Sunday, December 28, 2008

Thoughts on the Development of Our Ideas Regarding Diapers and Bed-Wetting

It seems that most of our ideas regarding continence related issues such as potty training and bed-wetting are passed down from our parents. Some parents take a more relaxed view of these matters whereas others are more stringent. This is also the case with pediatricians and other medical professionals. For example I saw an ad some years ago by a famous pediatrician(I believe it was T.Berry Brazleton) saying in essence that in terms of potty training parents should let nature take its course and follow the child's natural growth process-when the child is ready the parents should then begin a training regimen.

There are differences of opinion about when a child is ready for potty training. The psychologist John Rosemond disagrees with what is called the child-centered approach espoused by Dr. Brazleton and feels that children should be out of diapers as soon as possible. According to the website Rosemond believes it is “a slap to the intelligence of a human being that one should allow a baby to continue soiling and wetting himself past age 2.”

A Mayo Clinic article states that a large number of children become interested in potty training at age 2 but some don't show an interest until 2 and ½ years or older. As I have talked about in an earlier article there should be reasonable parameters established for these situations to rule out physical and/or cognitive problems but we also need to take into consideration the fact that people's bodies develop at different rates. Also some people do have physical and/or cognitive reasons for being delayed in this area. The reason for mentioning people's attitudes regarding toilet training is that many persons extrapolate their ideas from this area onto matters of bedwetting and diaper use. In my opinion this extrapolation is unwarranted.

For some reason our notions about potty training and when our children should attain night dryness have been linked-we feel that if the child is “mature” enough to use the toilet they should be mature enough to be able to sleep through the night without wetting themselves. It follows from this that if they are grown up enough to not need diapers because they have learned to use the potty,they should be grown up enough to not need diapers during the night. But we must realize that there is not necessarily a correlation between when a child is potty trained and their ability to stay dry at night. Some children might be able to be potty trained at an early age and not achieve night dryness for many years(in some cases never-there are plenty of adults who wet the bed and have this problem their whole lives). Physical and mental capabilities of all sorts sometimes develop at different rates.

Continence and people's conceptions of maturity have been inextricably linked in many persons' minds for a long time. I firmly believe it's time to rethink this. There may be physical or cognitive components(or both) that can be responsible for a person being delayed in their ability to achieve continence including those with bedwetting problems. The fact that they have these problems and might need diapers to manage them is not a reflection on their “maturity.” People have ailments effecting different parts of their body-their heart,liver,eyes,ears,etc. and use whatever means necessary to correct or manage the problem why should it be any different with a problem like bedwetting?

Parents like to tell their child how much of a “big kid” they are for not having to wear diapers any more. I realize that parents have good intentions with this approach because children are motivated to act and behave more like adults and the parents and other relatives of the child feel this method will help in this regard. I can also understand why children are proud of each accomplishment whether physical or cognitive that moves them closer to adulthood and independence such as learning to tie one's shoes, learning to swim without products such as “water wings”,being able to take the training wheels off their bike,etc. These are examples of things that demonstrate a child's competency and their ability to learn a new skill which to the child is a great source of pride because they feel more mature. This in turn bolsters their self-esteem. Not having to wear diapers anymore is universally acknowledged as another one of the milestones on the path to becoming an adult similar to the ones mentioned earlier in this section. Many people(including both the general public and the person suffering from incontinence) feel that wearing diapers is a sign of regressing which tends to lower the individual's self-esteem and subsequently damages their self-concept. However,the fact that a child,teenager,or adult has to wear diapers for bedwetting has nothing at all to do with their value as a human being, their competency,or level of maturity. A situation such as this is solely about the person having the ability to control certain bodily functions. A person can be the most intelligent, skilled,mature,independent,and competent person in the world yet not have the capability to stay dry at night for whatever reason.

People reading this article and other articles I've written about this topic might come to the conclusion that I believe a person should just use diapers for their bedwetting and not seek medical attention for the problem or look into new treatments should they become available. I feel this is in large part due to the fact that my articles tend to be about protection as opposed to treatments. Nothing could be further from the truth. As mentioned in other articles, I do believe that people should explore various cures for their bedwetting. It's very important that a person seek medical advice in order to rule out a potentially serious condition. However,if after seeing a doctor and serious conditions have been ruled out,and if all avenues at curing the bedwetting have proven unsuccessful, are not viable,or are not desirable for whatever reason, then the parents should have the youngster sleep in diapers. As I have indicated in my article “Bedwetting:When Cures Can Be Worse than the Disease” in some cases the treatments available for the bedwetting might be unpleasant or unfeasible for the particular individual. My articles are geared specifically toward those individuals who have tried different methods of treating their bedwetting without success or have found the treatments available unsatisfactory for whatever reason. The people in this group feel that wearing protection to bed is the best option at this point in time and I've written articles specifically for this audience due to the fact that there seems to be a dearth of articles for this particular group. In my opinion this group is unduly stigmatized and I wanted to address these individuals . A person who wets the bed(or suffers from any other form of incontinence) should not be denigrated for choosing to wear diapers either by medical professionals or the public if they feel that's the best course of action. I also feel that a person should not feel pressured to try a treatment that they find objectionable or not suitable for them just because diapers have a negative image.

