Step-by-Step Approach for Bed Wetters

By Dr. Bill Sears

AROUND 15 PERCENT of 5-year-olds still wet their beds, and boys outnumber girls four to one. As a pediatrician for more than 40 years, I want to dispel the myth that bed-wetting is a psychological or discipline problem.

Instead, it’s really a sleep quirk. It’s physiologically more correct to call this nighttime nuisance “sleep wetting.” Some kids sleep too soundly to respond to the get-up-and-go signals from their bladder. Here is a step-by-step approach that we’ve used in our family and in my pediatric practice.

Play show and tell. In my of office I draw a picture of the brain with “wires” connected to the bladder, explaining to the child, “Your bladder is like a balloon the size of a baseball. Inside the balloon are tiny nerves that tell you when your bladder is full. Your full bladder then sends messages to your brain, and the brain tells you to go pee. Because you sleep so deeply, the brain sort of says, ‘Don’t bother me. I’m sleeping.’ Yet, your bladder becomes so full it’s got to empty, so you pee in your bed. Here’s how we’re going to help your brain and your bladder listen to each other at night.”

Empty the bladder completely before going to bed. Many bed-wetters who are tired or in a hurry only dribble out a bit when they go to the bathroom before going to bed, so they go to sleep with a half-full bladder. Teach your child “triple voiding”: “To squeeze all the pee out of your bladder, grunt, grunt, grunt three times so you go to bed with an empty bladder.”

Have a bladder-programming talk. Be a bladder-training coach: As your child is dozing off to sleep, imprint on his mind what he will do when he feels a full bladder: “I will get up and go to the bathroom when I feel my bladder get big. I will splash water on my face to wake up, and grunt three times.” This bedtime rehearsal programs your child to help his bladder and brain cooperate at night.

Shake and wake before you retire. Since most children bed-wet within a few hours after retiring, before you go to bed, fully awaken your child and help him walk to the bathroom and again “grunt three times” to completely empty his bladder. Then help the sleepy child get back to bed.

Get things moving. Since constipation is a frequently overlooked cause of bed-wetting, give your child a tasty laxative: a fruit and yogurt smoothie with a tablespoon of flax oil.

Give high-tech help for the persistent bed-wetter. If your child is becoming increasingly wet and bothered, try a pad-and-buzzer apparatus called a bladder-conditioning device. When a drop of urine strikes the moisture-sensitive pad, it sets off a buzzer that’s attached to the child’s T-shirt or pajama top. Explain this to your child as the “beat the buzzer” game. Encourage him to get up and go to the bathroom before the buzzer sounds.

In my pediatric practice experience, more than 90 percent of bed-wetters become dry after trying these strategies. A patient of mine thanked me, “Dr. Bill, being dry makes me feel so happy. Now I can stay overnight at a friend’s house without feeling embarrassed.”

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Contain Your Irritation

As many as 20% of Americans have Irritable Bowel Syndrome (IBS). Cramping, bloating, constipation, and diarrhea can be painful, disabling, and lead to more serious conditions such as cancer. Although you can’t cure IBS, you can manage it.

  • Change your diet: Eating a high–fiber diet, avoiding caffeine, dairy, and alcohol, and bulking up on low–fat, high–carb meals might help reduce symptoms. Drinking 6–8 glasses of water a day flushes out the colon and keeps the digestive track functioning smoothly.
  • Tackle stress head–on: While the average person might experience butterflies before a stressful event, those with IBS have more pronounced symptoms. Stress reduction techniques such as yoga, walking, and meditation can help calm the mind… and the colon.
  • Avoid bloating: Fast eating, chewing gum, shallow breathing, and gulping water can lead to swallowing large amounts of air, which can trigger IBS. Make sure meal times are relaxed and eat smaller, more frequent portions.

Over-the-Counter Drugs work as well as prescriptions


Instead of Ambien (or generic zolpidem), Lunesta (eszopiclone), or Rozerem (ramelteon)

Go OTC Benadryl, Nytol, Sominex (or generic diphenhydramine)

Save as much as $47 a week

Why switch? OTC antihistamines that contain diphenhydramine can cause sedation and sleepiness as a side effect, temporarily helping to relieve mild insomnia. Although relatively inexpensive and easy to buy, they can also cause unwanted side effects, including next-day drowsiness, confusion, constipation, dry mouth, and trouble urinating. But keep in mind that prescription medications can come with their own disturbing side effects.

When to see a doctor If your insomnia lasts three or more nights a week for at least a month, schedule an appointment with your physician.

