Most children outgrow bedwetting by the age of 5 years. However, 7% of boys and 3% of girls take longer to stop bedwetting. By the early teen years less than 2% of children still experience this problem. Medical causes of bedwetting include urinary tract infections, constipation, and diabetes. Most of the time bedwetting after early childhood is related to a slow maturation of the ability to remain dry at night. Often this is related to genetic factors and one or both parents will report that they had difficulty with bedwetting in later childhood.
When I first meet a child, who is dealing with bedwetting I reframe the issue. The child’s issue is that he or she needs to learn how to keep the bed dry, rather than how to not wet the bed. Please check the blog published on May 18, 2021 for a discussion of why positive talk is so important to help achieve goals. If a child is less than 8-years-old I suggest that difficulties with keeping the bed dry are normal at a young age, and that the child and his or her parents remain patient, as the child is likely to outgrow the issue in short order. In other words, the child and family need not worry that something is wrong and needs to be “fixed.”
Before I start teaching how to use hypnosis to achieve a dry bed, we review the child’s history. I ask whether the child has any daytime accidents. If so, this suggests that there may be a physical abnormality leading to the issue. I ask if the child always uses the restroom before bedtime. If not, I recommend this become part of their bedtime routine. If the child is constipated this can cause the stool inside the abdomen to push on the bladder that can lead to nighttime difficulties. In such a case I recommend that the child increase fiber and even fluid in the diet to allow for regular bowel movements.
I encourage children to use a calendar to keep track of the state of their bed or Pull-ups every morning. They score a 0 if the bed is as dry as the desert, while they score a 10 if the bed is soaking wet and overflowing like Niagara Falls. I explain that by using a calendar they can track their improvement more easily as the bed becomes drier. Also, I recommend that the children be responsible for changing and washing any wet sheets, as well as remaking the bed. In this way, the children can take ownership of the solution to their issue, and have an extra incentive to overcome it.
With younger children we discuss that the bladder holds the urine until it is ready to come out. I suggest that every night, before they go to sleep, that they talk to their bladder in hypnosis and tell it to stay “Tight, tight, tight, all night, night night.”
With older children I ask them to draw their artist conception of the connection between the bladder and the brain. The children usually explain that when the bladder tells the brain that it is full, they go to the bathroom. I ask what happens at night. They respond that their brain is asleep. I then tell them this story:
“Did you know that part of your brain is always awake when you’re asleep? When I was young, I could tell my brain at night what hour I wanted to awaken in the morning, and that’s when I would wake up. This can only work if part of my brain was able to keep track of the time when I was sleeping. I learned more about the awake part of the brain when my first child was born. He would awaken in the middle of the night and cry until my wife awakened to nurse him. I used to stay asleep during these times. On the other hand, at the same time I was on-call as a physician and would receive phone calls in the middle of the night from the hospital. When the phone rang, I always woke up immediately to answer the calls, but my wife would sleep through them. Each of our brains decided what we needed to do even while we were asleep!”
The children then figure out that in hypnosis they can tell their bladder to talk to the awake part of the brain at night, so that the brain can either tell the bladder to hold it, or it can awaken them and they can go to the restroom.
If a child reports a period of at least several weeks of nighttime dryness at some point earlier in their lives this suggests that the problem is related to a psychological difficulty, rather than delayed maturation. In this case, hypnosis treatment can be focused on uncovering the difficulty and helping the child deal with the underlying stressor. For example, children can start having difficulty with wet beds because of worries about whether their parents’ arguments might lead to divorce.
Treatment for bedwetting first involves considering whether the problem is caused by a physical abnormality, psychological problem, or because of slow maturation of the body. Therapy is based on addressing the underlying cause of the bedwetting, for which hypnosis usually is especially useful.
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