February, 2009 Newsletter

WebMD's pediatric expert answers the 6 most common questions he hears about bedwetting.

Parents share secrets and strategies with each other about how to deal with fussy eaters, colicky infants, and tantrum throwers. But bedwetters?

The problem of bedwetting is still shrouded in embarrassment despite the fact that it's very common. As a matter of fact, one in five 5-year-olds is a bedwetter, according to the American Academy of Pediatrics.

To understand why kids wet the bed, we talked to WebMD's pediatric expert, Steven Parker, MD. He shares the six most common questions parents ask him about bedwetters -- and what he tells them.

Q: Why is my child bedwetting?

Before I answer, I need to know a few details. Has your child consistently wet -- that is, never had dry nights -- or has your child been dry, and the bedwetting is a recent problem?

Those are two very different situations. Most of the time, the child was never dry, a problem known as primary bedwetting (or by the medical term, primary enuresis).

A much smaller number of children has what we call “secondary” bedwetting or enuresis. In this case, the child was dry for a long time, maybe a year, and then becomes a bedwetter. That is more unusual, and there is more likely to be a medical cause or a trigger, such as psychological stress or trauma. But that's true in less than 10% of cases.

Most of the time, a child has primary bedwetting, and after a thorough physical examination and examination of the urine, no medical reason is found. In that case we rarely figure out the cause. But I say to the parents: one in five kids at age 5 has this. How abnormal can that be?

Q: What causes a child to be a bedwetter?

Bedwetting of the primary type does seem to run in families. So whatever the cause is, it is likely that children who are bedwetters have some sort of genetic reason. It's also possible one or both of their parents wet the bed.

The most popular theory is that bedwetters have a slight delay in maturation of their nervous system. When the bladder is full, the sleeping brain has to send a message down to the bladder not to pee. If your child's nervous system is a bit underdeveloped, the message might not get through.

Another theory is that children who are bedwetters are very deep sleepers. They are sleeping so soundly their brains don't tell their bladder to hold it. I think delayed maturation is probably the better explanation. And that perhaps if you are slow in maturation, you may also have a different sleep pattern.

Some experts also think that bedwetters may simply make more urine at night than other kids, and their bladder can't hold it all. Others hypothesize that their bladders have a smaller capacity to hold in the urine compared with kids who stay dry.

Q: What should be done about bedwetting?

The first step is to talk about it with your pediatrician, which many parents don't do because they are embarrassed, or their child is. But it's crucial to do so because the first step in assessing a bed wetter is to rule out any medical causes.

A urine test could reveal a urinary tract infection or excess sugar in the urine as a cause. A physical examination might demonstrate constipation, for instance, which could push on the bladder and cause the bladder to release urine at inappropriate times. A sleep history may reveal that a child has a sleep disorder called sleep apnea, in which breathing stops for a brief time. Urine can escape during those episodes.

Sometimes, secondary bedwetting can occur if a child is psychologically stressed or if he has lived through a disaster recently, such as a hurricane or fire. Those children may need some counseling or other help.

Most of the time, however, your child will naturally outgrow bedwetting as he gets older. To help your child outgrow bedwetting, you can try a number of behavioral strategies outlined below.

Q: At what age should we do something about bedwetting?

If you are all OK with it -- and I mean the entire family -- you don't have to do anything. Except wash the sheets, of course, and perhaps have your child wear disposable underwear. About 15% of bedwetters get better, or outgrow it, every year without any treatment. By age 18, only 1% to 2% still wet the bed.

But if you, or more importantly, your child, is so upset by this that it is disrupting your family, then we can talk about treatments.

The best time to do this is when your child says he wants to deal with it. When the child gets sick of it, says he feels like a baby, or is embarrassed because he can't go to friends' houses for sleepovers, this is a good time to talk to your doctor about remedies.

Q: What bedwetting product or treatment works best?

There aren't a lot of great studies comparing treatments. But it's pretty clear that what works best are the urinary alarms, far and away. In a recent published review, researchers compared bed alarms with behavioral interventions and medications. They concluded that bed alarms are the most effective.

Many models of alarms are available, but all include a moisture sensor that you put in your child’s underpants that sounds an alarm when it detects urine. Once the alarms train the sleeping brain to inhibit the bladder contractions -- and prevent the urine from being released -- most kids stay dry. Better still, they remain dry even after the alarm is discontinued.

