I am a Child and Youth Care student currently doing my practicum at a residential treatment facility. I recently came across a problem with one of the youth in my program, he is a 17 year old male and regularly wets the bed. We have made it apparent that it is his job to change and wash the sheets when this occurs no matter what time of night it is, we have ensure he stops drinking any form of liquids before bed and have even started doing calming relaxation activities with him before bed. Though it seems like nothing is really helping the problem. It occurs on average 4 nights a week and has no indication of slowing down. I was wondering if anyone has any suggestions as to other strategies of techniques I could have tried, as I imagine this is not the first nor the last time a problem like this has/will occur.
Has he seen a physician to rule out any physical issue?
Has your team thought about the causes behind the wetting? The causes can be a whole range of things including heavy sleeping or a small bladder as well as high stress or anxiety. If it's a physical cause perhaps trying an alarm to wake up and try the washroom at intervals might be worth a try.
Either way focusing on the front end of the problem
(e.g. practical supports, identifying the cause) may be more productive
than focusing on the back end of the problem (e.g. consequences of
cleaning up). I would encourage cleaning up and washing with him as a
way to show support, strengthen the relationship, and reduce anxiety.
Good question and stick with this kid – sounds like he can really use your support.
I'm also a Child and Youth Care student, but as this was not mentioned in your question, I feel it is worth putting out there – has this youth been to speak to a doctor about his bed-wetting? Though bedwetting can be a psychological reaction to trauma or a stress reaction, it can also have medical causes that are not related to these reactions. From what I recall from looking into this issue during my previous job (at an overnight homeless youth shelter), there are multiple possible medical causes; for example, the absence of the antidiuretic hormone present in non-bedwetters, overactive kidneys, or as a symptom of new-onset diabetes. There are other possible medical causes as well, and though life-long bedwetting is unusual, some studies have found that somewhere from 0.5% to about 2% of adults wet the bed, if I'm remembering the percentages correctly.
If medical causes have not been considered, I think they might be worth looking at in this situation. I no longer have access to the resources I was using at my previous job (it was a few months ago), so I regret that I can't supply more specific information/citations.
What we have done for a client is wake them up within half hour of falling asleep, then two more times and now we are down to half hour after falling asleep and a midnight wake up call. We have had three wet nights this month.
Has the child been to see a doctor so that medical causes can be ruled out? I'd be careful about getting punitive over an issue like this. Having to get up in the night to wash your own sheets is pretty disruptive to a good night’s rest, could be causing other problems, and I doubt it will "teach" him not to wet the bed again. Is there a way to facilitate a quick change of sheets, and allow laundry to be done later. I'd guess that he is pretty embarrassed by this. I'd do everything I could to maintain his dignity and privacy over the issue.
Have you tried going to the doctor? It could be a medical issue
In my experience it is important to make sure that the young person does not feel blamed or punished for bedwetting. There can be a lot of shame associated with this. I encountered a similar situation with an older adolescent. After several visits to a specialist, this adolescent was placed on Imipramine along with a nasal spray with great success. Of course every adolescent and situation is different, so I would suggest seeking assistance from his physician to explore medical options as this is may not be a behavioural issue.
First of all. I will call the situation a challenge not really a problem. However, the first thing among other things is to rule out medical underlying factor(s) regarding the bed wetting. If medical factor is ruled out then a simple approach, if all the parties involved are willing to do it, is to periodically wake the individual up for using washroom. That may not completely stop the behaviour but for sure will reduce the frequency. As a last option the use of medication can be considered.
What is the sleeping arrangement? Single room? Room mate? Dorm? Did this occur at his previous placement? At home? Context does make a difference! This young man is pretty old for this behavior. Has he had a thorough medical exam? Does he find it embracing?
If this is not caused by any of the above context or medical issues, then the moisture pad with attached buzzer can be very effective, since he is in charge of the situation himself.
I would encourage your team to downplay its response to his behavior, rule out medical issues, and join him in reducing anxiety and stress and join him in addressing this challenging situation.
Peter De Long
I have successfully treated enuresis in adolescents with hypnotherapy, so this is something you might want to consider.
It is important to rule out physical problems first, so a medical checkup is important. Then avoid punitive responses that reinforce feelings of shame or embarrassment, because that complicates things tremendously. In my experience, medication is often prescribed as well as a behaviour modification approach. I am not a fan of either, and I would avoid them if I can. Of course, you need to find the right approach for the right person.
Enuresis is often linked with past trauma and
current stress. However, stress reduction alone is often unsuccessful.
Hypnotherapy works really well, and I was very surprised that it worked so well (I am talking 2 sessions). Because hypnotherapy works at the unconscious level, it is so well suited for adolescents, especially in this situation. Teens in care often have very well developed psychological defense mechanisms, and hypnotherapy bypasses defensiveness.
It is important to find a qualified therapist. There are many hypnotists who claim to practice therapy, that is not what you want. You should look for a qualified therapist first and foremost, who is also a qualified hypnotherapist. And remember professional hypnotherapy is NOTHING like the stage hypnosis or entertainment hypnosis. There is no mind control, loss of consciousness or anything like that. It is purely a psychological intervention, and can be very effective. At the very least, it is very effective in reducing stress and it is a very low risk intervention.
Werner Van Der Westhuizen