MR is a 14 year-old girl who was dry for over a year from 2½ to 3½ years of age and who started to wet during treatment for a childhood cancer.  Her Mom and elementary school teachers noted that she peed frequently.  From about age 8 she was treated with DDAVP and while on this medication she was dry about 90% of the time.  She drank milk at the major meals and she drank a bottle of water during school hours.

My assessment revealed that she had good bowel health and a normal bladder capacity.  I recommended a different hydration strategy with much more fluids early in the day.  After working on her hydration for a month I asked her to stop DDAVP.  When she returned a month later, she reported that she only wet once in the two weeks off DDAVP.

A child with a normal bladder capacity in my office is a rare event.  However, when the bedwetting started during her cancer treatment, her bladder capacity was almost certainly lower than normal.  The evidence for a small bladder capacity by history is the later observation that she voided frequently in early elementary school.  Likely her parents and the physicians thought the bedwetting was related to “stress,” but this is rarely the case.  The very good response to DDAVP at 8 years of age implies that her bladder capacity was only modestly reduced at that time.  She stayed on the DDAVP needlessly for 6 years!  The drug companies love these stories, but I don’t.   Her bladder capacity eventually normalized with time as she grew, and with the increased pelvic volume courtesy of puberty, and somewhere along the way she achieved very good bowel health.

October 22, 2011

LZ is a 12 year-old boy who wet the bed every night, often more than once a night.  He voided frequently and did not have urgency or daytime dampness.  He is an “attentive voider.”  The bedwetting was not his main problem.  He had a longstanding history of constipation.  He had poop accidents every day.  His pelvic ultrasound showed the widest rectal diameter I have ever seen in a boy his age.  He was clearly motivated and we focused exclusively on his bowel health.  Within a month this boy was pooping every morning and a second time every day and he no longer had poop accidents.  Amazing!  About a year afterwards, he returned and wanted to work on night dryness.  Mom had found out about a week-long summer camp opportunity that he wanted to participate in. He had maintained excellent bowel health.  He responded very well to alarm therapy and within two months was totally dry and able to wake as necessary to pee.  He attended the camp, woke to pee as necessary, and was dry every morning.  He was really excited to describe the camp experience.  He did a river crossing, kayaked, slept out in tents, and had a great time.

October 22, 2011

NB is an 11¾ year-old girl who wet the bed almost every night.  She voided 7 times a day and she is an attentive voider.  Holding the urine, urgency, and daytime wetting were never a concern.  She didn’t poop every day.  Two months later, at her first follow-up visit, he bowel health and hydration were improved and she was dry about half the nights.  By seven months she had achieved consistent dryness for over four weeks and she had learned to wake up to pee.

October 22, 2011

LC is an almost 9 year-old boy who wet every night.  He routinely held his pee to the last minute and he had urgency and daytime wetting enough to change his clothes once or twice a day and he was damp with most voids.  He has ADHD, autism, fine and gross motor delays, and developmental delays. He didn’t poop every day.  The family was only concerned about the daytime wetting.  Three months later, at his second visit, Dad reported that Josh had improved his bowel health and he was not pooping most mornings.  With improvement in his bowel health, the urgency and daytime wetting improved and Dad reported that he only wet enough to change by day about once every two weeks.  Remarkably, he had not wet his bed for over a month.   This is a much faster improvement than the average and proves that excellent progress is possible for boys with complicated behavior, learning, and development.

October 22, 2011

SJ is a 7½ year-old boy who wet the bed twice a week, voided 10 times a day including five times while at school, had holding postures, urgency, and minor pre-void dampness at least once a week, did not poop every day and went up to 3 days without a poop.  He had Wilm’s tumor diagnosed at age 2.5 years and his right kidney was removed.  He had meatal stenosis, which is a narrowing of the hole at the end of his penis.  He returned four months later and reported that he had only wet his bed five times in the last four months and that he was no longer wearing a pull-up!  He followed my hydration recommendations precisely.  His Mom was reluctant to let him drink at bedtime but he told her, “Dr. Robson told me I needed to hydrate better in the evenings.”  Within a month of working on the hydration and bladder friendly bowel health recommendations his poops were every morning.  He was waking to pee twice a week at about 3 AM but he otherwise just slept dry.  Wow!

October 22, 2011

NZ is a 9¼ year-old boy who wet every night, voided five times a day, had holding postures, urgency, and minor pre-void dampness every day, was wet enough to change his clothes once a month, and did not poop every day and had once gone 11 days without a poop.  He started alarm therapy after about 6 months and he had a rough start but in the second month he was consistently dry, he woke to pee as necessary, and his bladder held an ounce more than the average for his age.  The timing of his dryness was great.  Mom had tentatively enrolled him in the same summer camp that his Dad had attended as a young boy, and now, he could attend.