There are many issues in psychology that both interest and puzzle me but there is one in particular that I am especially curious about and interested in-people’s attitudes toward various management techniques for nocturnal enuresis (the clinical term for bed-wetting) particularly in older children, adolescents, teenagers, and adults. Although this is not a psychological issue per se; how people react to, interact with, and perceive individuals using protective garments to manage their bed-wetting has psychological ramifications for these individuals. Depending on how other people respond to the incontinent individual the ramifications can be either positive or negative. I have read a fair amount about this subject and this article is a distillation of this knowledge.
This article discusses my thoughts and feelings on the stigma associated with the use of diapers to manage bed-wetting, a brief discussion about the different types of diapers to manage bed-wetting, how to deal with the possibility of teasing from siblings, various ways to deal with the stigma associated with using diapers for bed-wetting, psychological techniques a person can use to help him or her come to terms with using diapers to manage bed-wetting, ways to be discreet about diaper use and bed-wetting, and ideas I have for a reward system designed to encourage a reluctant youngster to wear diapers to bed in order to more effectively manage his or her bed-wetting. This article is long but I feel it covers a lot of useful information for both bed-wetters and their parents. The article is broken down into several sections for easier reading. The introduction discusses various treatments for bed-wetting and why in some cases they can be worse than the disease, the second part is called “Types and Brands of Diapers to Use” and is an overview of the various diapers available to manage bed-wetting in older children, adolescents, teenagers, and adults. This section also lists various companies that sell these diapers and their contact info.
The third part is called “Reasons for the Stigma Surrounding Diaper Use in Older Bed-Wetters” This section discusses what I feel are the reasons behind the stigma associated with using diapers in older children, adolescents, teenagers, and adults that wet the bed and ways society can reduce the stigma, the fourth part is called “Will Wearing Diapers Decrease the Motivation to Achieve Dryness?” There is a theory that wearing diapers for bed-wetting will decrease the incentive to achieve dryness. This section discusses why I feel this won’t be the case. The fifth part is called “Thoughts on the Development of Our Ideas Regarding This Issue.” The sixth part of this article is called “How to Encourage Older Children, Adolescents, and Teenagers to Wear Diapers to Bed and Other Issues.” This part offers several strategies and methods a parent can use to motivate and encourage a youngster who is reluctant to wear diapers to bed. In addition the section talks about issues of discretion and psychological techniques a youngster can employ to help them cope with wearing diapers to bed. Finally there is part 7. This part is called “Should Parents Require Their Older Child, Adolescent, or Teenager to Wear Diapers to Bed?” This section discusses why I feel parents should require their bed-wetting youngster to wear diapers to bed. It also talks more about how to approach them about this topic and how to encourage them to wear diapers to bed.
Introduction-When Cures Can Be Worse Than the Disease
Bed-wetting 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 bed-wetting persisting into adult years. In fact many adults suffer from bed-wetting 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 disorder. The adult bed wetter realizes the negative public perception of bed-wetting 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. While I am not aware of any studies corroborating this, the possibility that this might occur with some individuals should be considered. 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.
In addition 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. Finally 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.
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. Surgery is also another option to treat some cases of bed-wetting but again this can be an unpleasant choice for most people.
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 methods. I’m not suggesting that any of these methods are bad or don’t work for people. The fact is that they are successful with many cases of bed-wetting, but it’s important to keep in mind that with some people they don’t work for whatever reason-everybody is different.
The main point of this section (and I can’t stress this enough) is to help people realize 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 realize 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 example 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?
Sometimes in life we have multiple options to choose from but unfortunately there are situations in which there are only two alternatives neither of which is pleasant. In cases such as this we must choose the lesser of two evils. In the cases 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 because they are more cost effective than disposables 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!” 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!
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.