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Enuresis Causes FAQ

Tips, strategies and frequently asked questions when treating bed-wetting.

How long will treatment take?
Typically treatment is 6 to 8 weeks, but with treatment of any condition, there is a great deal of variability. If you are familiar with the normal distribution graph, this describes the treatment time parameter, i.e. some children will respond and be finished with treatment within a week, a larger group take 3–8 weeks, and a small group takes longer. While it is quite normal for some children to take longer, if you become concerned about the time, just contact us at cust.support@urocare.com.

Are there any things I should not do?
  1. Don't limit drinks - it will not help, and in fact it may make things worse. This is because the bed-wetter produces high amounts of urine because a hormone which is produced at night in adults and most children to cut down the production of urine when asleep, is not produced in large enough amounts in bedwetters. For this reason  their production of urine is too high. So the brain of the bedwetter tells the kidneys to produce just as much urine at night as it does during the day, and limiting drinks will not change the brain’s message to the kidneys.
  2. Don't expect that setting an alarm clock or waking your child at a regular time to empty the bladder will teach the child to wake—it doesn't.
  3. Don't blame your child or use punishment, as you can see it is not the child's fault. An anxious child will be less able to cooperate with you in the treatment.

Can drugs help?
Some of the earliest drugs used for treating bed-wetting were antidepressants. Specialist doctors agree that they should never be used to treat bed-wetting, because few children are cured from bed-wetting using these drugs, and they can cause rashes, irritability and carry a risk of poisoning.

An alternative drug stimulates a reduction in urine (a DDAVP) and can help for short term control, but most often bed-wetting starts again when the drug has stopped. However, used for two years or more at a maintenance level it is successful for some children. But these drugs also have side-effects, and in particular it is important to reduce water intake for the next 10 hours after taking this medication. Because the medication is reducing urine output, drinking after having the medication can result in a fluid build up and affect the fluid balance of the brain, and cause mental confusion, or even a convulsion (a fit). Doctors recommend that a child taking this kind of drug should be monitored by a doctor to make sure it is being used correctly. This means that allowing a child to take this medication while going to a school camp, for example, is potentially dangerous because there may not be close monitoring of the taking of fluids after the medication.
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Team-up against bed-wetting and help your child win!
For you to be a team, there has to be an alignment between you and your child. Maybe right now you are trying to use logic to get your child to agree to doing something about the problem of bed-wetting, but perhaps your child is in an emotional, negative mode and so there is no alignment between the logic that you are trying to use, and the emotional, maybe negative state your child is in. So when I say that you both need to be aligned, this means that you both need to be in a logical, fact based mode in which there is little or no emotion.

The way to get to the position of both being aligned is to have a very logical, unemotional conversation with your child about his or her bed-wetting. In particular ask whether it bothers him or her, and whether he or she would like to stop wetting the bed. If the answer is yes, then explain that you have to work on it together as a team, and the team is you, your child and the DRI Eclipse®. Explain that you all want the same thing, and that is for him or her to be able to wake up if he or she needs to go to the bathroom in the night.

Explain that the issue with bed-wetting is that he or she is too much asleep to wake up, and the only way to stop wetting the bed is to learn to wake up, but that you both know that he or she cannot do that alone (it's important that you also have agreement on that). So what you are asking your child for, is for him or her to agree to work as a team with you, and the DRI Eclipse®.

The next step is to summarize what you have both agreed on and to make sure that your child understands that you are going to work together as a team to beat the bed-wetting. The conversation you have just had with your child is an example of how good communication proceeds, and so it is important that you tell your child how grown up he or she has been in listening and understanding how you are going to beat the bed-wetting as a team. It may be necessary to have this conversation again if there are objections, but at all times stay unemotional and just stick to the facts as I have explained above.

Finally if your child says that he or she does not want to work as a team and will not use the DRI Eclipse®, then tell him or her that you will leave it until he or she is old enough and ready to work as a team. However, because he or she has decided to keep wetting the bed then he or she will have to look after it, i.e, to change the bed linen and put everything in the wash every day, and to make the bed up again (depending on the age of your child you may need to help). If it happens in the night he or she will have to do it then as well.

