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Bed-wetting

I have been working with a 14 year old youth for over a year now. He has many presenting problems but one of the issues we are trying to help him get control over is bed wetting. This youth wets the bed on a nightly basis. We have tried various medications to combat this as well as limiting water intake past 8:00 p.m. at night and waking him up at night to go to the washroom. The youth is generally responsible for his actions and does his own sheets on a daily basis however often gets into conflict because he cannot keep up with the amount of sheets he has to wash and other residents get on his case because they have only one day a week to wash and this resident often takes over their slot in the washer.

If anyone has any experience with strategies to deal with enuresis please drop me a line.

One interesting fact in this is the resident does not have a bed wetting problem when he is on home visits away from the treatment centre.

Thanks
Neil Hosler
...

Replying to Neil's query ...
If at times this youth does not have a bedwetting problem, then one could assume that this is not a medical problem particularly because there is consistency. Enuresis is often a symptom of an emotional problem which needs to be addressed. The less attention he receives about the bedwetting, the better. Do the other youths need to know? Can you not purchase extra sheets, or have a staff member help out during the day so that this is done as discreetly as possible. This youth does not need the embarrassment nor the guilt associated with inconveniencing others. This is such a difficult problem to deal with, but what needs to be paramount is this youth's sense of self, and reduced anxiety. I had a much younger student (gr. 2) who was put back into the "Goodnights" (a pull up diaper replacement for older children) to wear while at school. Within a month, she was out of the pull-ups and not having any more accidents. This was a daytime problem and was addressed successfully rather quickly. The reduced anxiety was the key. Good luck

Angela Dougherty 
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Dear Neil,

It could be that the client that you work with is suffering from some anxiety issues about being away from home. If this is the case my suggestion to you is to try to let the youth decorate his room or his area with some things from home such as pictures of friends and family or things from his own bedroom at home. Also maybe allowing this youth to bring some bedding (sheets, pillows, blankets, etc.) from his own bed at home. Other than that, has he been looked at by a doctor for possibly having some bladder problems other than control.

There are also several great clinics and doctors, mostly in the states, that specialize in dealing with enuresis. Oh, and one other thing to suggest is perhaps using some Narrative Therapy techniques. Check out one of Michael White's books, he specializes in Narrative Therapy. Good luck.

Sharon Vanderveen 
...
Neil,

I do not have a lot of experience with bedwetting, however I took a course in regulations in human behavior and learned the following... "a pad on the child's / youth's bed is used (a simple device) that whenever the first bit of moisture is sensed a buzzer goes off and rings until the child / youth shuts it off. It is an older study I believe conducted by Hobart / Molly Mowrer ... not sure what year. Supposedly the child / youth is cured of bedwetting in a couple of days. However where you would get one of these pads I have no idea? Also if it is only occurring at the treatment center maybe it is something more than mere bedwetting? The above does work ... and could be a solution if you can get a pad. At least it would help in stopping bedwetting at the treatment facility and so that he would not have so much laundry. It's maybe something to look into. That is the only help I can offer. Good luck!

Laura-Lee Jordan 
...

Hello Neil,

 I know this is a difficult challenge for the adults in the setting, but it is a huge challenge for the youth involved. I have worked with older adolescents who struggle with enuresis and self esteem is a real issue. No one wants to wet the bed, whatever their age! I am wondering if staff have had discussion with the youth on how he is managing with this enuresis. It sounds in your email as if there is open discussion. What is his comfort level in talking about the enuresis, is there a staff person he has greater comfort with... We talk with the youth involved in an effort to develop a support plan. Has the youth seen a urologist? This would rule out a medical reason for the enuresis. This referral is our first step in the process. We have then approached the young person and offered to wash the sheets, discreetly, in the a.m., this avoids involving the other residents in the process. If the youth can get them in the wash himself, great, if not the staff have checked the room and put them in the laundry. This takes a lot of pressure off the youth. I know our youth have always felt anxious that their peers not be aware of the bed wetting. We have had youth who have wanted to use "Depends" and others who chose not too. There are also sheet protectors available to place over the bedding. The protectors don't slither during the night, so we have had success with them. They are available through home health care departments at Sears and Shoppers. One particular youth went from wetting nightly to staying dry on a regular basis, it was a matter of reducing the anxiety level associated with the enuresis.

Good luck to all involved.
Lorna Findlay 
...
Neil,

 If he's got this problem in one place and not others, then it will be important to explore why the treatment centre is a discriminative stimulus for bed wetting.

Make sure his bedroom isn't being used for anything other than sleeping (i.e. make sure he isn't being sent to his room as a punishment).

You could try moving him to another room to see if there is something about the particular room he is in.

Is he having an allergic reaction to anything?

Is he too anxious to use the bathroom at the treatment centre so that he is holding onto his urine and only relaxes enough when sleeping to actually pee? I.e. Is any bullying going on in the bathrooms?

Another question to look at is whether there is any possibility at all that other youth are contributing to this individual's bed wetting problem by setting him up? I have had two different clients who report that they were bullied in residential settings by others deliberately peeing on their beds to get them in trouble.

Another question to look at is whether he is purposely peeing on his bed as a protest against something happening at the treatment centre. When I worked at a residential centre, one of the young boys who was considered to have a wetting problem was found standing and peeing on his bed when he was angry about being sent to his room.

Just a few thoughts off the top of my head.
Linda Hill 
...

Something is happening to him at the centre.
Anne Ruck 
...
Working in an open residential treatment center where youth sleep in a dorm like setting makes it very unlikely that the bedwetting can be kept a secret. Further I am not convinced that keeping this a secret is the best approach. What the other residents see is a youth getting special privileges without explanation.

 We attempt to have the youth which is wetting develop the self hygiene skills to take care of his situation. When addressed with discretion and openness the other youth are usually very accepting and helpful and see the staff as caring and nurturing. Kids who live in a residential setting have very few secrets and where there are secrets they make something up to fit in the void of non-communication. If it an adjustment or settling from being away from home it should get better with time. we have 24 hr supervision including a night staff in the dorm. Again it may take time for the youth to get used to this life style change.

If this has been a pattern which the youth had even prior to coming to the treatment center and all physical possible complications have been eliminated then a very close examination of the wetting may be examined. Are there particular days when this occurs, times, precursor events or whatever. I am of the position that a youth may be able to gain control of life without necessarily having to deal with all the events that have resulted in emotional scars before they can do so.

I would agree that special attention or punitive measures should not be used in addressing enuresis but the youth can still be empowered to take care of him/herself. We work with youth 12 to 17 so working with smaller kids may require a different approach. An interesting story: Some years ago we had a 14 year old who had enuresis 3 or 4 nights a week. When we discussed this with his mother she said he never wet the bed at home. When asked how she could be so sure she responded that he still sleeps with her and if he wet the bed she would know. Say no more! 

Larry James

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