Nocturnal enuresis

Psychophysiological (mind impacting body) dis-ease is caused by the brain responding to a perceived threat within the immediate environment. This ‘threat’ (real or imagined) affects the limbic system, which triggers the fight, flight, freeze – stress response.

The information about the threat is held as an emotional memory image (EMI) inside the mind, creating a barrier to learning. This explains why it is so difficult for the child to consciously overcome involuntary urination whether monosymptomatic enuresis or nonmonosymptomatic enuresis. The limbic system, which is involved with motivation, emotion, learning, memory and behaviour is driven subconsciously, outside of the child’s awareness.

What contributes to emotional memory images?

Emotional memory images (EMI) are created after negative or positive learning experiences, from which the brain derives the best strategy to survive the current and future contexts.

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study showed that 61% of adults had experienced at least one adverse childhood experience and (16%) 1 in 6 adults reported they had experienced four or more types of ACEs.

That’s an awful lot of EMI’s, which can attribute to long term health problems, of which primary monosymptomatic nocturnal enuresis can be a marker.

Psychophysiological causes of enuresis in children and adults:

Sexual abuse, physical/psychological harm from family members, arrival of a new sibling, growing up in a family that has mental disorders, toxic stress, the loss of a loved one, divorce, social and financial worries from family members passed on to the child.

Traditional talking therapy for these presenting problems often take years to bring about results, as many children have no conscious access to the experience, therefore can’t talk through it. Behavioral Therapy or any approach that targets the limbic system can bring about faster results. As the intersection between body and mind, the limbic system holds the key to many psychophysiological disorders.

The EMI remains stored inside the mind, activated only when something similar to the original context/experience comes along, triggering the original enuresis. This may account for secondary enuresis when the urinary symptoms return to be a problem many years later. More research is needed.

Enuresis treatment for children

Enuresis in children refers to the involuntary loss of urine during sleep, occurring at least twice a week in a child 5 years of age or older, for at least 3 months.

Enuresis in children is a normal condition that young children go through, but if your child has primary enuresis and shows no signs of stopping, then a treatment plan may be necessary.

Breaking non monosymptomatic enuresis

Enuresis in children is nocturnal enuresis (whilst asleep) and nonmonosymptomatic nocturnal enuresis means that the child has other symptoms contributing to enuresis.

To begin helping your child to be free of primary enuresis you must allow him/her to feel uncomfortable for a while with the cold wet bedding or clothes. Discomfort helps them to learn from a sensory basis. This can take a little time but it is worth the week or so that it might take.

Breaking primary nocturnal enuresis

When the daytime symptoms have gone, nocturnal enuresis becomes the final challenge. Remember the rule of uncomfortable at this stage, use cheap nappies/diapers for bedtime. Modern diapers are designed to keep baby dry for long periods of time, so if you use these during this stage it will make it difficult for the child to notice urinary symptoms.

What about Fluid intake?

Nocturnal enuresis in children is hardly impacted by normal fluid intake. Some parents reduce the fluid intake of the child to almost zero and still all of the bladder training, and bladder control fly out the window as the child falls asleep and nocturnal secretion occurs.

The child needs to have good hydration, keeping his fluid intake regular can help to prevent chronic constipation, which can cause an overactive bladder.

Nocturnal polyuria can develop too as a result of the child dehydrating during the day and drinking large quantities of fluids in the evening.

Nocturnal enuresis alarm therapy

Alarm therapy shows good results in children aged 7 and older but not so good for children younger. The enuresis alarms or bedwetting alarms have a moisture sensor, which buzzes or rings if the child begins to urinate. Enuresis alarm therapy has been used successfully over 30 years for the treatment of primary monosymptomatic nocturnal enuresis.

Each time the child’s bladder capacity creates dysfunctional voiding, the child is awoken by the bedwetting alarms signal. The brain is learning bladder training and associating this with a positive feeling of success. The parents then compound this success, which steadily supports the child to being able to maintain bladder control over an overactive bladder, nocturnal polyuria and monosymptomatic nocturnal enuresis.

Enuresis treated with Tricyclic antidepressants or Alarm therapy?

Desmopressin therapy, tricyclic and related drugs are first-line medications most commonly used in children with nocturnal polyuria and normal bladder range. Tricyclic antidepressants also goes by the name of imipramine [Tofranil]) and anticholinergics. Desmopressin is an analogue of antidiuretic hormone.

