Tag Archives: continence

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


Nighttime Toileting and Osteoporosis

1 Jul

Despite the significant effort in public education messages and pharmaceutical advertising, osteoporosis-linked fractures have risen dramatically over the past decade.  According to the Agency for Healthcare Research and Quality (AHRQ) in the Department of Health and Human Services, the hospitalization rate of patients admitted for treatment of hip, pelvis and other fractures associated with osteoporosis increased by 55% between 1995 and 2006.  An estimated 10 million Americans suffer from osteoporosis, which causes bones to become brittle and subject to easy fracture.  Even worse, osteoporosis slows healing following fracture and can contribute to multiple fractures leading to excessive pain, disability and permanently impaired mobility, and eventually death.  Because osteoporosis is involved mostly in older adults, with 90% of hospitalizations for patients 65 and older, the increasing longevity of our country has only increased the likelihood of higher prevalence, all else being equal.

Couple this trend with the heightened risk factor for overactive bladder (OAB) accompanied by aging, and we are facing the perfect storm.  Overactive bladder, including symptoms of nocturia or being awakened more than once nightly to urinate, affects an estimated 33 adult Americans, with prevalence increasing with age.  Impaired mobility coupled with middle of the night toileting in the dark is an equation leading to disaster for millions.  And with increasing numbers of the elderly living along, the problem is only exacerbated.

Our country has to get smarter about the convergence of these risk factors and wiser about how to practice practical, preemptive intervention.  Yes, it’s important to have bone density screening and  for patients to be compliant with osteoporosis-prescribed medication.  However, it’s equally important to take steps to strengthen bone, with strength-building exercises, with supervised instruction and in a safe environment.  If OAB is in the equation, then a full-scale intervention with behavioral therapy including pelvic floor muscle exercises, bladder retraining, and dietary changes and possibly medication is called for.   And watch out for medications prescribed for other problems that can cause you to be unsteady on your feet or easily disoriented, as research shows a link between sedatives/narcotics and falls.  Even chronic pain has been found to increase the risk of falls in older adults.

If nighttime toileting and overactive bladder problems persist, there are other remedies including peripheral nerve stimulation and device implants for sacral nerve modulation.

We’ve got to wise up to the combination of factors and preempt the perfect storm before it comes to shore.

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


5 Apr

Just weeks have passed since the March 11th earthquake and tsunami in northeast Japan – the fifth worst recorded in world history. Today, the official death toll exceeded 11,000, with numbers of the still missing and unaccounted for exceeding 16,000. Those missing were likely swept out to sea, so American military forces are assisting in the search for bodies offshore. Not only is the ensuing disaster surrounding local nuclear power plants uncontained and ill-defined, its impact on the future lives of Japanese remains totally undetermined. Those who haven’t already had their homes destroyed have been temporarily relocated with the others as far away as 50 miles from where they had been living. Farmers are being instructed to throw out crops and not replant until further notified, for fear of food being contaminated by radioactive elements released from the power plants. Photos and videos of the physical devastation are unbelievable. While there is virtually no limit to the list of losses and therefore needs of the Japanese people directly affected in this region – beginning with uncontaminated water, power, and warm shelter – the immediate list extends to medical supplies for those with a variety of conditions and illnesses. The obvious is access to medications or emergency surgery especially for injuries sustained during the earthquake or flood waters. The less obvious is medical products and devices for those with chronic diseases or circumstances, such as people with multiple sclerosis or spinal cord injuries or SCI disorders.
Specifically, the National Association For Continence (NAFC) has been alerted to an emergency relief effort being organized by the Japan Continence Society (JCAS) because the following kinds of supplies are needed urgently: urinary catheters for daily self-catheterization, urine drainage bags for indwelling catheters, indwelling urinary catheters, prepackaged disposable enema solutions, laxatives, portable toilets, and disposable nonwoven adult absorbents. Should supplies internal to the country run short, NAFC has pledged to contact U.S. manufacturers of these products to secure donated supplies for the stricken areas of Japan through their distributors. In early April, JCAS will be in northeast Japan setting up relief centers to get such supplies to individuals so desperate for help in their personal, daily bladder and bowel management at a time when the normal outlets are destroyed or non-functioning.
Additionally, we are working at NAFC to help JCAS connect with CNN to be identified as a legitimate relief outpost in need of donations to underwrite their outreach to earthquake and tsunami victims, many uprooted from their homes and from their local outposts for supplies. We have advised them to established a PayPal account to receive donations from individuals online by credit card, NAFC will post this information on our web site home page latest news.
Regardless of your religious faith or personal, moral code in life, all of us as citizens of the world are called to lovingly minister to the needy. This calling is without borders. Stay in touch via nafc.org or send any questions or comments you have to us in this international appeal.
Thanks for caring about continence. Thanks for connecting the globe over with those facing the very same, daily concerns as you. Thanks for your consideration and generosity.

Nancy Muller, Executive Director
National Association For Continence