Prevent it in the first place Cognitive behavioral therapy, a form of psychotherapy where you single out and replace thoughts and behaviors that are or causing you problems, can improve sleep habits. Also, try exercising and avoid alcohol, caffeine, and smoking. And keep in mind that certain prescription drugs can cause insomnia. So can using a computer or smart phone or watching TV right before bedtime. Other things that can make you toss and turn at night include inconsistent sleep and wake-up times (on weekends, for example) and late-day napping. Finally, if you can’t sleep, get out of bed and do something relaxing, like reading, until trying to catch your zzz’s again.

Joint pain

Instead of Celebrex (celecoxib)

Go OTC The NASIDs Advil or Motrin IB (or generic ibuprofen), Aleve (or generic naproxen), or the non-NASID Tylenol (or generic acetaminophen)

Save as much as $265 a month

Why switch? These anti-inflammatory drugs block the production of substances in the body called prostaglandins, which play a role in aches and pain, inflammation, fever, and muscle cramps. At low doses, NASIDs (nonsteroidal anti-inflammatory drugs) essentially work as pain relievers. At higher doses they can actually reduce the body’s inflammatory response to tissue damage as well as relieve pain. Studies show the nonprescription NASIDs are as effective as Celebrex.

When to see a doctor If you take these drugs for longer than 10 days or the recommended doses on the label aren’t effective, make an appointment. Prolonged use of these drugs can cause side effects including gastrointestinal bleeding, stomach ulcers, kidney failure, heart attack, and stroke. So consider taking Tylenol first.

Prevent it in the first place Regular stretching, exercise, and muscle strengthening can help prevent joint pain.

Lower back pain

Instead of Long-acting opioid pain medication, such as OxyContin (or generic oxycodone)

Go OTC The NASIDs Advil (or generic ibuprofen) and Aleve (or generic naproxen), or non-NASID Tylenol (or generic acetaminophen)

Save as much as $115 a month

Why switch? Unlike opioid painkillers, which block signals to the brain, these NASIDs reduce pain by inhibiting the release of a certain enzyme that produces hormones that cause inflammation. For milk to moderate chronic pain, studies show that NASIDs work about as well as opioid drugs and are less risky. Opioids are only moderately effective and little is known about their long-term effects. Also, they don’t always completely eliminate pain; can cause side effects like nausea, constipation, sedation, and dizziness; and can cause your body to build up a tolerance so that you need increasingly higher doses, raising the risk of side effects. And they can actually increase your body’s sensitivity to pain and lead to addiction. To treat lower back pain, try nondrug treatments like exercise, physical therapy, and cognitive behavioral therapy. Acupuncture, massage, or yoga may help, too.

When to see a doctor If pain lasts longer than a week or two, radiates down your leg, or is accompanied by leg weakness, call your physician. Also be aware that NASIDs have been linked with gastrointestinal bleeding, stomach ulcers, kidney failure, heart attacks, and strokes. So you may want to consider Tylenol, a non-NASID, first. NASIDs can also aggravate high blood pressure.

Prevent it in the first place Clinical studies have found that exercise can help prevent non-acute back pain. try water and walking workouts as well as aerobic exercise, weight training,a nd muscle endurance and stretching exercises.

Migraine headaches

Instead of Imitrex (or sumatriptan) or Maxalt (rizatriptan)

Go OTC Advil or Motrin IB (or generic ibuprofen), Aleve (or generic naproxen), or the combination products Excedrin Extra Strength, Excedrin Migraine (or generic acetaminophen, aspirin, and caffeine)

Save as much as $31 a week

Why switch? These OTCs have been shown in studies to help some people who suffer from migraines.

When to see a doctor Even if the OTC drugs ease your pain, you should still see a physician for a diagnosis if your migraines are moderate to severe in intensity, or they disrupt your life, or if the meds listed above don’t provide relief. Also be aware that overusing these OTC painkillers can sometimes cause rebound headaches, where the pain can persist and become more frequent over time.

Prevent it in the first place Figure out what prompts your migraines. Culprits can include alcohol, caffeine, certain kinds of cheese, dehydration, plane rides, skipping meals, or stress.

Great foods to try in your diet

Agave nectar
Agave nectar was prized by the Aztecs as a gift from the gods. A natural sweetener and a healthier alternative to sugar and honey, the nectar (sometimes called syrup) has a consistency between honey and maple syrup.

With a significantly lower glycemic index than refined sugars, agave provides sweetness but not the blood sugar spike of other sweeteners. This makes it a wise choice (when used in moderation) for diabetics.

Light nectar has a mild, neutral flavor; amber agave has a slight caramel taste; darker agave has more distinctive caramel notes.

Recipe: Use agave nectar in hot and cold beverages (start with 1 teaspoon to 1 cup liquid), as well as baked goods.

For baking, substitute ¾ cup of nectar for 1 cup of sugar, and reduce other liquids in the recipe by a third. Lower oven temperatures by about 25 F and bake 10 minutes longer.