Studies with randomized controlled trials show a small but not significant change in nocturnal enuresis in children vs enuresis alarms or doing nothing at all.

A recent study was carried out to measure the effectiveness of alarm interventions vs tricyclic to resolve nocturnal enuresis in children Cochrane Database of Systematic Reviews. The research concluded that alarm therapy may be more effective than no treatment in reducing enuresis in children.

Considering there were 74 trials with a total of 5983 children, the researchers are uncertain if alarm therapy is more effective to treat bedwetting than desmopressin therapy. The study concluded there were no risk factors with alarm therapy.

The authors concluded

Although tricyclics and desmopressin are effective in reducing the number of wet nights while taking the drugs, most children relapse after stopping active treatment. In contrast, only half the children relapse after alarm treatment. Parents should be warned of the potentially serious adverse effects of tricyclic overdose when choosing treatment. Further research is needed into comparisons between drug and behavioural or complementary treatments, and should include relapse rates after treatment is finished.

Common risk factors of Tricyclic antidepressants (TCA’s) can include:

The side effects should ease after a couple of weeks as your body begins to get used to the medicine.

For more information on enuresis in children Cochrane database is a useful resource

Psychophysiological treatment for enuresis

Using the lens of psychophysiological dis-ease we may be able to have a positive affect on both primary monosymptomatic enuresis and nonmonosymptomatic enuresis, which opens the door to what western medicine describes as complementary and miscellaneous interventions.

As you have read earlier, the anti-depressant drugs are a front-line treatment for enuresis. Hopefully that will cause you to search for another way to help your child and it’s probably the reason you have read this far.

Enuresis in children is a natural process that each of us has been through on our journey to adulthood. For some, there maybe a troublesome EMI that creates a psychological barrier to learning, which continually prevents the next step in development.

Urinary incontinence presents with larger social and psychological stigmatism as the child grows older, therefore a fast solution to enuresis in children is called for.

Using the psychophysiological model to treat enuresis creates a therapeutic experience for the child’s subconscious mind to use. This intervention aims to clear the negative EMI, which may help to relieve behavioral disorders that have developed as a result of the EMI firing overtime.

Interestingly, bladder capacity, neurogenic bladder, overactive bladder, dysfunctional voiding and behavioural disorders may all be improved with a psychophysiological approach to helping your child.

What is a psychophysiological treatment for enuresis?

A psychophysiological treatment can be defined as a therapy or intervention that utilises the mind to create a change in the body. The limbic system holds the key to automatic responses that have happened as a result of adverse experiences. Interacting with this perceived reality can allow the emotional brain to upgrade.

The limbic system contains

The amygdala is at the core of a neural system for processing fearful and threatening stimuli. This includes detection of threat and activation of appropriate fear-related behaviours in response to threatening or dangerous stimuli.

The hippocampus, is essentially the memory centre of our brain. Connections made in the hippocampus also help us associate memories with various senses (the association between Christmas and the scent of gingerbread would be created here). The hippocampus is also important for spatial orientation and our ability to navigate the world.

Think of behavioural change as experiential learning, this includes Hypnotherapy, EMDR, Yin Yoga, Qigong, Tai Chi and even Salsa dancing. They can all create change in the stored emotional memory images. Opening up of the mind and body to listen and learn will influence the amygdala and hippocampus, allowing your system to take on new learning.

Hypnosis can be achieved via audio downloads or digitally via the internet.

MindReset app combines the strategies of limbic system learning and accelerates the intervention process via state of the art eye-tracking. The whole process works outside of the users conscious awareness, which can initially create confusion, as the user struggles to understand what has happened outside of their awareness.

The key to gaining the best results in any of the psychophysiological treatments is curiosity. The state of curiosity gives you the ability to overcome previous learning and upgrade your life.

Is a psychophysiological treatment for enuresis harmful?

A psychophysiological treatment for enuresis is usually done outside of conscious awareness, to create a change in the limbic system. There are no harmful effects associated with its use. Unlike the potentially serious adverse effects of tricyclic and other antidepressant drugs that are prescribed for children.

Antidepressant drugs and psychophysiological treatments have the same intention – to adjust the way a person perceives their reality. The latter is noninvasive whilst the former has a list of side effects.

A better way…

The good news is there is a better way to help with certain types of enuresis, more research is needed in this area.

This content was originally published here.

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