Enuresis is the medical term for bedwetting and is defined as the involuntary passage of urine in the night by children older than 5 or 6 who should have developed nighttime dryness. About 90% of children have always had bedwetting, also know as primary enuresis. The other 10% have had at least 6 months of dryness, then resume wetting, which is known as secondary enuresis. We know that bedwetting is inherited and that the chance of a child bedwetting is 44% if one parent had bedwetting, up to 77% if both parents had bedwetting.

There is no single, simple cause for enuresis. Some factors that play a role in bedwetting are:
-Decreased arousal from sleep in response to a full bladder
-Small bladder capacity
-High nighttime urine production
-Constipation
-Other factors, such as evening fluid loading, medications, attention problems, urinary problems, sleep apnea

Since there no single cause, looking at multiple factors is important. Bedwetting alarms address the decreased arousal from sleep by helping your child to develop the ability to wake to a full bladder. Small bladder capacity may change as your child grows older but bladder “stretching” exercises do not seem to speed up this process. High nighttime urine production may be adjusted by drinking earlier in the day. The other factors listed above can be looked at by your health care provider if you have concerns for your child.

The biggest thing to remember is that your child is not wetting on purpose and primary enuresis is seldom due to emotional or psychological issues. Being supportive and offering a solution such as a bedwetting alarm when your child is ready is a good way for parents to help their child stop bedwetting.

When some people ask about a bed wetting mat, they are inquiring about a moisture sensing alarm mat that their child sleeps on. This type of bedwetting mat is plastic or vinyl with a moisture sensor that sounds an alarm when it gets wet. Your daughter probably doesn’t need this type of mat alarm yet. If she is still wetting in a year, using a moisture sensing alarm is a good way to help her achieve complete dryness.

Our most popular moisture alarms (bedwetting alarms) are the wearable models, such as the Malem Ultimate or Malem Wireless. The moisture sensor is attached to the outside of your son’s own underwear. The Rodger Wireless has specialized briefs that sense the moisture. We also carry a couple pad type alarms, although these are a little less sensitive to small amounts of moisture.

Moisture alarms work by sounding and/or vibrating to alert you that the wetting is occurring. The next step is to turn off the alarm and walk to the bathroom. Over time, the brain begins to make the association to stop the flow of urine and get out of bed to urinate. Eventually, your son will be alerted to the feeling of a full bladder and get up before the alarm sounds or hold his urine until morning.

This whole process is quite amazing and it can end bedwetting in a matter of weeks instead of years of waiting for him to “grow out of it”.

SJ writes, “My 9 year old needs help! I even offered to buy him a favorite Lego set if he didn’t wet for 7 nights. He stayed dry one night but has wet every night since then. I don’t know what other motivation he needs”.

Offering a reward for something your son has no control over can be counterproductive and very frustrating. I’m sure your son would love the new toys but he doesn’t know what steps he can take to get there. Even if he cooperates with limiting evening fluids and empties his bladder before going to bed, he does not have a method for getting up if he needs to in the nighttime.

Introducing a tool, such as a bedwetting alarm, to help him to make a change is very effective. Instead of sleeping through the wetting episode, now both your son and you will be alerted that wetting is occurring.

Initially, I recommend rewarding cooperation, something that he does have control over. By cooperation, I mean hooking up the alarm before bed, getting up as a response to the alarm (it is ok if mom and dad help him with this part) and double voiding before bed. Double voiding means urinating twice, about 20-30 minutes apart, before going to sleep-even though he doesn’t feel the need to urinate again. Your son can easily accomplish all of these things and earn a sticker or token as a reward for his cooperation. The important thing is that all of these things are necessary steps on the road to dryness and you’re helping to condition him to do these things. Dry nights will follow. Initially, he does not have control over whether or not that night will be a dry one. Once he does begin to have dry nights, if you want to add two stickers or tokens for dry, that’s fine. If a certain number of tokens equals a new toy, he does have the ability to earn that just by cooperating and trying to do his best.

You’re not alone with this situation. Other parents also report that they sleep soundly, with their door closed or a distance from their child. We’re happy to have a NEW solution. The Malem Wireless Alarm System is now available with two receivers, one for your son’s room and one for your room.

Once the sensor, which is fastened to his underwear, detects moisture, it transmits wirelessly to both receivers (up to 50 feet). Both are programmed to receive the same frequency. You can turn your receiver off while getting out of bed to make sure your son is waking up and walking to the bathroom. It is important that one of the receivers be in your son’s room. He has to begin to make the association that the sound happens when his bladder is full and he needs to get up to use the bathroom. This is sometimes a subconscious response. Once he no longer needs your help, you can stop turning the second receiver on. It’s important to turn the receivers off when you’re not using them to preserve the battery life.

