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Behavior Modification as Treatment for Bed Wetting

Behavior modification is a psychological approach to treatment that was first developed by an American behaviorist by the name of B.F. Skinner (1904-1990). 

Behavior modification has its roots in operant conditioning, which means, "undesirable behaviors are replaced with more desirable ones through positive or negative reinforcement." Positive reinforcement is by far the most widespread use of this treatment whereby specific behaviors are rewarded. Behavior modification has been used effectively to treat bed wetting in both children as well as adults.


Other problems behavior modification has been helpful in treating include generalized anxiety disorder, separation anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), phobias, obsessive-compulsive disorder (OCD) and a variety of others.

Chiropractic Care and How it Can Aid Bed Wetters

Alternative methods of treatment such as massage are becoming more and more popular as ways to complement traditional treatments for a variety of health problems, and this includes bed wetting. More and more parents who believe in the positive attributes of chiropractic treatment are flocking to offices to have their children treated in the hopes that it will improve or completely rid their child of the condition of bed wetting.

A chiropractor will adjust a child’s spine accordingly and in particular will pay special attention to the sacrum or lumbar spine. The spine and nerves play a role in urination and improving the functioning of these can improve the way the bladder works. It is the detrusor and trigone muscles that control when and how the bladder is emptied of urine. The "nerve supply to thee muscles is via the sacral parasympathetic nerves from S2 to S4." The urogenital diaphragm also plays a role in the emptying action of the bladder and it gets its rich supply of nerves from what is known as the L2 spinal nerve.

The tailbone (or sacrum) doesn’t develop as one complete section but instead does so in five different segments. These segments grow and then stay separate until puberty begins. Once puberty commences, each one of the sacral segments begins to fuse together to make a complete whole. The complete process of sacral fusion does not come to a conclusion until a person has reached their mid to late twenties.

Due to the fact that there are five separate parts that make up the tailbone it is conceivable that misalignment of any one of the parts can result in nerve irritation or nerve facilitation. Nerve facilitation in particular can directly affect the bladder and can well be the cause of nocturnal bed wetting in a child. If a child has sustained any kind of trauma or injury to the spine during these sensitive years when it is still in separate parts, such as a fall, a break or a fracture this can lead to bladder problems at an early age. This includes problems with bladder control at night.

Many studies done on the effectiveness of chiropractic treatments in children and in particular, the "adjustment of the sacral segments" has yielded different results. Some studies have shown that it helps children suffering from enuresis while other studies show it does very little good at all. This also might be indicative of the fact that in children with spinal problems who also wet their beds, chiropractic treatments can prove beneficial but it does very little for bed wetters who have perfectly healthy spines that are in perfect alignment according to their stage of development.

It is worthy to note that a chiropractor is also able to improve other problems that babies or children experience that can be related to the spinal column and the nervous system. It is not advisable to only seek out alternative therapies to help a child with bed wetting. Always try to put into play the most general methods at home first and as a second course of action make a trip to the doctor’s office with your child. Sometimes a doctor will suggest combining a few types of treatments for optimum benefits.

Forms of behavior modification to treat bed wetting are safer than medical types of treatment and they also tend to be more effective in the long run. However the only drawback is that you need to be patient as it takes longer to see results. The aim of behavior modification for bed wetting is that the child learns to be responsible for his or her bladder control. With this method a child is both praised and encouraged by parents upon waking in the morning and being dry. Children tend to respond more favorably to positive reinforcement then to being scolded or punished when they wake up wet. Keep in mind that nocturnal enuresis is not the child’s fault or his doing.

It is important to always gently remind a child to go to the bathroom before he or she turns in for the night. Even if the child doesn’t feel a tremendous need to urinate, tell him or her to go to the bathroom and just make sure because you want to avoid any accidents at night if possible. It is wise to decrease your consumption of liquids at least two to three hours before bedtime. According to behavior modification principles, it is a good idea to encourage the child to change his or her own sheets when they are wet. But be careful to not make the child feel as if he or she is being punished.

One form of behavior modification is known as retention control training. In this instance the child is encouraged to strengthen the muscles of the bladder by delaying going to the bathroom when the need first arises. It is a gradual process. First he is encouraged to delay it by a few minutes and then working up to longer periods of time (not until it actually causes discomfort in the abdominal area of course!). This simple exercise serves to "extend the capacity of the bladder and strengthen the muscle that holds back urination." Retention control training should never be done without a doctor’s permission to do so.

Night-lifting is a form of behavior modification whereby a parent periodically awakens their child during the night to inquire if the child needs to pee. The parent physically walks with the child to the bathroom and then does the same when the child returns to his or her bed. The goal of night-lifting is to support and encourage the child in waking itself up when the need to void arises in the night.