The point of this is that even a child must learn that decisions have consequences. Cooperation has the consequence of working as a team and being helped to solve things, not cooperating means the problem continues and you have to look after it yourself. That's a very important lesson of life.

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What happens when my child has started to wake to the alarm?
Over the next few weeks the child is learning to react more and more quickly to the alarm, and then begins to “beat the buzzer” by waking up before starting to pass urine. Now the child is beginning to respond to the sensation of the bladder filling, which is exactly where the treatment has been heading to.

The process is then to keep using the DRI Eclipse® every night until there have been 14 nights in a row with no triggering of the alarm, and no bed-wetting.

My child sleeps very deeply so how will DRI Excel® help?
All children who wet the bed sleep very deeply, but research indicates that all young children sleep more heavily than adults, because they spend more time in the deep sleep phases. Therefore there is no consistent evidence that children who wet the bed actually sleep more heavily than children who do not. Nonetheless parents will usually agree that their bedwetter sleeps more heavily that their other children. So we have designed the DRI Excel® alarm to be maximally alerting for heavy sleepers, firstly because of its loudness and position on the shoulder, and secondly because the frequency is particularly alerting.

An alarm clock does not wake my child and so how will the DRI Excel®?
There are several reasons why the DRI Eclipse® is more likely to wake your child.
  1. The alarm unit of the DRI Eclipse® is placed on a Velcro patch on the shoulder of the child, and so is much closer than an alarm clock, and therefore, while the alarm clock may appear to be quite loud, it is not as loud as the DRI Eclipse®.
  2. The DRI Eclipse® is triggered as the child starts to pass urine, and this is likely to be when the stage of sleep is closer to waking, and so there is a higher chance of the child waking to the sound.
  3. An alarm clock being set to go off at a particular time will have no relationship to the child experiencing the urge to urinate, and so not only is the alarm clock not as loud as the DRI Eclipse®, but it is going off without there being the important relationship between the sound and the urge to empty the bladder, and the child being in a lighter state of sleep.

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What if the alarm does not wake my child?
Surprisingly these are the children for whom the use of an alarm is very important. Take a look at what well-known pediatrician Dr. Green says. He explains that the children who initially do not wake to the alarm are very suitable for alarm treatment. With these children the strategy is that you hear the alarm, go into the room, put on the light, say your child’s name, and if no waking is happening, wipe your child's face with a cool damp cloth. Leave the alarm beeping. Then have your child get up (by themselves) and go to the bathroom with the alarm still sounding, and ONLY then should you unplug the alarm.

The reason for this is so that waking is happening with the alarm sounding, and a link between waking and the sound of the alarm can be formed in your child’s brain. It is very important that in the morning that your child remembers the alarm sounding and going to the bathroom, because only if your child remembers will learning happen effectively. However, for these children there is this extra step in the treatment program and so expect it to take longer.

Priming to help waking.
Another strategy to assist with waking is what I call a “priming” strategy. It is possible to “prime” your brain to remember to do something in the future, for example we can say to ourselves that we need to remember an appointment next Tuesday, and in fact as Tuesday approaches the thought about that meeting comes into our mind. People also use the same strategy when they need to wake early in the morning, they set the alarm clock for the early hour, but almost invariably will wake up before the alarm clock. What I suggest is that as your child is preparing for bed, that you have her or him lie down in bed just as he or she would when he or she is sleeping, have the alarm attached to the shoulder, and you trigger the alarm with a coin or something similar. Your child is to get up, after a few moments unplug the alarm, and go to the bathroom, pretending to use the bathroom as she or he would if he or she needed to pass urine. Practise doing this five times in order to assist (priming) your child's brain to be more ready to respond to the alarm when it sounds during the night.

