Nocturnal Childhood Enuresis

Bed-wetting is a common problem affecting many children. According to ERIC (Education and Resources for Improving Childhood Continence, 2008) about 1 in 12 young people in the UK struggle with daytime and/or bedtime wetting.

Experiencing such a condition can be worrying and stressful for the whole family and requires much patience, reassurance and love on the part of the carers. But this problem is especially worrying for the child, often reducing feelings of confidence and self-esteem, and curtailing many of the usual fun childhood activities such as sleep-overs and trips away from home.

All of us start life being incontinent, but as maturation occurs, voluntary control of the bladder is normally gained, first by day and then by night. It varies greatly as to when children become naturally dry at night, some simply developing bladder control later than others. But, the vast majority of children grow out of nocturnal enuresis, and intervention is not normally considered necessary for those under 7 years of age. For younger children who wet the bed, as long as a full medical assessment has been made and nothing problematic discovered, simple reassurance that they will grow out of it is required, because with most children under 7, the problem resolves itself quite naturally.

For those children aged 7 and over who are still experiencing nocturnal enuresis, sensitive, child-friendly treatment and support are required, beginning with a full medical assessment by the local GP. Once it has been diagnosed that nothing physiological is awry, the next step is to find appropriate treatment that will best suit the child and their individual needs. Hypnotherapy has been shown to be highly effective at helping children develop a greater sense of bladder control. It is a safe, non-addictive form of therapeutic treatment that can empower a child to make the changes necessary to enjoy the freedom of both dry days and dry nights.

Treatment begins with an initial consultation. Although shorter than adult initial consultations, the time allotted (usually 90 minutes) provides ample opportunity for the child and accompanying guardian/parent to get to know and become comfortable with the therapist, to learn more about how the bladder functions, about hypnotherapy and how it’s going to help, and to talk about all that they’ve been experiencing. A thorough case history is taken during this time, assessing the nature of the enuresis (primary or secondary – see below *), previous medical and professional assessments and past interventions experienced, any genetic or dietary issues that might have relevance, and so on. At this first meeting, the child will also experience a very relaxing, enjoyable introduction to hypnosis.

In following sessions, through simple hypnotherapeutic techniques, the child is made aware of their own mind/body connection, recognising their ability to control their body by tuning into body messages and responding appropriately to them. The body can be re-trained to either send very loud messages to the brain to wake up during the night and to not open the bladder gates until in a safe place to do so, or to encourage the bladder to stretch that little bit more until it is safe to be emptied on awakening in the morning. Visual imagery is very useful in this process.

Goal visualisation is a crucial element of the ‘dry nights’ treatment programme, moving current focus away from memories of a wet past and ‘failed’ attempts to address the problem, to anticipation of a comfortable and secure dry future. The child is encouraged to take direct responsibility for self throughout the change process. Deep relaxation hypnosis and further visual imagery are used to counteract the negative physical and psychological side-effects of stress and worry, and direct positive suggestion employed to boost self-confidence and build self-esteem.

Each child is asked to keep a Success Chart, and to listen to the complimentary mind/body connection CD every night, just before sleep. A typical ‘dry nights’ treatment programme extends over 6 sessions, although more sessions may be required if the child is experiencing secondary nocturnal enuresis.

* Primary nocturnal enuresis, when the child has never been reliably dry at night, most often represents a developmental delay that will be achieved with time. Secondary nocturnal enuresis, when a previously reliable child starts to wet the bed again on a regular basis, may be due to a urinary tract infection, or, perhaps, a serious emotional upset.