Bedwetting - Finding an Overnight Cure

January 2005
Bedwetting: Take the Right Steps to Find a Cure Overnight
By S.C. Torrington
 
Which easily diagnosed medical condition affecting about 5 million U.S. school-age children has so few resources available that many families give up trying to treat it? Nocturnal enuresis, or bedwetting, seems to be a treatable condition that many health care providers are not prepared to treat.
“Bedwetting is typically not so complicated that an urologist has to handle it,” says Renee Mercer, RN, MSN, CPNP and author of Seven Steps to Nighttime Dryness: A Practical Guide for Parents of Children with Bedwetting (Brookeville Media, 2003). “But pediatricians don’t always have the time, interest or expertise to treat bedwetting either.”
As a pediatric nurse practitioner for more than 20 years, Mercer witnessed the embarrassment, frustration and helplessness of families unable to find solutions for their children’s bedwetting. In 2000, she studied with Dr. Max Maizels in Chicago to learn and develop treatment protocol.
Mercer now works in her own private practice, Enuresis Associates, in Ellicott City. She co-founded The Bedwetting Store, an online and catalog source for products and information.
Mercer also attributes the lack of urgency for treatment on the fact that every year, 15 percent of bedwetters stop without intervention and only 1 percent still wet the bed by the age of 18. According to Mercer, a well-meaning medical professional may tell parents “Don’t worry. Your child will outgrow it. It won’t be a problem.”
But, for a 10-year-old child looking forward to his first overnight camp or her first pajama party, it is a problem.
“Often it’s a precipitating event that prompts a family into action,” says Mercer. “Maybe a child is tired of missing out on special events or, unfortunately, experienced an accident.”
Readiness on the part of child and commitment from the family are an essential beginning for dryness success.
Mercer breaks down the process of helping a child achieve nighttime dryness into seven progressive steps, beginning with understanding the basics of the condition.
Bedwetting is defined as “the nightly release of urine by children older than 6 who should have developed nighttime dryness.”
Mercer explains how the urinary system works and how the important “bladder and brain connection” should develop urinary control.
Parents learn what might cause bedwetting and what doesn’t. A simple urine test by your pediatrician can rule out any infections or underlying urological problems. Because enuresis can be inherited, Mercer points out those parents may have resolved themselves to think “I wet the bed until I was 12; I guess my child will have to wait until 12, too.”
She also shares the Ten Common Myths and Facts about Bedwetting and reminds parents that their child needs patience, not punishment.
Selecting the right time to start treatment is key for a positive outcome. Because the process generally takes several months, parents are encouraged to begin during a stable time in the family’s life. A busy holiday season or the arrival of a new baby might not be conducive for success.
In setting realistic dryness goals, Mercer suggests considering your child’s temperament. “You know your own child the best,” she says. “Is he eager or reluctant to start?”
Mercer believes working with younger children (6 or 7) is often easier because the child’s motivation level is high and their social obligations less than the older children.
“If you have an older child and you think he’s not motivated because he’s acting not interested,” observes Mercer, “it might really be because he’s feeling hopeless.”
Reassure your child that it’s never too late, and that this process gives him or her the power to do something and to see results.
Supportive and Curative
Treatment approaches falls into two categories: supportive and curative. Supportive options such as waiting and doing nothing, using disposable underpants, restricting fluids, waking or “lifting” your child, setting alarm clocks or medication generally have only a 15 percent long-term effectiveness rate. Mercer discusses the pros and cons of these choices, but considers them merely ways of buying time until the family is ready to work toward a curative approach.
“The treatment of choice from some health care professionals is prescription medicines,” states Mercer.
A synthetic hormone, DDAVP, mimics the natural hormone vasopressin that decreases the quantity of urine produced for eight to 12 hours. And while it can certainly be effective for a special occasion where the child must stay dry, Mercer reminds parents that medicine can “provide short-term dryness for many children,” but it’s not a cure.
When considering a curative therapy, Mercer points out “the success rate of using a bedwetting alarm approaches 80 percent, and the relapse rate is much lower than when using medication alone.”
The last four steps to nighttime dryness discuss the stages of its use.
Unlike a traditional alarm clock, used to awaken a parent and child at an arbitrary time each night, (regardless of whether the child needs to urinate or not), a bedwetting alarm sounds at the first drops of urine. Most systems consist of a moisture sensor that attaches to the outside of the child’s underwear and a small, lightweight alarm box that usually attaches to the child’s shoulder. Over time, the alarm helps to strengthen the bladder and brain connection and inhibits the flow of urine.
“Many parents are under the misconception that the first time the alarm goes off, their kid will hear the alarm, jump up and run to the bathroom,” says Mercer. “They worry their child’s a heavy sleeper and ask, ‘How will he wake up? How can this work?’”
Truth is, it probably won’t work without the initiative and help of a parent. It usually takes the parent arousing the child, reminding him of the alarm and getting him to the bathroom to establish a new behavior.
Before purchasing an alarm, families should consider usability, comfort, durability, type of connection, sound and turn-off. Seven Steps to Nighttime Dryness offers a detailed chart comparing types and brands of alarms. Mercer recommends the child be involved, especially in picking a “kid cool” design to encourage its use. But ultimately, parents need to trust their own judgment regarding their child’s ability and willingness to use a bedwetting alarm.
Parents must also make a commitment to its use and realize consistent dryness is not going to happen overnight.
“The first month is the hardest,” admits Mercer. “But within that month, you should see some progress such a smaller wet spot, less frequency or closer-to-morning wetting.”
During the second month, expect more and more dry nights. By the third month, it’s a matter of fine-tuning the treatment.
The goal is 14 consecutive dry nights with alarm use and 14 more nights using the alarm every other night.
Mercer tells her readers up front that the bedwetting alarm approach can be frustrating, is not a quick fix, nor is it guaranteed. She estimates a 10 percent relapse rate, often caused by the stress of an illness or injury requiring bed rest. Sometimes medication for other conditions such as ADD, anxiety or depression can affect a child’s bedwetting.
“But even if your child isn’t 100 percent dry, it’s going to be better than what she’s experiencing now,” Mercer says.
Mercer’s book offers detailed record-keeping and reward suggestions, insight on working with adolescents, siblings and children with special needs as well as a discussion of sleepovers and life-long strategies. The FAQ chapter even lists some helpful cleaning tips.
“I want parents to know there is help available. There are techniques that work. It’s a process over time. I help patients set dryness goals and obtain them.” BC

For more information or for a copy of Seven Steps to Nighttime Dryness: A Practical Guide for Parents of Children with Bedwetting, by Renee Mercer, RN, MSN, CPNP, contact Enuresis Associates, Dorsey Hall Medical Center, 9501 Old Annapolis Road,
Ellicott City, Md. 21042; 301-774-1349. Or, go online to www.dryatnight.com, www.bedwettinghandbook.com or www.bedwettingstore.com.