So, I quickly fired up my computer and searched for his name in my files. Nope, nothing. I had't conducted an assessment. What had I done to deserve this note? There was an e-mail. He asked me to call. I did.
You see, he had wet the bed every night of his life. I had not heard of this. What a teaching experience this whole process became.
The family had seen "everyone". I asked them if they were willing to do anything. "Yes, of course." He was becoming panicked over going to college and being "found out". He had had enough. They learned of me because I evaluated a family member.
I took a different approach with this family. Instead of my typical interview format, I pulled out my 36-page developmental history that I give each family to complete and began working through it. What I had learned in private practice is that the key lies somewhere in that history. Somewhere.
When I got to page 16, I asked a question that was the "key" to the lock that was 17 years old. I asked about "problems with elimination". The three of them, more or less, burst out laughing. He excused himself quickly and returned from the bathroom and told me that when he laughs or exerts, he "spurts" urine. He was not expecting to "laugh this hard" in my office. Uh huh, yeah. You don't know me, I'm hilarious. Another key.
Mother asked permission to give his early history with constipation. Apparently, he was "born constipated". Mom reviewed up through the elementary years and then, he took over. Nothing worked for him. He couldn't move his bowels, so his bladder made up for it was his basic conceptualization of the problem.
I had come to learn, from another client and yet another gastroenterologist, that we carry anywhere from 5 to 20 pounds of feces with us daily depending on your height, age and diet, so I knew I was on to something.
I sent them to a pediatric gastroenterologist. He was 17 and didn't qualify to see an adult physician. They had seen two gastros over the years. Some temporary relief, but no resolution. I explained that the doctor I wanted them to see had that "old country doctor common sense" and that he had pulled one of my teens back from the brink of death after he had gotten hold of spoiled seafood in a restaurant.
I called the doctor's office, handed them the phone and they made the appointment. I never heard back from them again. It really, really, bothers me when I don't hear back. I thought, "It didn't work out" or "They got busy with going to college and things got better" or whatever, I just didn't know. Now, one of my "mysteries of life" has been solved, but it took about 15 years, I'm guessing.
At the time of the call, he was on his way to a medical residency in internal medicine. No surprise there. I asked "why" internal medicine. "Because I want to be one of those lily pads you talked to me and my Mom and Dad about". I thought, "Oh sure, I say that a lot". It's not a Florida Gator reference or anything, but if you look at how frogs and other critters travel about, they leap from one "safe place to another". I call it "Leap Frogging".
It took this young man about a year to clear up the constipation using enemas to keep his colon working correctly. He described himself as "perfectly normal" now. I told him that, as a psychologist, there's a lot of variation of "normal".
He put me straight, though, by talking about what his "normal" looked like as a kid and a teen. I commended him on his personal strength by not falling apart and coping with a desperate situation and rising to a noble profession.
He credited his parents, of course, who were doing well and were the ones who, apparently, mortified in their realization that they had left me in the dark, were the "force" behind sending the announcement. All is well. Give them my best. We parted ways. I'm a happy, happy girl.
So, I did a bit of research thinking that, as is appropriate, parents seek out physicians and get the issues resolved. Yay!!!
Here's some of what I found:
- 5 million kids wet the bed
- 1 million of them are tweenagers (8-12) and teens
- About 25% of US teens who are 5 years old wet
- Most stop before age 10
- 2% of 11-year old kids still wet which is the same percentage as adults who have never been dry
- It's estimated that a 9 year old who wets the bed has a 75% chance of wetting as an adult
- Your child is in a deep sleep and doesn't respond to the "signals". The problem with that explanation is that healthy bladders don't need to empty overnight (provided you haven't had a lot to drink before bed). Otherwise, we'd have a LOT more bedwetting older kids.
- Your child has a small bladder. OK, that could be the case, so can we do some imaging to see if that's actually true?
- Your child is lazy. He doesn't want to get out of bed and go to the bathroom. Seriously? This is lame. Sure, he loves to lay in cold urine all night long.
- Your child is stressed out. No, where's the evidence for that?
As for that first one. I found three sources that reported that kids who wet actually don't sleep as soundly as do other kids. Anxiety, perhaps? Sounds about right.
The stool (a.k.a. poop) starts to pile up and the colon never empties, putting constant pressure on the bladder which is never really allowed to fill completely and competently hold urine, so there's that "spurting" action when sneezing, exerting, laughing, coughing. Apparently, the rectal nerves are highly irritated, releasing the bladder. Ugh. If a person has bedtime wetting along with this "spurting" dynamic, their chances of becoming dry are poor (whatever that means).
I read where one source indicated that the "normal" rectum size is less than 3 cm, but stretched from chronic constipation, the rectum can reach about 6 cm. Clearly, not set up for strong control for either stool or urine.
A study was done using Miralax and enemas. Miralax worked but not as fast. It took 3 months for 30% of the group to reach the 3 cm rectum diameter and with enemas, 85% of the group were at the target diameter in 3 months. If the rectum and colon are cleaned out and stay cleaned for months, the rectum can shrink, but time is of the essence.
DO NOT DO NOT DO NOT start enema therapy without a doctor's diagnosis, treatment plan or monitoring. This is not one of those "do-it-yourself" projects. You can and will cause serious damage. As with other health problems, constipation and chronic bedwetting can be related to other conditions such as neurological disorders, diabetes, or anatomical problems (the "parts" aren't right).
The kids who actually outgrow bedwetting are the ones who wet at night from time-to-time and are dry throughout the day without "spurting".
So, don't do this on your own. This article is to "educate and inform" only. Use it to talk to your doctor. All of you, as a team, will take it from there.
Be advised that the "facts" about this young man characterized in this article aren't exactly the same as the young person who came to see me. Features have been changed to protect identity even though s/he was not formally my client, I take this confidentiality thing seriously, just sayin'...
Just do the best you can, Claudia
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