But what if even that doesn’t work?
When there is still no progress (and I guess it’s no comfort to you that not many children are in this category), a part of the learning to wake to the alarm is practised during the day. Have the alarm box already attached to a favorite pijama top, or maybe a T-shirt that you have bought especially for this treatment (anything that makes the process special will help). Check the DRI Eclipse®. alarm is working correctly by plugging in the Urosensor™ and touching the Urosensor™ surface with a coin such as a dime to and noting that it beeps.
Before you follow this routine, make sure you know it well. Explain it to your child, and make sure your child understands that this practise is teaching the brain to be ready to wake to the buzzer, and, that with practise your child's brain will get fast enough to beat the buzzer. Then he or she will have dry beds.
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  1. From dinner time on, have your child drink extra liquids. This may sound strange, but we are wanting to get plenty of practise at the routine of responding to the alarm.
  2. Have your child tell you when he or she needs to go to the bathroom (you could call it having a “bladder signal” or any other term you like, as long as it is one that you have agreed on and you continue to use that term).
  3. Immediately go with your child to the bedroom, have him or her put on the pijama top with the alarm box attached, lie on the bed, and pretend to be sleeping. Plug in the Urosensor™ of the DRI Excel® (or switch on the DRI Eclipse® and you pick up the Urosensor™ and hold it.
  4. When he or she is relaxed, you make the alarm “beep” by touching the Urosensor™ sensing surface with a dime. Then your child is to get up and you both run right along to the bathroom, with the alarm still beeping.
  5. Have him or her unplug the Urosensor™ from the DRI Excel® alarm box (or switch off the DRI Eclipse®, just as would happen if this were during the night.
  6. When possible, another parent or sibling may also help, by going to the parents’ room and when the DRI Excel® alarm starts beeping, “race” the child into the bathroom. Children of this age tend to like this kind of competitive involvement. It also encourages the sense of urgency to react to the alarm beeping.
  7. Have your child splash his or her face vigorously five times in a row with cold water. Then pretend to use the toilet for a few seconds as if to urinate, and have your child say, “I have a bladder signal (or whatever is the term you have agreed on), but I can wait to urinate.”
Return to the bedroom and repeat steps 3 to 7 above four more times. If your child cannot hold off urinating, then let him or her urinate and then continue until you have practised steps 3 to 7 five times in total.
If after a week your child is still not waking to the DRI Excel® alarm at night, then increase the number of repetitions to 10 times per evening. For more difficult cases go to 20 repetitions in the 3rd week.
If even this is not successful (and that’s very rare) then leave it for a few months to allow more brain maturing and then start again.
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My child wets several times a night and so does that mean my child will always have to get up to go to the bathroom during the night?
The answer is no, and here is another aspect of bed-wetting that is not understood. As I mentioned before, children who suffer primary bed-wetting (never having been dry at night since coming out of diapers) produce too much urine during the night, as well as being unable to wake themselves. However, a consistent observation from my experience over 30 years, is that after being successfully treated with the DRI Eclipse®, within a month or two (and often more quickly) the child begins to sleep right through the night, and does not wet the bed, but also does not need to get up to go to the bathroom. This suggests that they are now moving into the more adult pattern of producing less urine while they are asleep and therefore most often not needing to get up during the night. However, this is a guess, and has not been researched at this stage.

Even after treatment, could my child relapse?
A few children may go back to bed-wetting after a few months, and in that case simply using the DRI Eclipse®. again will fix the problem. However there is also a method called over-learning which can be used to prevent relapsing and to strengthen the
When your child has had 14 consecutive dry nights with no wetting and so no alarm activation, start to have him or her drink an 8-10 oz glass of water around a half an hour before bed. What this will do is make it necessary for him or her to need to go to the bathroom two or three hours later, and either it will cause the alarm to be triggered, or he or she will wake up. Either way this brings about more learning to respond to the sensations of the bladder filling. Continue with this for 7 nights. Then stop the extra drinks (let your child drink what he or she wants to) but keep the DRI Excel® attached each night until he or she has achieved 14 dry nights.

My child has a problem with wetting during the day, can the DRI Excel® help?
Yes, parents have used the DRI Eclipse® and the DRI Excel® successfully during the day to teach the child to tune into their bladder signals. Even from using the alarms at night many parents notice an improvement during the day because their child has become more aware of daytime bladder signals.

My child has special needs, can the DRI Excel® help with toilet training?
Yes, both the DRI Eclipse® and the DRI Excel® have been used successfully for children with special needs to assist them to become toilet trained so that they can become mainstreamed at school.

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