Nocturnal enuresis is the medical term of bed wetting. It refers to the phenomenon of involuntary urination during sleep. This is a very common problem in children. Most children stop wetting the bed before they are five, but in some cases this condition persists until teenage. Below is the graph showing the approximate bedwetting rates at different ages.
Bedwetting children tend to suffer from more psychological burden and stress, for some parents blame their children without truly understanding the underlying reasons. Bedwetting children may feel inferior, tend to become withdrawn, become difficult, and have low self-esteem. Some even suffer serious psychological and behavioral problems. Parents should address the bedwetting problems to find out the best treatment for their children as early as possible. Delay in undergoing treatment only worsens the situation.
B. TYPES OF NOCTURNAL ENURESIS
Primary nocturnal enuresis refers to a child who has never stopped wetting the bed for a long period of time (usually six months or more).
Secondary nocturnal enuresis refers to a child who had been able to control urination at night, but suddenly wets the bed again. This is usually due to pressure arising from some unexpected events, for example, birth of a brother/sister, the child’s entering school or some family issues. In general, most secondary bed-wetting will go away as the environmental pressure is relieved or when there are some incentives. However, if the problem persists, you must consult a doctor to rule out a variety of physical problems.
C. MAIN CAUSES OF BEDWETTING
1. Genetic factor
Bedwetting appears to run in family. If both parents had bedwetting habit when they were children, the chance of their child being a bedwetter is higher.
2. Slower development of central nervous system
Some bedwetting children are simply slower in developing the ability to respond to the signal that the bladder is full.
3. Insufficient antidiuretic hormone (ADH) production
ADH is the hormone that reduces urine production during sleep. Children who have insufficient ADH produce more urine than the capacity of their bladders during sleep.
4. Infection and disease
Secondary nocturnal enuresis and daytime wetting can be related to infection and disease. In rare cases, it is caused by infection such as urinary tract infection.
Most people generally believe that bedwetting is caused by immature urinary control. Frequency of happening will gradually decrease and finally disappear as a child grows up. However, this is a misconception. Researches show that only 15% of bedwetters stop bedwetting without proper intervention each year. In other words, 85% of bedwetters will continue wetting their beds in the immediate subsequent year should they have no treatment received. 1 out of 3 kids who have bedwetting problem at the age of 10 keep having this problem even when they reach adulthood. Hence, people prefer dealing with bedwetting proactively rather than passively.
2. Drug therapy
Medication is an alternative of curing bedwetting. DDAVP is the most popular medicine prescribed for bedwetting. It is a synthetic version of vasopressin (a natural hormone) and is usually administered as a small pill. DDAVP decreases the amount of urine produced at night and can successfully stop wetting in about half of the children taking it.
Oxybutinin (Ditropan) is a medication used to treat overactive bladder. This can be helpful to children who experience frequent urination in daytime as well as night-time.
While medication may provide a temporary relief to bedwetting, children may suffer a relapse once they stop taking it. Causing potential side-effects is also a great concern of many parents.
3. Bedwetting alarms
Alarm therapy is a kind of behavioral therapy. The concept is to wake a child up as soon as wetting occurs. The child will be trained to sense the need to get up in response to a full bladder over time. Typically, 25% of alarm users stop night-time wetting in 30 days, 50% in 60 days, and 90% in 90 days. The relapse rate is in general lower than any other type of therapy. People using it can be free from worries over potential side-effects.
E. TYPES OF ALARMS
All bedwetting alarms consist of three main components: an alarm unit, a moisture sensor and a transmission medium. They all function in a similar principle: when urine is detected, the moisture sensor will trigger the alarm to sound/ vibrate which will, in turn, awaken a child to get up and use toilet. With the proper use of the alarm, a child will be taught to respond to a full bladder gradually.
Bedwetting alarms are generally classified into 3 categories: wearable alarms, wireless alarms and pad-type alarms.
1. Wearable alarms
Both the moisture sensor and the alarm unit of a wearable alarm are attached to the user’s clothing. When urine is detected, the moisture sensor will send a signal to the alarm unit via a physical cord. Since the sensor is attached directly to the user’s briefs, only a small amount of urine will trigger the alarm to respond.
2. Wireless alarms
Instead of using a cord like a wearable alarm, the moisture sensor of a wireless alarm transmits signals to the alarm unit in a wireless way. The moisture sensor is attached to the user’s briefs whilst the alarm unit can be placed on bedside or anywhere in the child’s room. Some wireless alarms provide an extra alarm unit for parents so that they can put it in their own room and be alerted as well.
