Tuesday, December 23, 2008

Bedwetting:When Cures Can Be Worse Than the Disease

Bedwetting for many youngsters can be extremely traumatic-there is the potential for teasing from siblings and other family members,punishment from parents,and the possibility of their peers discovering it especially if the youngster wants to attend sleepovers.

Although many cases of bed-wetting can be cured using medicines,alarms,and other methods there are cases of enuresis persisting into adult years. In fact many adults suffer from this problem their whole lives. The statistics vary but anywhere from 2 to 3% of adults wet the bed. Due to the negative image associated with enuresis we should consider the possibility that these figures might be significantly higher. Just as some rape victims are reluctant to report their rape because they feel ashamed,many adult bed wetters could be reluctant to see a doctor because of the shame they are experiencing. The reason for this shame is the perception shared by a large number of people of bed-wetting as a child's disease. The adult bed wetter realizes the negative public perception of this disorder and as a result, many adults don't seek treatment and resign themselves to wearing diapers at night.

Bed-wetting it seems carries more of a stigma than other forms of incontinence. Why this is so is puzzling to me. While younger children are not immune from feeling embarrassed about this condition it seems that the older one gets the more embarrassed one feels.

Due to the stigma associated with nocturnal enuresis there is tremendous pressure with most people to cure it,and while I believe that a person should consider different methods to cure their bed-wetting and be open to trying new treatments when they become available, there are a number of factors that should be kept in mind. First of all,it can sometimes be more distressing and embarrassing going to countless doctors and specialists and having endless tests and procedures done without success. Second, there are many instances of people trying a wide variety of treatments to cure their bed-wetting without success and unfortunately there may always be circumstances in which the bed-wetting can't be resolved for whatever reason.

Third,some people might not be happy with the options available to treat their bed-wetting and prefer to wear diapers instead-as hard as it is for most people to believe there are people that prefer to use diapers to manage their bed-wetting! The reason for this is that in some cases the cure can be worse than the disease and bed-wetting and the various techniques used to cure it is no exception. For example,I have heard and read that bed-wetting alarms can disrupt a child's sleep patterns and as a result the child has difficulty both staying awake and being able to focus in class. This was discussed briefly on an incontinence forum. While I don't know if there's any validity to these claims and I am not aware of any studies corroborating this, the possibility that this might occur with some individuals should be considered. I think the prudent thing to do is to discuss the likelihood of this happening with a physician if parents are considering using this approach to treat their youngster's bed-wetting. If the parents choose to use a bed-wetting alarm they should monitor the youngster's sleep patterns and if the youngster reports any difficulties then the parents should discuss these problems with the physician. If it looks like these symptoms might be a result of using the alarm and if these problems persist or get worse over time, they should consider discontinuing use of the alarm. If enuresis alarms do disrupt a youngster's sleep patterns it could be that occurrences of this sort are not prevalent. In addition this disruption might only be temporary.

Another thing that should be kept in mind as far as bed-wetting alarms are concerned is that some children and teenagers are very deep sleepers and sleep right through the alarm. In fact I've heard of cases where the alarm wakes up everybody else in the house except the bed wetter. That's another reason why alarms might not be a viable option in some cases-it might wake up the other members of the household and they might not be able to get back to sleep.

Furthermore,sometimes the alarms create false positives-i.e. false alarms. This can occur if the child or teen sweats a lot at night. Also some children are frightened or embarrassed by the alarm. The reason the alarm might embarrass the child is that as mentioned it might wake up other members of the household and as a result it draws attention to the fact that the child or teenager had an accident,therefore it's difficult for the youngster to be discreet about the bed-wetting. Finally,in some situations the alarms don't work for some people for whatever reason. Treatment with bed-wetting alarms can take a long time and there are cases where the children relapse and they need several attempts with the alarm to cure the enuresis. That is why this method requires the child to be highly motivated. Children without the necessary motivation might resist this type of treatment. It was reported in the summer 2006 issue of Urology Journal that some people experienced extreme discomfort during their course of alarm therapy for bed-wetting: "It has been shown that adults that use the alarm(even those who are cured) recall the treatment period as the worst time of their life." The article also has this to say regarding alarm therapy for nocturnal enuresis: "Unfortunately treatment with bed-wetting alarms has a dropout rate of 10% to 30%. To achieve optimal results,alarm therapy requires a motivated patient and family and significant commitment of effort and time. These considerations make alarm therapy a less favorable choice in enuretic adolescents and adults. Studies have shown that most enuretic adults prefer not to use alarm therapy or discontinue it very soon." Despite this it's been shown that alarms have a high success rate with those individuals who have the motivation to stick with the treatment. In an article on the Dr. Spock website written by Dr. Robert Needlman it reported that 70% of children who are treated with the alarm become dry in a month or two. The Urology Journal article previously mentioned reports a success rate of more than 50%. It would seem that the prudent thing to do would be for the parents try the alarm out for short period of time with their bed-wetting child or teen. If he or she doesn't seem motivated to stick with the regimen,it might be advisable to try the alarm at a later date. If the youngster is still resistant about using the alarm I wouldn't push the issue. As the Urology Journal article said there are cases where the people who used the alarm found it to be very stressful and their could be psychological reasons for the youngster being reluctant to use the alarm. If this is the case and other treatment options have not been successful it would be wise to have the youngster wear diapers to bed.

