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THE SACCHARIN CONTROVERSY AND THE FDA

It seems to have been overlooked that similar mechanisms operate in the conditioning treatment and doubtless they have received too scant attention in discussions of its rationale although contributing to its striking success. Typically, within about a week of conditioning therapy, sphincter contraction follows rapidly the onset of micturition, which results in progressively smaller wet" patches instead of a drenched bed. As Dr Roy points out, "On being woken, the child should go to the toilet and finish emptying the bladder." In addition, the nightly frequency of wettings or self-awakenings to urinate diminishes as bladder capacity increases. Recorded data of these events from telephoned weekly reports in over 4,000 conditioning treatments have been used by us as reliable indicators of progress useful in reassuring the patient. Further, over 50% of successfully conditioned enuretics conclude treatment with bladder capacity adequate for sleeping through the night without waking to urinate, or wetting. These are the ones at least risk of relapse. In a significant proportion of cases presenting with diurnal frequency and urgency as well as enuresis, conditioning treatment leads to remission both of the nocturnal and of the diurnal symptoms. The few published systematic studies of the bladder and sphincter exercise approach are less encouraging than those of conditioning by pad and bell but they vary with the therapist and, in the latter case, with the effectiveness of the instrumentation. Ramsey-Coote Instruments, M. A. COOTE, 49 Ardoyne Street, B.SC., DIP.ED. Black Rock, Vic. 3193.