3. Pad-type alarms
Unlike the foregoing alarms, pad-type alarm is not fixed to the user’s clothing. The moisture sensor is hidden inside a pad that is placed under the user’s bed sheet. The alarm unit is connected to the pad by a cord and is usually placed on the bedside. Since the sensor is not attached directly to the user’s briefs, the amount of urine which is required to trigger the sensor to respond will be relatively larger.
Comparison among various types of bedwetting alarm
- The greater the number is, the better the performance is / the cheaper the alarm is.
- The greatest number is “5” and the smallest one is “1”.
- Comparison is made by taking the average of the alarms available for study.
Types of sensors
There are a few types of sensors available in the market, among which, “clip” type and “rubber pad” type are commonly used
1. “Clip” type
The sensor is attached to the outside of the underwear with the use of a clip. As it is easy to be attached, use of this type of sensor is commonly found.
2. “Rubber pad” type
Instead of using an attaching device, the sensor is put inside a mini pad by which the former can be held in place. Before fixing the sensor in the pad, a slit has to be cut in the absorbing layers of the mini pad and then have it taped across by a sticky tape so as to prevent the sensor from being pulled out.
F. CHOOSING A SUITABLE BEDWETTING ALARM
There are lots of bedwetting alarms available on the market. Not only are they of different types and designs, their price also varies. It is not an easy task to choose the right one. The following are the key factors one needs to take into consideration when making such a choice.
Loudness is one of the most important factors that should be considered. Many reviews show that it is of no use if the alarm volume is not loud enough to wake your child up. However, the same volume level can be too soft for one person but too loud for another. A fixed volume level is unable to cater to different needs. An alarm with volume control is therefore desirable.
Since a typical treatment takes about 6-12 weeks and the user may need to go to toilet during night time, it should be easy for him/her to attach and detach the alarm unit and sensor from the clothing. Depending on the types of sensor, ways to attach the sensor to the clothing are different.
As the user has to wear the alarm during sleep time, both the size and the weight of the alarm unit are the factors that should also be taken into account.
The selling price of a bedwetting alarm ranges from AUD$50 to over AUD$150. To get your money’s-worth, you can simply make a comparison among the features of the alarms against their selling price. Since some alarms have to be used together with accessories, such as mini pad, the selling price of the alarms can be higher than those stated. Hence, when you estimate the price, don’t forget to include the potential cost!
G. USEFUL TIPS IN USING BEDWETTING ALARM
- You are recommended to have a trial run of all steps in using the alarm during day time with your child before the first time use.
- Rapid response on hearing or feeling the alarm can enhance the success rate in overcoming bedwetting. Parents play an important role, in particular at the initial stage, in awaking a sleeping child for urination and are therefore recommended to sleep in the same room with the child for the first 2 weeks of using the alarm.
- Your child does not want to wet the bed. Do not scold or blame him/her for any wet night. Encouragement can help your child overcome bedwetting.
- Use progress card to show your child his/her steady improvement and enhance his/her sense of achievement.
- Keep using the alarm for 2 more weeks after dryness so as to lower the chance of relapse.
- Test the alarm by wetting the sensor and pressing down the sensor lever before use. The alarm vibrates and/or sounds (as the case may be) with the LED light on when it is activated.
- Always keep the sensor dry. Never put anything under the sensor lever.
- Ensure the sensor is adequately cleaned every few days so that its sensitivity can be maintained. Urine residue left on the sensor can keep the alarm from working properly.
- Do not clip anything onto the cord or damage it by any means. Do not pull the cord out of the alarm unit.
- The cord should go UNDER the pajamas as it can prevent the sensor from being dislodged. Do not unplug the cord from the alarm unit unless for cleaning.
- To achieve the best results, it is recommended to set the operation mode to “vibration and sound”.
- Always use the same type of batteries. Do not mix the old ones and the new ones.
- Always watch the product video to know more about the features and operation details of an alarm before making a purchase!
H. RELATED ARTICLES
Nocturnal enuresis – By Dr. Darcie A. Kiddoo (http://www.cmaj.ca/content/184/8/908)
Nocturnal Enuresis – By Urology at UCLA (http://urology.ucla.edu/body.cfm?id=146)
Bedwetting – By University of Florida IFAS Extension (http://edis.ifas.ufl.edu/he794)
Bedwetting – By The Royal Childrens Hospital Melbourne (http://www.rch.org.au/kidsinfo/fact_sheets/Bedwetting/)