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Bedwetting (also known as nocturnal enuresis) is one of the most common paediatric-health issues. It occurs in 15-20% of five-year-olds, 6-8% of eight-year-olds and declines to 1-2% by fifteen years of age and over. However, your child shouldn’t be considered enuretic, i.e. a bed wetter, unless he or she wets the bed more than twice a week after the age of five.
Bedwetting in children who are old enough to have bladder control is usually the result of a variation in normal bladder neurological development. In bed wetters the signal to wake when the bladder is full is weak or inoperative and the bladder reflex system allows automatic, involuntary voiding when the bladder fills above a certain level. In some cases bedwetting children may also not produce enough ADH hormone to reduce night-time urine production so they can sleep through the night. In a minority of cases bedwetting is caused by anatomic, urological or neurological defects. If you have any concerns it always pays to check with your doctor.
No. Many children who sleep deeply do not wet the bed. However, deep sleepers who are also bed wetters are less likely to wake to use the bathroom and this is a factor you need to take into consideration in their treatment.
Genetics do play a part –a child has a 40% chance of becoming a bed wetter if one parent wet the bed when young and a 70% chance if both parents did. Recent studies have also identified genes associated with enuresis.
Primary bedwetting is used to describe the condition where a child has never attained bladder control during the night. It is usually regarded as a variation in the development of normal bladder control. Secondary bedwetting is used to describe the condition where a child starts to wet the bed after at least six months of not wetting the bed. In some cases secondary bed-wetting may appear following emotional distress e.g. the birth of a new child, moving house, or death of a relative.
Studies indicate that only around 15% of bedwetting children will outgrow the problem each year.
Bedwetting is a pathologically benign condition, i.e. it is not a life threatening illness. However, due to the low rate of spontaneous resolution and the emotional stigma that often accompanies this condition, it can lead to self-esteem issues, disrupt family routines and increase the amount of housework required to keep your child dry and clean. For these reasons a safe treatment regime with minimal side effects is highly recommended. If your child is ready and wants to cure his or her bedwetting discuss the options with him or her.
Making a child do their own laundry as a ‘punishment/incentive’ for bedwetting is hurtful, humiliating and will not cure the bedwetting. Therefore, it is not recommended. However, where other members of the family also do their own laundry as part of the normal family routine then this may be acceptable.
If your child is not affected by his or her bedwetting and is not yet ready to begin a treatment programme then disposable diapers are a practical solution and reduce laundry loads. They also allow the child and the family the freedom to sleep away from home. However, older children can find diapers demeaning and the environmental cost of disposing of them in landfills is well known.
As a parent or caregiver you need to be closely involved with helping your child treat their bedwetting. Remember, it’s not your child’s fault. Your child cannot help this condition and he or she is not being lazy or badly behaved. Help them limit their feelings of guilt by letting them know that they have a treatable condition and that they are not being naughty. Love, support and encouragement are a critical part of any treatment regime.
There are a three main treatments for bedwetting:
- Bedwetting Alarms
- Behavioural Therapy (Reward Programmes and ‘Lifting’)
- Pharmacological Therapy (Drugs)
Bedwetting alarms work on the principle of Conditioned Learning. This principle was discovered by Pavlov, a Russian psychologist in the early 1900s. He found that if a powerful stimulus is associated with a neutral one then after a time the neutral one acquires the same strength as the powerful one. In his work with dogs Pavlov found that putting food in a dog’s mouth was a powerful stimulus triggering the production of saliva. He then experimented with ringing a bell each time he gave the dog some food and after a time he found that simply ringing a bell would result in the dog producing saliva. People are also affected by this kind of learning and mostly we are completely unaware that it is happening. Whenever a powerful and neutral stimulus occur together a link is made.
In the case of bed wetters the sensation of a full bladder should trigger awakening but it doesn’t. However, the sound of a loud noise can trigger waking and cause an immediate contraction of the external sphincter muscle which stops the flow of urine from the bladder. The solution is to pair up the feeling of a full bladder with a loud noise so that, in time, the sensation of a full bladder will do the waking just like a loud noise.
Bedwetting alarms work by placing a sensor in the child’s underwear that sounds an alarm when a small amount of urine is released, waking the child up. Over time the child gradually learns to associate the sensation of a full bladder with the need to awaken and eventually the bladder reflex will function correctly and let your child sleep through the night.