The downside of alarms? They take a while to work -- usually months. They require participation by the parents, who may have to get up with their child and take him [or her] to the bathroom when the alarm goes off. It requires a lot of commitment.

Another strategy is to wake your child up two or three hours after he has gone to bed, and perhaps right before you go to bed, and have him pee. It has some effectiveness. You might also have your child wear disposable underwear until he or she outgrows bedwetting.

Somewhat less effective, I think, is limiting fluids after dinner. And if your kid is really thirsty, it's not worth it.

Some parents work with the child during the day to help him hold in the urine longer. They may set an egg timer when the child says he has to go and ask him to hold it for another few minutes, starting with 5 and working up to 45 or so. The theory is it will increase bladder capacity.

Medications are another option. Two options are decompressing (DDAVP), which reduces the amount of urine produced at night, and an antidepressant called imipramine (Tofranil), which may work the same way or may change the sleep pattern. However, medications only work when they are taken. Once the medication is stopped, the bedwetting comes back.

Although medications have side effects, often they can be used on a short-term basis, such as when your child wants to go on a sleepover.

Q: What else can I do for my bedwetting child?

You can reassure your child that he will eventually grow out of it. No matter how frustrated you are, don't punish your child for bedwetting. I try to normalize the experience for the child. I sit down and talk to them. I say, "You think you are the only one. But you are not. I know a lot of kids at your school who also wet." That seems to make them feel better, or at least less humiliated.

To the parents, I repeat: "One in five kids at age five has this. How abnormal can it be?"

Science has proven 20^th Century Ancient Wisdom

Magnets’ effectiveness at relieving pain has been proven by both scientific and clinical studies.

One of the worst forms of pain suffered is by polio patients. They’re often attacked by severe muscle pains, stiff neck, and lower back pain. Polio pain is a perfect test for the effectiveness of bio-magnet therapy.

Doctors at Baylor University in Texas conducted a double-blind study with pain patients receiving either a real magnet or a placebo magnet. Here are the results.

	Real Magnet	Placebo Device
No. of Patients	29	21
Pretreatment Pain Score	9.6	9.5
Post-treatment Pain Score	4.4	8.4
Change in Pain Score	5.2	1.1

	Real Magnet	Placebo Device
No. of Patients	29	21
Pain Improved	22 patients (76%)	4 patients (19%)
Pain Unimproved	7 patients (24%)	17 patients (81%)

Patients who received the active device experienced an average pain score decrease of 4.4 on a 10-point scale. Those with the placebo devices experienced a decrease of 1.1 points. The proportion of patients in the active-device group who reported a pain score decrease greater than the average placebo effect was 76%, compared with 19% in the placebo-device group.

The application of a device delivering static magnetic fields of 300 to 500 gauss over a pain trigger point results in significant and prompt relief of pain in post polio subjects.”

Diabetes and Foot Pain Study:

Perhaps you know of diabetics who suffer pain due to lack of circulation in their legs. Now, there’s a proven solution:

“In a report published in the January issue of the American Journal of Pain Management, researchers noted that magnets sewn into socks alleviated the chronic pain of diabetic peripheral neuropathy (nerve deterioration and chronic pain in the feet due to diabetes.)” James Balch, M.D., Prescription for Nutritional Healing, 3rd Ed., p. 724.

Lower back pain may be the most common chronic pain complaint. Many back pain sufferers gave up long ago of ever living pain-free again.

A double blind scientific study selected 100 volunteers who suffered from back or shoulder pain. 50 participants were given real magnets and 50 participants were given placebo magnets. The results showed that subjective pain sensation improved for 70% of those using real magnets vs. 26% of those using placebo magnets. Restriction in movement improved for 50% vs. 16%. Use of pain killers improved for 46% vs. 10%.

With reference to the tested trial criteria the therapeutic effectiveness of the magnetized foils is unmistakably higher than the placebo effect of the non-magnetized foils applied to the control group.”

To determine the effectiveness of permanently magnetized pads for the treatment of heel pain syndrome. A double-blind study was performed on patients who have had symptoms in the above areas for at least two weeks.--- Permanently magnetized and demagnetized pads will be applied to the symptomatic feet without the patient of the clinician able to differentiate due to identical appearing pads. Only an impartial referee is aware of the true identity of each pad.

