidance and information. Most parents are ill-informed and react with frustration, anger, or acceptance, none of which are helpful to the child.

Nocturnal enuresis, or bedwetting while sleeping at night, affects over 5 million children in the United States. In population-based cross-sectional studies on children between 6 and 12 years of age, a prevalence of 0.2-9.0% (daytime incontinence), 1.5-2.8% (combined daytime and nighttime incontinence), and 1.5-8.9% nocturnal enuresis, respectively, have been reported in published research. It is well known that nocturnal enuresis resolves over time. Every year 15% of those suffering from bedwetting become dry without treatment. But bedwetting also appears to run in families, and young people who suffer from bedwetting as children are more likely than others to have problems with incontinence later in life as adults.

Before discussing the treatment of nocturnal enuresis, there are two important things to keep in mind. First, children do not wet the bed on purpose. Second, most pediatricians do not consider bedwetting to be a problem until a child is at least six years of age. A recent study showed a significant communication breakdown between parents and doctors on this issue. While 80% of parents want healthcare providers to discuss bedwetting, most feel uncomfortable initiating the discussion themselves. Furthermore, 68% of parents said their children’s doctor has never asked about bedwetting at routine visits. Therefore, parents need to be more proactive by asking for help if they have a child who is wet at night. And they MUST be involved in the remedy. The most successful intervention strategies, with or without sophisticated bed alarms, require the parent’s involvement and positive reinforcement.

Bedwetting by the older child is a common and embarrassing problem that can greatly affect children and families. Life at summer camp, for the camper and the counselors, can be a disaster and is major problem summer camps are forced to address. It is neither the fault of the child nor the parent. Despite the frustrations that families have to endure, many parents do not raise the issue with their health care providers. The most important thing to remember is that with care and perseverance, nocturnal enuresis is a problem that can be successfully treated.

Nancy Muller, Ph.D.
Executive Director,
National Association for Continence


Sleepless Nights

23 Jun

Getting up every night to use the toilet?  Often more than once?  Waking once or more during the night to urinate is referred to as nocturia.  As we get older, we seem to get up more frequently.

Some causes are gender specific.  For example, nocturia in men is often linked to an enlarged prostate that blocks the flow of urine from the bladder.  Such men fail to fully empty their bladder during the day, sending themselves to bed with a partially full bladder that soon sends a wake-up call to be emptied. This is helpful to understand because getting the prostate enlargement diagnosed and treated may allow the symptoms of nocturia to all but disappear.  The onset of nocturia in women is generally linked to the consequences from childbirth, menopause, and even pelvic organ prolapse.

It is often difficult to separate the cause of awakening from the tendency to get out of bed, once awakened, to use the toilet.  If the problem is at least partly due to sleep disorders including sleep apnea and restless leg syndrome, these problems need to be investigated and treated separately.  Sometimes nocturia is a symptom of a greater medical problem that alters the way in which the body functions during sleep.  If the problem is excessive nighttime urine production, the first step is to look for the cause.  Targets include:

  • Diabetes
  • High blood pressure
  • Heart disease/Congestive heart failure
  • Vascular disease/Varicose veins/Swelling due to fluid accumulation in lower extremities

There may be steps you can take on your own (to read more, visit http://www.nafc.org/bladder-bowel-health/nocturia/)

  • Eliminating caffeine and alcohol from the diet, especially 3 – 4 hours prior to bedtime
  • Taking prescribed diuretic medications about 6 hours before bedtime
  • Minimizing all fluid intake 2 – 3 hours before bedtime, including foods with high water content
  • Avoiding strenuous exercise within 3 hours of retiring for bed
  • Avoiding engaging mental activity or stressful dialogue within several hours of bedtime
  • Turning off the television
  • Darkening the bedroom and sleeping with blinders
  • Kicking your pet out of the bed!

Of course……fall prevention is of major concern with nocturia.  That’s the next blog just around the corner.

Signs of Prolapse? Are You At Risk?