Simple behavioural therapy reinforces that while it is not the child’s fault the treatment is the child’s responsibility. Reward systems involve positive reinforcement like sticking stars on a calendar for dry nights but no negative reinforcement for wet ones. However, it may be difficult to convince your child that a wet night is nothing to be ashamed of when dry nights are rewarded!
Rewards may increase a child’s vigilance for a while making his or her sleep lighter and by this means controlling the bladder and not wetting the bed. However, because behavioural therapies used on their own do not train either the child’s brain to wake with the sensation of a full bladder or the bladder reflex system to stop urine leakage, complete cure is unlikely in the majority of cases.
‘Lifting’ or waking your child in the middle of sleep to toilet can lead to frustration and conflict, especially if the child does not feel he or she wants to go to the toilet. Any attempt to force a child to go to the toilet before bed or during sleep will not bring any improvement in bladder control unless, fortuitously, it coincides with the sensation of a full bladder and the child is aware of this.
Synthetic hormones such as Desmopressin, or antidepressants such as Imipramine, may be prescribed for bedwetting. Treatment with synthetic hormones reduces the amount of urine produced during the night whereas antidepressants make the bladder muscle relax whilst causing the smooth muscle at the bladder neck to contract, inhibiting involuntary urination.
Drug treatment is relatively expensive and runs the risk of uncommon but severe side effects. In the case of Desmopressin it needs to be used with great caution in children who have problems with fluid balance or cystic fibrosis because excessive fluid intake can affect the fluid balance in the brain leading to confusion or even convulsions. Also, it tends to be ineffective with children with viral or symptomatic allergic rhinitis. Imipramine can lead to emotional irritability in children and there is the possibility of accidental overdose which can lead to convulsions and coma.
Desmopressin can be effective for short-term treatment when on camp or sleepovers and Imipramine can be effective for short term treatment of distressed, older children if other treatments have been unsuccessful.
Drugs do not cure bedwetting long term. Once a child stops taking them the symptoms usually return.
Bedwetting alarms have the highest success rate in treating bedwetting compared to other treatments. Long-term success rates range from 70-90% compared to approximately 25% for Behavioural Therapy and 60% for Drug Therapy. However, with Drug Therapy, once the medication is ceased the relapse ranges between 59-100%.
The advantage of bedwetting alarms is that they are cost effective, do not require medication and have no side effects.
DRI Sleeper® alarms have been curing bedwetting since 1979 and have up to a 90% success rate according to independently audited annual surveys. Furthermore, when you purchase a DRI Sleeper® alarm direct from the DRI Sleeper® website you receive FREE ongoing advice and guidance, as you need it, over the treatment period. Our bedwetting experts are part of the bedwetting team with you and your child.
Successful treatment with a DRI Sleeper® alarm takes from a few weeks to a few months. Some bed wetters, who are particularly deep sleepers, may take longer and require more encouragement and help from parents to make sure they wake in response to the alarm and carry out their toileting routine.
Parents or caregivers have a pivotal role in coaching, supporting and encouraging their child to treat the bedwetting condition. Coaching may involve training the child while he or she is awake in what they need to do when the alarm triggers during the night. Support may initially involve ensuring your child responds to the alarm in the night by going to the toilet and preparing the Urosensor™ for immediate re-use. Encouragement will involve praise for any and all progress made towards the child’s goal of ending his or her bedwetting.
The DRI Sleeper® excel has a world-leading, patented, double-sided, flexible, moulded polymer Urosensor™ for your child’s comfort which goes right inside the underwear where the urine escapes. The Urosensor™ is attached to an 85cm (33”) lead that plugs into the alarm which you attach with Velcro to the shoulder of your child’s night clothes.
The DRI Sleeper® eclipse is a true two-part wireless alarm. The Urosensor™ has no wires connecting it to the alarm and no transmitter attached to the underwear which it must be plugged into. The Urosensor™ goes right inside the underwear where the urine escapes and the alarm can be placed next to your child’s bed. The DRI Sleeper® eclipse can also transmit to more than one alarm at the same time, so parents and caregivers can have an alarm in their room.