Agave nectar can be stored at room temperature after opening.


Called the mother grain by ancient Incas, quinoa is actually a seed related to spinach. A complete protein with all essential amino acids, quinoa is high in fiber, magnesium, potassium and iron; low in saturated fat and cholesterol; and gluten-free. Quinoa has a fluffy texture and a mild taste, and can be used on its own like rice, couscous or barley, or in salads, pilafs, casseroles and soups. In its natural state, quinoa has a coating of bitter-tasting saponins. While most quinoa sold commercially has been stripped of this coating, it’s still a good idea to soak it for 15 minutes and rinse before cooking.

Recipe: Prepare quinoa as you would rice. Boil 2 cups of water, or chicken or vegetable stock (quinoa benefits from some seasoning while cooking) and add 1 cup of quinoa. Simmer for 15 to 18 minutes, or until the germ separates from the seed (it’ll still have a slight bite). Hot quinoa is also good for breakfast with cinnamon, nuts, fruit and honey.

Steel-cut oats

Unlike rolled oats, which are flattened, steel-cut oats (also called coarse-cut or Irish oats) look like small kernels of golden rice. They are rich in fiber; are a good source of vitamins B1, B2 and E; and contain gamma-linoleic acid (GLA), an essential fatty acid. Research shows eating unprocessed oats regularly can help lower blood cholesterol levels and stabilize blood sugar.

Recipe: To cook, add one part steel-cut oats to four parts boiling water. When the porridge begins to thicken (four to six minutes), reduce heat and simmer for 30 to 40 minutes. To cut cooking time, the night before add one part oats to four parts water. Boil for one minute, stir and cover, then turn heat off and leave until morning. Cook as above, simmering until done, approximately 10 to 15 minutes.

Steel-cut oats can also be cooked in the microwave: Mix ½ cup oats with 2 cups water in a large, microwaveable bowl. Cook on high four to six minutes. Remove from microwave, stir and cook for another four to six minutes on high. Steel-cut oats remain chewy even after soaking and cooking.

Acai berries

The acai berry (which grows only in the Amazon) is said to be one of the most nutritionally dense berries on the planet, with between 10 and 30 times more antioxidants than grapes, pomegranates and blueberries. It’s also rich in vitamins, minerals and essential fatty acids, which help prevent heart disease and lower cholesterol. The acai berry is highly perishable and not available fresh. It’s sold instead as a powder, capsule or liquid.

Enjoy acai on its own as a fruit juice drink (it tastes like a combination of blueberries and chocolate), or add acai powder to smoothies and other juices. It’s also delicious sprinkled on fruit salads.


These tiny brown seeds (or gold ones—there’s no difference) are rich in omega-3 fatty acids, alpha-linolenic acid (ALA), lignans and fiber. Studies suggest they help lower the risk of heart disease, protect against certain types of cancer, lower the risk of inflammation that leads to some immune diseases and guard against constipation. Whole flax seeds add color and crunch to cookies, cereals, salads and pilafs. But because whole seeds are hard to digest, it’s best to whirl them in a coffee grinder (used expressly for that purpose) before using or buy milled flax seeds. Sprinkle the powder onto cereal or add it to dough, batter, casseroles and other cooked food. Flax oil, which provides ALA but no fiber or lignans, is excellent on fresh salads.

Flax seeds can be stored at room temperature, but ground flax seeds and flax oil should be refrigerated.

Start out easy—too much flax can initially upset your digestion. The Flax Council of Canada recommends 3 teaspoons of milled flax or 1 teaspoon of flax oil daily.


In cultivation for thousands of years, spelt is referred to as the grandfather of common wheat. High in fiber and rich in B vitamins, spelt also contains a more easily digestible protein than regular wheat, making it popular with people who have an intolerance or allergy to traditional wheat. However, it does
contain gluten, making it unsuitable for those with celiac disease.

Replace a portion of wheat flour in any recipe with an equal amount of nutty-tasting spelt flour. Because of its lower gluten content, loaves won’t rise as high, but that’s not an issue for cookies or flatbreads such as pizza dough and pita bread. Whole spelt berries can be soaked overnight and cooked like rice or added to soups like barley or other grains.

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Oils, Discretionary Calories and Daily Water Needs


Oils are fats that are liquid at room temperature. They occur naturally in plant foods (such as nuts and seeds, avocados, and olives) and in fish. Oils contain a mixture of fats, and they are important dietary sources of monounsaturated and polyunsaturated fatty acids.

Many oils are also good sources of vitamin E. Oils from plant sources are cholesterol free.

Although the monounsaturated and polyunsaturated fats found in vegetable oils and foods naturally rich in oils do not raise blood cholesterol levels, the oils provide a lot of calories in relatively small portions. Because we get most of the oils we need naturally from foods, we need to limit the amount of vegetable oils and other fats we add to foods while cooking or at the table.

