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.

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.

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.

It sounds like your daughter will be very motivated to do what it takes to get to dryness. You can give her the tools necessary to make the transition from sleeping through the wetting episode to alerting and getting up to go to the bathroom. It is so frustrating for the kids to sleep through and have no idea when the wetting is occurring. Moisture sensing bedwetting alarms provide a way for your daughter and you to be notified when the wetting occurs. Initially, she may have little urine left to empty in the toilet. Over time, her brain will begin to make the association that the sound of the alarm means to stop the flow of urine in the bed and walk to the bathroom to empty urine in the toilet. This will eventually enable her to wake up and get to the bathroom when the urge to urinate occurs.

I often use the small and comfortable Pink or Purple Malem Ultimate alarm or the Malem Wireless alarm for girls her age. She can look at and listen to the different alarms on-line and choose which she would be most likely to use. Once she begins using the alarm, she can get out of pull-ups and wear regular panties to bed. The Starter Kit, with the alarm, two mattress overlays (which help with middle of the night clean-up), and my book, Seven Steps to Nighttime Dryness, is your best buy.

Giving her some control over her wetting is sure to help with her feelings of frustration and eliminate her tears at bedtime.

I have used a moisture sensing alarm for children who need some help putting together the feeling that happens before wetting occurs with the actual wetting episode. No matter how often the parent or teacher checks their pull-up, they inevitably wet the minute they pull the pants back up. The type of alarm that I commonly use is the Malem recordable alarm, because the parent can record a message, such as “You need to go to the bathroom now”, which is triggered by the first sign of wetness. (This alarm also makes 8 different pre-recorded sounds that you can choose from). Initially, you can reward cooperation, that is going to the potty when the alarm sounds. Then you can begin using the reward for “beating the alarm”, going potty before the alarm is triggered. If your son isn’t frightened by sounds, you could also use a less expensive Malem auditory alarm, which just makes one loud sound at the onset of wetting. (You would have to role play what the sound means a few times so he could make that association). I recommend that he wear regular underwear when using the alarm. The small sensor is fastened to the outside of his underwear where you expect the first drops of moisture to appear.

Training of stool continence is often a separate experience, especially in boys. If you train him to sit when urinating, letting go of stool might be easier. Sitting long enough, playing a game or looking at books is important for bowel training. If you see him posturing before having a BM, encourage him to sit on the potty.

The newest features of the Rodger alarm include the ability to select one of 8 sounds and the ability to get an alarm with dual receivers, one for the child and one for the parent. This is a nice feature, especially for families who are worried that they will not be able to hear the alarm and assist their child during the night. The specialized briefs are machine washed and dried. Two briefs come with the alarm, additional ones can be purchased separately. Many of my older patients have had great success using this style of bedwetting alarm.