DRI Sleeper® alarms are manufactured by Anzacare. They are registered with the FDA and ARTG. DRI Sleeper alarms also carry the CE mark for conformity with European Community rules for medical device manufacture and the DRI Sleeper® eclipse complies with the international standards for electromagnetic compatibility.
The DRI Sleeper® excel has built-in safety electronics to stop current passing through the sensor once the alarm is triggered. This ensures your child’s urine does not acidify and lead to skin irritation and rashes, which can happen with other types of alarms. The DRI Sleeper® eclipse, on the other hand, emits just two low frequency radio waves of only 1.4 seconds duration so it is completely safe to use with children.
DRI Sleeper®’s world-leading patented Urosensors™ are made of moulded polymer so they are easy to clean and dry for instant re-use. What’s more, they contain no metal contacts that can corrode and deteriorate in urine. They are the ideal size for the maximum detection of urine. The DRI Sleeper® excel Urosensor™ measures 40mm x 20mm x 3mm (1.6” x 0.7” x 0.2”). The DRI Sleeper® eclipse Urosensor™ measures 52mm x 25mm x 10mm (2” x 1” x 0.4”).
There are a variety of ways of placing the Urosensors™ in your child’s underwear and these are outlined in the instructions that come with the alarms. The method recommended and preferred by most parents is to cut a pocket using a pair of scissors in a sanitary minipad, or panty liner, for the Urosensor™ to fit into, then stick the minipad into the crotch of the underpants. Because the DRI Sleeper® Urosensors™ do not have to be clipped or domed to the outside of your child’s underwear but go directly inside the underpants where the urine escapes they are more effective at detecting bedwetting. Also there are no clips or fasteners that can be broken or damaged in use.
DRI Sleeper® Urosensors™ are consumable items. They should last at least a year if they are cleaned and maintained in the recommended manner. Replacement Urosensors™ are available for purchase on the DRI Sleeper® website.
DRI Sleeper® alarms are designed to wake children rather than provide audio entertainment or ineffective, battery consuming, alternatives to sound such as vibration or flashing lights. The Urosensors™ respond to small amounts of urine by emitting a loud alarm around 95dB at 3.3 kHz, a frequency that has been established as one to which the human ear is especially sensitive.
DRI Sleeper® alarms come with batteries. Effective electronics design means that the batteries will last through the usual treatment period. The DRI Sleeper® excel uses 4 LR44 batteries and the DRI Sleeper® eclipse uses a CR2354 battery. These batteries can be replaced when they run down. The DRI Sleeper® eclipse Urosensor™ has a battery sealed inside the unit. This cannot be replaced when it runs down, however, it should last at least a year used nightly. The DRI Sleeper® eclipse Urosensor™ is a consumable item and replacements can be purchased from the DRI Sleeper® website.
DRI Sleeper® alarms and the bedwetting team at Anzacare have been helping children overcome bedwetting for 35 years. We are committed to providing you and your child with the guidance and support you need to ensure treatment with our alarms is successful.
Over the years we have focussed improvements to the DRI Sleeper® alarms on the needs of children and their parents rather than the dictates of fashion or marketing. As a result DRI Sleeper® alarms have patented, world-leading, plastic Urosensors™ which are comfortable, easy to wash and dry for immediate re-use, and do not contain metal contacts which can corrode in urine. Our Urosensors™ are inserted directly in underwear where the urine escapes rather than being clipped to the outside of the underwear with uncomfortable clips or domes which can be broken or damaged in use.
The sound and frequency of DRI Sleeper® alarms is pitched at a level to wake sleeping children rather than provide audio entertainment and ineffective, battery consuming, alternatives to sound such as vibration or flashing lights.
For ultimate comfort and convenience the wireless DRI Sleeper® eclipse has been developed with the transmitter in the Urosensor™ so it does not need to be attached to an alarm by wire or to a separate transmitter on the child’s undergarments. The Urosensor™ is able to transmit to more than one alarm so it can be used in conjunction with a second alarm in parents’ or caregivers’ rooms.
DRI Sleeper® alarms have a 90% success rate in treating bedwetting based on our independently audited annual customer surveys. You can be assured they are a well-priced investment in your child’s health and happiness.
DRI Sleeper® alarms are warranted against manufacturing defect for 6 months following purchase.