Medicines are another method used to treat bed-wetting but these can have unpleasant side effects with some people and there are also instances of people who in general don't like taking medicines whether due to the side effects,their fear of long term effects on the body,or both. I was also reading that there have been cases of children dying from using some medicines for bed-wetting. For example there was an article published on December 4,2007 which discussed an FDA warning about the drug DDAVP. The article mentioned that 61 seizures were reported and of these 36 were connected with the intranasal form of the drug. In addition there was a report of 2 people dying from the drug. There have also been cases of children dying from the drug Tofranil or Imipramine. It should be mentioned that these cases appear to be rare but nevertheless it's important for parents to be informed about all potential risks involved with using medicines to treat their child's bed-wetting. Another thing to keep in mind concerning using medicines to treat bed-wetting is this-if the person is taking another medicine or medicines for another condition(or conditions)this combination can have unpleasant and in some cases serious side effects. This is another reason why medicines are not a viable option to treat some cases of bed-wetting. Surgery is another option to treat some cases of bed-wetting but again this can be an unpleasant choice for many people. There are instances where the person's quality of life can decline due to various complications that can arise as a result of the procedure. Before undertaking any surgical procedure it's important to be well informed. Some of the things that a person should inquire about are the following:what the risks are for this particular type of surgery,what complications can occur after the surgery and whether or not these are permanent or temporary, what the procedure entails,and if there are any other ways to treat the condition. It's also good to get a second opinion.

There's an old saying- "if all you have is a hammer,every problem looks like a nail" The people who sell bed-wetting alarms are naturally going to view their method as the best way to treat bed-wetting, the pharmaceutical company marketing a particular drug for bed-wetting is going to be biased about their method of treating bed-wetting, etc. It's important to realize this when evaluating various treatment options. It's crucial that people understand that I'm not dissuading them from trying any of these methods to try to cure their bed-wetting. I'm a firm believer that people should keep an open mind in terms of evaluating various treatments for any illness they might have. I'm also not suggesting that any of these choices are bad or don't work for people. The fact is that they are successful with many cases of bed-wetting, but it's vital to keep in mind that with some people they don't work for whatever reason-everybody is different.

The main point of this article(and I can't stress this enough) is to help people be cognizant of the fact that if they're given a choice between several options to treat their bed-wetting they need to evaluate the pros and cons of each in a calm,objective way and not feel pressured to find a cure just because they feel embarrassed and/or pressured by what others think. It's important to recognize that all of these methods have their advantages and disadvantages and with some people the disadvantages might far outweigh the advantages. The same is true with most medical decisions in addition to other choices we make in life. A person has to weigh all these options and then ask themselves what are the best choices given their particular circumstances. For instance if it comes down to two options to deal with the bed-wetting-say wearing diapers or taking medicine and the medicine causes unpleasant side effects then the user has to ask him or herself the following question-which is worse wearing diapers to bed or taking the medicine? Personally I would think taking the medicine is worse but everyone is different. Or what if the only option to treat the bed-wetting was surgery but the risks and/or complications from the surgery were unacceptable to the person or what if the expense of the surgery was too great? Or perhaps all three?