The indication groups for all trial criteria showed a significantly higher therapeutic effectiveness with the magnetized pads than the control groups (demagnetized pads).

The best results were achieved with reduction in subjective pain in the heel spur syndrome category. 57.2% of all test persons in this category treated with magnetized pads expressed significant relief of symptoms.

The patients who showed increase in ability to walk without pain after treatment represented a 77.1% improvement rate with the magnetized pads versus a 16.6% improvement reported by those with the demagnetized pads. This percentage represented a placebo effect.”

There are so many different types of pain. But, they all have the same root causes of acidity, swelling, and lack of circulation. A German scientist tested magnets on many different types of pain and came to this conclusion:

...magnetic pads proved to be successful as pain relieving means for superficial aches, strains, sprains, spasms, varicose vein and phantom limb syndrome.”

If you’ve ever spent several hours on your feet, then you probably know what it’s like to experience foot pain.

“At Columbia-Presbyterian’s Pulmonary Hypertension Center…several of our patients…tried magnets to treat their jaw and foot pain. These patients report significant decreases in foot and leg pain associated with magnet use, and note that they can walk further when they wear the magnets. Jaw pain is also alleviated with magnet use, according to our patients.” Clinician Reviews, Positive Feedback for Magnet Therapy, August 1999.

There have been hundreds of studies on magnet therapy. This encyclopedia summarizes the results:

“Since the late 1950’s, hundreds of studies have demonstrated the effectiveness of magnetic therapy.” Magnetic Therapy, Kim Sharp, Gale Encyclopedia of Alternative Medicine, Kristine Krapp and Jacqueline L. Longe, Ed’s., Gale Group, Detroit, pp. 1114, 2001.

Now that you know bio-magnets have been proven to relieve pain, how can you get magnetic energy into your body?

Chronic Pain and Depression:

Managing Pain When You’re Depressed

Living with chronic pain should be enough of a burden for anybody. But pile on depression -- one of the most common problems faced by people with chronic pain -- and that burden gets even heavier.

Depression can magnify pain, and make it harder to cope. The good news is that chronic pain and depression aren't inseparable. Effective treatments can relieve depression and make chronic pain more tolerable.

If you have chronic pain and depression, you've got plenty of company. That’s because chronic pain and depression are common problems that often overlap. Depression is one of the most common psychological issues facing people who suffer from chronic pain, and it often complicates the patient's conditions and treatment. Consider these statistics:

According to the American Pain Foundation, about 32 million people in the U.S. report pain lasting longer than one year.

From one-quarter to more than half of patients who complain of pain to their physicians are depressed.

People whose pain limits their independence are especially likely to get depressed.

Because depression in patients with chronic pain frequently goes undiagnosed, it often goes untreated. Pain symptoms and complaints take center stage on most doctors' visits. The result is depression, along with sleep disturbances, loss of appetite, lack of energy, and decreased physical activity which may make pain much worse.

"Chronic pain and depression go hand in hand," says Steven Feinberg, MD, adjunct associate clinical professor at Stanford University School of Medicine. "You almost have to assume a person with chronic pain is depressed and begin there."

Pain provokes an emotional response in everyone. Anxiety, irritability, and agitation -- all these are normal feelings when we're hurting. Normally, as pain subsides, so does the stressful response.

Over time, the constantly activated stress response can cause multiple problems associated with depression. Those problems can include:

Some of the overlap between depression and chronic pain can be explained by biology. Depression and chronic pain share some of the same neurotransmitters -- the chemical messengers traveling between nerves. They also share some of the same nerve pathways.

The impact of chronic pain on a person's life overall also contributes to depression.

"The real pain comes from the losses" caused by chronic pain, according to Feinberg. "Losing a job, losing respect as a functional person, loss of sexual relations, all these make people depressed."

Once depression sets in, it magnifies the pain that is already there. "Depression adds a double whammy to chronic pain by reducing the ability to cope," says Beverly E. Thorn, professor of psychology at the University of Alabama and author of the book Cognitive Therapy for Chronic Pain.