2 Jul

Prolapse in women has been associated with many factors. Studies have implicated pregnancy, aging, hormonal status, obesity and weight gain, chronic pulmonary disease and smoking, genetic factors, congenital anatomic factors, connective tissue abnormalities, and acquired neurological abnormalities. However, the strongest relationship exists with childbirth and its effects on the muscular and tissue support structures of the pelvis.

First, let’s review what is really happening anatomically.  Pelvic organ prolapse is defined as the descent of the top of the vagina or cervix and may involve the collapse of the front or back walls of the vagina.  When this support is compromised, compartmental structures, such as the bladder, uterus, or lower intestine, can move out of their proper position and even protrude from the body’s outlet in later stages.  Hence, the term “fallen bladder.”  There’s a feeling of perineal pressure, sometimes back pain, and urine retention if the bladder outlet is blocked.

 I like to think of our female pelvic organs as the solar system.  Each organ has its place relative to the other organs and structures.  Collagen and connective tissue help to keep them in orbit.  If one planet were to suddenly disappear or shift its orbit, a corresponding shift in positions of the remaining planets would likely occur.  So it is with organs of a woman’s pelvis.

Certain factors can throw those planets out of orbit.  Although there’s much more for us to learn from future research, how can you best protect yourself against the risk of experiencing prolapse – or allowing mild prolapse to worsen –  based on what we do know?

  • Follow a faithful, lifelong routine of doing pelvic floor muscle exercises, both short and long contractions, before, during, and after pregnancy.
  • If you’re carrying excess weight, lose it.  If you’re at your ideal weight, maintain it.
  • Avoid heavy lifting.
  •  Engage in regular exercise that minimizes the downward forces of gravity, e.g., swimming over gymnastics
  •  If you have a chronic cough, seek treatment for it.  If you smoke tobacco, stop. Eat a high fiber, low fat diet and stay hydrated to avoid constipation.

Find out more, including treatment intervention, visit our web site www.nafc.org or call us at 1.800.BLADDER


Strengthening the Pelvic Floor

25 May

Too many people have the impression that pelvic floor muscles are used only in childbirth.  And many men don’t realize that they have these muscles too, just like women.  The truth is that the pelvic floor is a key member of a team of muscles that, along with a vast network of nerves, vessels, and connective tissue, form our inner core.  The other muscles are the transverse abdominis, or “abs,” the diaphragm, and the deep, back muscles.  They all are linked and work in unison to support the pelvic organs, stabilize the pelvis, and our keep our posture erect.   When these muscles are strong, you are at less risk of back injuries and falling.  When they are weak, you’re at risk for spinal injuries, back pain, poor posture, breathing disorders, and yes, incontinence and prolapse of pelvic organs.

Weight gains in pregnancy, and subsequently childbirth, place a woman’s body at significant risk of weakening and even damaging the pelvic floor, nerves, and connective tissues.  These are the muscles that help us maintain control over both the bladder and bowels.  Pelvic nerves maintain strong and healthy pelvic muscles, and connective tissues help to secure the pelvic organs in place.  Incontinence affects 30-50% of childbearing women by age 40.

In addition to the urinary sphincters serving as the valve whose job is to keep the bladder neck closed when the bladder is filling, the pelvic floor can be weakened in men undergoing prostate removal for cancer.  Studies indicate that as many as 50% of men report leakage of urine in the first few weeks following surgery.  Even after a year, approximately 20% will continue to have a significant problem with incontinence. And yet even after a year, improvement in bladder control can be gained when pelvic floor muscle exercises are regularly and correctly performed.  So don’t give up!

In both men and women whose pelvic floor muscles are weakened or damaged, bowel incontinence can occur as well as urinary incontinence.  This is because these muscles include the bundle of fibers that spans to the anus, or bowel outlet.  These help to control the release of gas or fecal matter from the bowel.  Keeping these muscles strong as a lifelong passion can help prevent loss of control in later years.

So keep up those kegel exercises, throughout your lifetime! Visit nafc.org to learn how.