There are times in life when we have multiple options to choose from but unfortunately there are also situations in which our range of choices are narrowed to a couple of options and sometimes neither alternative is pleasant. In a case such as this we must choose the lesser of two evils. In the examples mentioned above the lesser of two evils would be wearing diapers to bed. If this was any other medical problem the person's decision to not take the medicine or undergo surgery would be respected but with incontinence(particularly bed-wetting) we have a double standard. With any medical problem we must choose the most appropriate tools and equipment to manage it and since everybody has different needs they'll require different tools for their particular situation and circumstances. An example that comes to mind are mental health disorders. Although people might have similar symptoms,the symptoms might manifest themselves in different ways therefore people experience these diseases differently. This means they might need different medicines or treatments. The same is true for problems like bed-wetting. People might wet more at night than others and require a product with more absorbency,they might have problems with side leakage due to the fact that they tend to sleep on their side and require products that are more effective at dealing with that issue,they might prefer cloth diapers due to the fact that they're more cost effective than disposables and and also because they're presumably better for the environment,etc. With this in mind people must wear products that best suit their needs and be less concerned about whether or not the products have a good "image"(which is a euphemism for being less "babyish.")

One of the key issues that seems to be forgotten when discussing bed-wetting is quality of life. While bed-wetting is unpleasant it is not as bad as having daytime incontinence since it is much easier to be discreet about it and in terms of medical issues there are many disorders and medical issues that are far worse to live with-multiple sclerosis,chronic pain,cerebral palsy,diabetes,cancer,schizophrenia,etc. That's not to say that life is peaches and cream for the bed wetter but it's good to be able to put things in perspective. Although most bed wetters want to seek a cure for their enuresis(due I suspect primarily because of the stigma associated with it and as a result of that stigma societal pressure) there are a significant number of them who have tried multiple cures without success and while some of this group might be depressed about it there are also a number of them who take a more stoic approach to the situation. With these people they feel that their quality of life is not that significantly effected by the bed-wetting and don't have any problem putting on a diaper before going to bed. This could be because they have friends,relatives,or a spouse who are supportive of them and aren't concerned about the bed-wetting and diapers,because they have a strong self-image,or they have both a strong self-image and supportive friends and family,etc. The people who have tried different methods of curing their bed-wetting without success and who feel that their quality of life is not significantly diminished should not be pressured to find a cure if they can live with it and should not be stigmatized for using diapers to manage the bed-wetting.

Why people are stigmatized for wearing diapers for bed-wetting is a mystery to me. Just about every other medical aid is accepted by people-canes,glasses,hearing aids,wheelchairs and walkers,pacemakers,insulin for diabetics,inhalers for asthma,etc. Everything except night diapers. For example people don't say to a person using a hearing aid or a cane- " you should feel ashamed of yourself-you need to find a cure!" or they don't say to a person with asthma "don't you feel embarrassed using that inhaler?" People are more pressured to cure incontinence(especially bed-wetting) than any other disease.

Individuals are different in their ability and propensity to tolerate different things in life-one man's backache is another man's headache. Some people feel real upset about their bed-wetting whereas others are not that concerned about it. Some people might find it puzzling that a person can take a relaxed view of a problem such as this-after all most people believe that only babies or small children wet the bed. But it's important that we face life's challenges with grace and dignity and in the overall scheme of things the fact that a person has to wear diapers to bed is not that bad.

Finally with some individuals it is difficult to ascertain the cause or causes of the bed-wetting. We must not forget that while medical science has made tremendous strides in dealing with different diseases there are times when even the professionals are stumped and cannot provide answers or cures with some individuals. In situations such as this we must use whatever means necessary to manage the problem in order to live a fuller and richer life. Diapers enable many bed wetters to do this. As mentioned there are people who wet the bed their whole lives and many of these people sleep in diapers their whole lives. If this is the case a person shouldn't feel discouraged or depressed. It's okay to be a bed wetter and it's okay to wear diapers to bed no matter how old you are! It's been pointed out that people who use diapers to deal with their bed-wetting might get complacent about finding a cure,that they'll become dependent on the diapers and they'll become a security blanket for the person. I've written an article about this issue called "Will Wearing Diapers to Bed Decrease the Motivation to Achieve Dryness?" I encourage people to read this article because it talks about the reasons why I feel this won't be the case. Due to the stigma surrounding using these items,I believe the likelihood of this happening is small.