Research has compared people with chronic pain and depression to those who only suffer chronic pain. Those with chronic pain and depression:

Because chronic pain and depression are so intertwined, depression and chronic pain are often treated together. In fact, some treatments can improve both chronic pain and depression.

Chronic pain and depression can affect a person's entire life. Consequently, an ideal treatment approach addresses all the areas of one's life affected by chronic pain and depression. Because of the connection between chronic pain and depression, it makes sense that their treatments overlap.

The fact that chronic pain and depression involve the same nerves and neurotransmitters means that antidepressants can be used to improve both chronic pain and depression.

"People hate to hear, 'it's all in your head.' But the reality is, the experience of pain is in your head," says Feinberg. "Antidepressants work on the brain to reduce the perception of pain." Tricyclic anti-depressants (Elavil, Doxepin) have abundant evidence of effectiveness. However, because of side effects their use is often limited. Newer antidepressants known as serotonin and norepinephrine reuptake inhibitors (Cymbalta, Effexor), on the other hand, seem to work well with fewer side effects.

Many people with chronic pain avoid exercise. "They can't differentiate chronic pain from the 'good hurt' of exercise," says Feinberg. But, the less you do, the more out of shape you become. That means you have a higher risk of injury and worsened pain.

The key is to break this cycle. "We now know that gentle, regular physical activity is a crucial part of managing chronic pain," says Thorn. Everyone with chronic pain can and should do some kind of exercise. Consult with a physician to design an exercise plan that's safe and effective for you.

Exercise is also proven to help depression. "Physical activity releases the same kind of brain chemicals that antidepressant medications release -- [it's] a natural antidepressant," says Thorn.

Chronic pain affects your ability to live, work, and play the way you're used to. This can change how you see yourself -- sometimes for the worse.

"When somebody begins to take on the identity of a 'disabled chronic pain patient,' there is a real concern that they have sunk into the pain and become a victim," says Thorn.

Fighting this process is a critical aspect of treatment. "People with chronic pain end up sitting around," which leads to feeling passive, says Feinberg. "The best thing is for people to get busy, take control."

Working with a health care provider who refuses to see you as a helpless victim is part of the formula for success. The goal is to replace the victim identity with one of a "well person with pain," according to Thorn.

Is there such a thing as "mind over matter"? Can you "think" your way out of feeling pain?

It may be hard to believe, but research clearly shows that for ordinary people, certain kinds of mental training truly improve chronic pain.

One approach is cognitive therapy. In cognitive therapy, a person learns to notice the negative "automatic thoughts" that surround the experience of chronic pain. These thoughts are often distortions of reality. Cognitive therapy can teach a person how to change these thought patterns and improve the experience of pain.

"The whole idea is that your thoughts and emotions have a profound impact on how you cope" with chronic pain, says Thorn. "There's very good evidence that cognitive therapy can reduce the overall experience of pain."

Cognitive therapy is also a proven treatment for depression. According to Thorn, cognitive therapy "reduces symptoms of depression and anxiety" in chronic pain patients.

In one study Thorn conducted, at the end of a 10-week cognitive therapy program, "95% of patients felt their lives were improved, and 50% said they had less pain." She also says, "Many participants also reduced their need for medications."

The best way to approach managing chronic pain is to team up with a physician to create a treatment plan. When chronic pain and depression are combined, the need to work with a physician is even greater. Here's how to get started:

See your primary care physician and tell her you're interested in gaining control over your chronic pain. As you develop a plan, keep in mind that the ideal pain management plan will be multidisciplinary. That means it will address all the areas of your life affected by pain. If your physician is not trained in pain management herself, ask her to refer you to a pain specialist.

Empower yourself by tapping into available resources. Several reputable national organizations are devoted to helping people live full lives despite pain. See the list below for their websites.

Find a cognitive therapist near you with experience in the treatment of chronic pain. You can locate one by contacting the national pain organizations or cognitive therapists' professional groups listed below.

We hope that you found some answers to help. Till next month, Have a good month and PLEASE take care of yourself and your loved ones. With the economy such as it is, we don’t know why you are not using our Guaranteed products to make your life easier and less strenuous.

	Real Magnet	Placebo Device
Less Subjective Pain Sensation<	70%	26%
Less Restriction of Movement	50%	16%
Less Use of Pain Killers	46%	10%