MyPyramid recommends 3-11 teaspoons of oils per day depending on your individual calorie needs. Each of the following are the equivalent of 1 teaspoon of oil and contain approximately 45 calories:

• 1 teaspoon of oil (including canola, corn, cottonseed, olive, safflower, soybean, sunflower, sesame, or walnut oils); mayonnaise; mayonnaise-type salad dressing; or margarine (soft, trans fat free)
• 1 tablespoon Italian or Thousand Island salad dressing; mayonnaise (light or low-fat)
• 2 tablespoons light salad dressing
• ½ cup avocado, sliced
• Olives (15 small or 10 large black pitted; 7 green [queen size]; 12 stuffed green olives)
• ½ oz. of most nuts (14 peanuts, 12 almonds, or 9 cashews) or 1 tablespoon nut butters (these also count as 1-oz, equivalents of Meat and Beans)

Monounsaturated fatty acids are healthful unsaturated fats that provide calories and are liquid at room temperature but can become more solid when refrigerated.

Polyunsaturated fatty acids are essential unsaturated fats that need to be obtained by the diet because the body cannot make them; they’re healthful unsaturated fats that provide the body with calories and are usually liquid at room temperature or when refrigerated.

Discretionary Calories

In addition to the basic food categories, MyPyramid provides a discretionary calorie allowance; these are extra calories that are available every day in addition to the calories provided by the lean, low-fat, and low-sugar foods and beverages in key food groups. You can use your discretionary calories for larger portions of foods, or to consume a desired fatty or sugary treat (for example, full-fat cheese instead of low-fat cheese). You can also count foods that don’t fit neatly in any of the basic food categories as discretionary calories; these include solid fats (like butter or cream cheese), sugary foods, and alcoholic beverages.

MyPyramid recommends between 165 and 648 discretionary calories per day depending on your daily calorie needs.

Discretionary calorie allowance is the amount of calories left in a person’s total energy or calorie allowance after accounting for the number of calories needed to meet recommended nutrient intakes from low-fat, low-sugar foods and beverages.

Daily Water Needs

Although humans can survive a few weeks without food, we can’t last more than a few days without water. About 55%-75% of the human body is made of water. Water has several vital functions in the body:

• It carries oxygen and nutrients such as glucose and fat to muscles and helps eliminate wastes such as carbon dioxide and lactic acid from the body.
• It regulates body temperature.
• It prevents dehydration.
• It reduces fluid retention.
• It provides moisture to the skin, ears, nose, and throat.
• It aids digestion because it’s a key component of saliva and gastric juices.
• It helps fiber pass through the body more easily (to prevent constipation or gastrointestinal discomfort).
• It protects joints, organs (including the brain, eyes, and spinal cord), and other body tissues from shock.
About 80% of our daily water needs typically comes from water and other beverages, but about 20% comes from water-rich foods such as fruits, vegetables, grains, meats, fish and cheese.

Daily Recommended Amounts

The Institute of Medicine recommends the following intakes of “water” (from foods and all beverages) each day:

• Women – 11 cups of water
• Men – 16 cups of water

Because only 20 percent of daily water needs can typically be met from foods, 80 percent should come from liquids including water. To meet these needs, women should aim for the equivalent of 9 cups of fluids and men about 13 cups of fluids.

Because daily water needs increase during pregnancy and breastfeeding, the Institute of Medicine recommends the following daily intakes:

• Pregnancy – 13 cups of water
• Breastfeeding – 16 cups of water

Daily “water” needs can be met by drinking any beverage including water, milk, 100 percent fruit juice, coffee, tea, and other beverages.

Water needs also increase in a variety of conditions and situations, including the following:

• If you exercise, especially for long periods of time or in warm weather
• When the weather is hot and you sweat a lot
• When the weather is cold and you skin is less moist
• If you live in or visit places in high altitudes (greater than 8,200 feet)
• When you travel on an airplane where air is recirculated
• When you have a fever, vomit, or have diarrhea
• If you have certain health conditions such as kidney, liver, thyroid, adrenal, or heart disease and retain more water

Because young children (including infants) don’t sweat as much and don’t tolerate high temperatures as well as adults, their fluid intakes need to be monitored more closely. Also, older adults are less able to sense thirst than younger adults, and may drink less water than they need and should also be monitored. The best way for most people to gauge that they’re getting adequate water is to make sure they’re urinating at least every 2 or 3 hours; urine should be pale yellow or clear in color, although sometimes dietary supplements or medicines can alter the color of urine to make it appear more concentrated.

Constipation is a condition characterized by difficult or infrequent bowel movements.