With certain children it might be advisable to wait for the child to outgrow the problem unless it is causing the youngster a considerable amount of distress. As Donna Clark says in her article "Gentle Remedies for Bed-Wetting: "Indeed just as some children walk sooner than others,some stay dry at night sooner than others. We need to appreciate our child's natural growth pattern even when it inconveniences us. And if we begin wondering what is wrong,the answer may well be: nothing at all." and "For the older child,bed-wetting need not pose a problem. Some older children with enuresis sleep in diapers which keeps them comfortable and cleanup minimal." If parents have exhausted all avenues at resolving the issue it might just be that the child's bladder is not mature enough. There are a number of components of bladder maturity. The pediatrician Dr. William Sears has this to say about this issue: "Delay in bladder control can occur if there is a delay in awareness of bladder fullness, a small bladder, or the bladder-emptying reflex continues to be strong well into latter childhood. These components of bladder maturity occur at different ages in different children. Bedwetting is simply a developmental lag in the mastering of a bodily skill. There are late walkers,late talkers,and late dry-nighters." As I have pointed out in my article "Will Wearing Diapers for Bed-Wetting Decrease the Motivation to Achieve Dryness?" there are some people who don't believe in waiting for the child to outgrow the problem. It seems like the majority of people feel this way. I think there are two reasons for this. The first reason is that bed-wetting effects the child's self-esteem(which in my opinion is due primarily to the stigma attached to this disorder) and two there are many people who feel that the parents are sending a message to the child that "it's okay to wet the bed" or "they're giving them permission to wet the bed." Personally, I think we make too big a deal of this issue. Bed-wetting is not inherently shameful, just like it's not inherently shameful having diabetes, multiple sclerosis,heart disease,or any other illness. I believe that we're the ones who make it shameful and as a result of this we jump through hoops attempting to cure it. While bed-wetting is unpleasant for the person experiencing it and it can be an inconvenience to deal with,the person who does have this problem should not be made to feel ashamed or embarrassed about it or feel pressured to cure it. It's natural to feel distressed when something goes wrong with our bodies. For example no one wants to have high cholesterol,asthma,depression,or any other ailment,but we shouldn't feel bad about ourselves for having these problems. In cases such as these we take the appropriate measures to manage the problems and get on with our lives. The same approach should be taken with a problem such as bed-wetting.

There are many online support groups in which you can talk to individuals dealing with the same problems. In addition many psychologists,counselors,and other mental health professionals deal with this issue and can provide therapy for the individual having difficulty coming to terms with wearing diapers to bed. If the parents decide to go this route they should talk to child or teen beforehand and ask them if they would prefer to talk to a male or female therapist. They should also tell the child the reasons for going to therapy and how you feel it will help the child. The parents should talk to the therapist before the session and discuss the goals they have. They should let the therapist know that they've tried many different methods to cure the bed-wetting to no avail and tell him or her that they prefer to use diapers to manage the bed-wetting but the child or teen is having difficulty adjusting to wearing the diapers to bed. The parents should ask the therapist if it would be a good idea for them to meet with the therapist and if he or she wants to meet with both them and the child at some future point.

People have different personalities and temperaments which play a big part in how they cope with life's challenges. This includes the time it takes to adjust to various hardships whether grieving over the loss of a loved one, the end of a relationship,or adjusting to the effects of a serious illness. Over time we acquire various strategies and coping mechanisms which help us get through these difficult times. Life experience gives us the strength,knowledge,and wisdom to more effectively deal with the vicissitudes of life. Friends,family,and relatives are another source of comfort when times are tough. A person needs to keep this in mind when they feel discouraged about their bed-wetting and the fact that they have to wear diapers to bed. It's important that the person suffering from incontinence have a strong support system whether friends,family,or relatives. Having a person to confide in makes living with the incontinence a lot easier.

If the methods you've tried to cure the bed-wetting have been unsuccessful and you decide to use diapers to manage the child or teen's bed-wetting, then I encourage you to read my articles "Choosing the Right Diaper to Manage Bed-Wetting with Older Children and Teenagers" and "Ways to Encourage Older Children and Teenagers to Wear Diapers for Bed-Wetting."

It can be very frustrating living with this problem but it doesn't have to be. There are people out there who are real compassionate,intelligent,and sensitive .If it turns out that the current methods available to treat the bed-wetting are not viable and you have to wear nighttime protection, remember-you're not alone.

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.