Q: My 7-year-old daughter and 4-year-old son both have a problem with bed-wetting. We have tried many things, and now I am at a loss for solutions. Any suggestions? -- S. H., Reisterstown
A: Hardly a day goes by that we don't get a call from parents desperate to find a cure for bed-wetting. Many of them complain that traditional remedies like bed alarms and medication haven't worked.
Since writing about this topic several months ago, we've discovered an innovative treatment program at Children's Memorial Hospital in Chicago.
This program, under the direction of pediatric urologist Max Maizels, has been recently named "Try For Dry." Dr. Maizels has pTC treated 400 children in the past five years, and 80 percent of them showed vast improvement in just one month. After three months, bed-wetting usually disappears.
"The main thing we want people to know is that bed-wetting is as legitimate a problem as any other childhood problem," Dr. Maizels says. "The child who wets the bed is not disturbed or lazy. It's a physical problem."
Dr. Maizels believes bed-wetting is actually caused by a combination of problems that must be treated simultaneously. The three most significant factors are deep sleep, small bladder size and constipation. Some children are affected by other factors such as diet, urinary tract infections and physical abnormalities requiring surgery. Pinworms, although uncommon, can also cause bed-wetting.
To try Dr. Maizels' program, you will need the help of the child's doctor. The child needs a thorough medical exam to screen for infections, abnormalities and constipation. You'll also need a moisture-sensitive bed alarm, a prescription for a bladder-calming drug such as oxybutynin and, when constipation is present, laxatives. Be aware that most doctors, Dr. Maizels included, will not treat bed-wetting with medicine until the child is 5 years old.
To treat deep sleep, Dr. Maizels uses the moisture-sensitive bed alarm, which costs about $55, to interrupt the sleep cycles and readjust the child's biological sleep clock. The parent is responsible for hearing the alarm, getting up and waking the child, because deep sleepers can't do this for themselves. Dr. Maizels has found that when his program doesn't work, it's usually because parents do not carry through on this part.
Children can get results without medication, but it takes so long that Dr. Maizels has found most families give up. He recommends the medicine be taken once a day at bedtime, and then tapered off or discontinued after 14 dry days and nights.
He asks all patients to eliminate milk, artificial colors, vitamin C, 00 watermelon and cantaloupe for two weeks to see if the bed-wetting stops.
Dr. Maizels has found constipation to be very common in bed-wetters: It causes a plug in the rectum, which is very close to the bladder. As the bladder fills, the plug irritates the bladder and causes it to contract without the child's permission.
This was a revelation to Richard Weinstein, a Chicago pediatrician trained to use the program. "I never knew there was such a strong correlation," says Dr. Weinstein, who has been in private practice for 23 years. "There are a lot of children you can cure just by clearing up the constipation."
The Try for Dry success rate was what persuaded Dr. Weinstein to pursue the training. "In one to two months, the bed-wetting is pretty well resolved," he says.
Dr. Maizels is currently training several physicians each month.
His office staff also tries to assist other doctors who are interested in trying his approach.
Interested physicians may contact Try for Dry by calling (312) 880-4428 or writing Try for Dry, c/o the Division of Urology, Children's Memorial Hospital, Box 24, Chicago, Ill. 60657.
While a reporter at the Miami Herald, Beverly Mills developed this column after the birth of her son, now 5. Ms. Mills and her husband live in Raleigh, N.C., and also have a 3-year-old daughter.
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