Regarding using garments such as pull-ups or “Goodnites” it seems in general that diapers provide more effective protection for the management of heavy incontinence such as bedwetting which I discuss in my article “Choosing the Right Diaper to Manage Bedwetting With Older Children and Teenagers.” That being said some parents might opt to use the pull-on type disposable products. Products such as “Goodnites” were introduced into the market several years ago due to their underwear like design. It was thought that these types of garments would be less stigmatizing for an older child or teenager to wear. There are reusable style pull-on garments as well which also look like regular underwear. Again this style of garment is supposed to be less embarrassing for an older child or teen to wear. If however the parents decide to try these products and find they are ineffective at protecting the youngster then the parents need to consider other forms of protection such as pin-on diapers covered with plastic pants or disposable tape-on diapers(known as disposable briefs)Or the parents can use both styles of diapers to handle the child or teenager's bedwetting. As I mention in my article on the different types and brands of diapers available to deal with this problem, some people use both styles of diapers to cope with their bedwetting. For instance there are people who wear pin-on diapers and plastic pants on some nights and disposable diapers with the tape fasteners on other nights. There are also people who wear both types of diapers to bed but find it uncomfortable wearing pin-on cloth diapers covered by plastic pants during the warmer seasons such as spring and summer and switch to disposable diapers with tape tabs during those times of year. As this example shows and as I've pointed out in other articles there is a lot of flexibility in how to deal with the bedwetting.

As far as pin-on cloth diapers are concerned,there are a number of characteristics of these diapers which make them particularly well suited for the management of heavy incontinence such as bedwetting. Some of these properties include absorbency and wicking. Cloth diapers have superior absorbency and wicking ability. Wicking refers to how well liquid is dispersed throughout the diaper. Since bedwetters generally lose a large volume of urine during the night and many wet multiple times throughout the night,the use of cloth diapers is an option that should be considered. The better a diaper is at wicking and absorbency the better it will be at protecting the person and bed. If the parents are concerned about the amount of laundry and the time involved in taking care of cloth diapers and plastic pants, the parents can use disposable briefs instead. There are a number of disposable briefs that are considered good for managing bedwetting. If the parents do decide to use cloth diapers and plastic pants but want to cut down the time involved in taking care of these items,the parents can alternate using disposable and cloth diapers as I've recommended in previous articles. I go into more detail about the wicking and absorbency qualities of cloth diapers in my article “Information Regarding Pin-On Diapers for Older Children and Teenagers With Bedwetting Problems.” This article also talks about the different types and brands of pin-on diapers. If you decide to use pin-on diapers you must cover the diapers with waterproof pants. Plastic pants(which many people refer to as rubber pants even though this is a misnomer) are the most widely used pants to put over cloth diapers. For a discussion of the different brands of plastic pants available for this problem see my article “Brands of Plastic Pants for Older Children and Teenagers With Bedwetting Problems” The brands mentioned in these articles are highly regarded by many people in the incontinence community particularly for managing heavy incontinence such as bedwetting.

One of the key things I have pointed out in my articles and a point I feel bears repeating is this-don't be concerned with the image of a product. Even though there is a lot of stigma attached to wearing diapers and despite the fact that they have a negative image it's better to focus on the following criteria when choosing absorbent products to manage the bedwetting: how comfortable the garments are and how effective they are at keeping both the person and bed dry. Unfortunately the stigma associated with diapers has prompted many manufacturers to focus on products which are more “underwear” like in appearance. Although there's no doubt these items work for some individuals(primarily those with lighter forms of incontinence), diapers appear to be the products most suited to deal with heavier forms of incontinence such as bedwetting. I believe this emphasis on the appearance and image of the incontinence garment hurts those individuals who might require diapers because they'll feel pressured to buy garments that might not be as effective at managing their particular form of incontinence. By wearing a garment that does not provide adequate protection a person will feel less comfortable,less secure,and as I mention in my article on bedwetting and hygiene,there is the potential for the person to develop skin problems. I talk more about the stigma surrounding older children,adolescents,and teenagers wearing diapers to manage their bedwetting and the different ways we as a society can overcome this stigma in the article “Reasons for the Stigma Surrounding Diaper Use With Older Bedwetters and Ways to Reduce this Stigma.”

Although the child or teen might be reluctant to wear diapers to bed and it might take them a while to make this adjustment,I think in the long run it's better for the youngster-after all it's unsanitary(not to mention uncomfortable) lying all night in wet bedding and clothing. My article “Bedwetting and Maintaining Appropriate Hygiene” discusses this issue in greater depth and talks about why I feel that diapers are an essential component in helping the bedwetter prevent any possible skin problems that may arise from the incontinence. If you feel that it would be best for the child or teenager to wear diapers at night but they resist wearing them, I encourage you to read my article “Ways Parents Can Encourage Older Children and Teenagers to Wear Diapers for Bedwetting.” This article offers several strategies a parent can use to encourage and motivate an older child or teenager who might feel embarrassed and ashamed about wearing nighttime diapers. Finally, I would tell the older child,adolescent,or teenager that is having difficulty coming to terms with wearing diapers to bed that there are plenty of adults who wet the bed and have to wear diapers at night their entire life.

1 comment:

  1. Bedwetting is the loss of bladder control during the night. The medical term for bedwetting is nocturnal enuresis or enuresis. Bedwetting can be an embarrassing issue, but in many cases, it is perfectly normal.