The Rodger wireless alarm can also be ordered with two receivers, one for the child’s room and one for the parent’s room. This alarm comes with two pair of specialized briefs, with built in moisture sensors. The two receivers use the same frequency so both sound at the same time and can transmit up to 50 feet. When the wetness is detected on the special underwear, both the parent and child are alerted.

Other solutions are to use a baby monitor in your child’s room or to temporarily have your son sleep closer to your room. As you begin to see his response to his bedwetting alarm, you can decide when to move him back to his own room.

This is a common question this time of year. I am re-posting some suggestions that I wrote last year about this time. Parents wonder what to do??

First, if your child is currently using an alarm, we would not expect him or her to take it to camp with them. They can interrupt usage and restart when they come home.

Secondly, a back up plan should be in place, even for kids who wet intermittently. There are a few choices:

• Wear disposable pants, with a plan for putting them on discreetly and disposal in the morning. Disposables come in all sizes, even small through extra large adult sizes. If your child has outgrown traditional children’s pull-ups, there are still many options. Disposable male guards or women’s incontinence pads can be secured to regular underwear to catch a small amount of urine. Disposable underpads that lie on a sheet or in a sleeping bag have tape strips to hold them in place.

• Use washable bedtime pants to preserve dignity. These can be a nice back-up for kids who are dry most nights but want to make sure there is no leakage onto bedding.

• Waterproof sleeping bag liners fit into a regular sleeping bag. They provide a comfortable, waterproof surface for sleeping without raising questions from other campers.

• Mattress overlays can be used on top of a sheet or used inside a sleeping bag. The overlays can be discreetly pulled into place when your child is ready to go to sleep. The new blue cloud overlays are colorful and look like a regular piece of bedding.

• Make arrangements with the camp counselor to have toileting twice before bedtime and to continue a lifting routine if this is used successfully at home. (Lifting is when a caregiver walks the child to the bathroom at a designated time.)

• Medication, such as desmopressin, can be used temporarily to decrease the amount of urine produced that night. The correct dosage should be determined a week or two before camp begins. Only a small amount of liquid (2-4 ounces) should be ingested once this medication is used. It is best dosed shortly before actually going to sleep.

Lastly, make sure that your child knows that they are not alone and most camps are very helpful in discreetly handling any wetting episodes. Fluid of choice after dinner is water. Double voiding before going to sleep is helpful. Staying well hydrated during the day is helpful so the kids are not so thirsty later in the day.

Taking calls from the listening audience was interesting because you didn’t know what question would come in next. Although many of the questions centered on toilet training, one concerned parent of an 8 year old daughter with nightly wetting called in. To listen to the broadcast, simply click here.

I highly recommend listening to 98.1 KISS-FM, in the San Francisco Bay Area on Sundays from 7-8 am or you can listen to any of the past shows by going to the website, http://www.childhoodmatters.org/index.html.

What you are describing is perfectly normal in the beginning. In the first night or two, the alarm is new and your son may not have been sleeping as soundly. It’s quite common for the kids to sleep through the alarm and have no memory of what happened when morning comes. You should go to his room when you hear the alarm sound and make sure he is turning it off, then walking to the bathroom, even though it looks like all the urine has been wet out in the bed. If you can’t hear the alarm from your room, put a baby monitor in his room. After a couple of weeks of consistently doing the right response, his brain and bladder begin to make that association and work more independently. Making it more difficult to turn off in his sleep, by doubling up on the underwear or the shirts is also a good strategy for right now.

Secondly, the alarms are all designed to be used to detect a small amount of wetness from cloth. Most of you know how quickly disposable pants wick moisture away from the skin. Alarms sense the moisture more quickly and your daughter will become more aware of the feeling of wetting if disposables are not used in conjunction with the alarm.

In special situations, such as lack of laundry facilities or working with a special needs child, using a disposable pull-up with the alarm may be the only option. The Malem alarm company does make a Standard Sensor that can sense moisture from a disposable product. A small slit is cut in the pull-up and the flat sensor is slid into the pull-up at the spot where you expect the first drop of moisture. This sensor can be purchased as an accessory with any of the Malem alarms. Another option is to use a pull-up over the Rodger underwear that come with the Rodger wireless alarm. The pull-up should not cover the transmitter that is attached on the waistband. The underwear would still need to be laundered once it becomes wet.