The following is an article I'm interesting in publishing. It was suggested by an individual at The Simon Foundation for Continence that I publish it here on HealthUnlocked. I hope it helps both individuals suffering from bedwetting as well as their parents. Any comments or suggestions are greatly appreciated.
Introduction:
One of the most common health concerns facing youngsters is nocturnal enuresis, the clinical term for bedwetting. In addition, there are a significant number of adults all over the world who deal with this issue on a nightly basis. There are a number of causes of bedwetting both physical and psychological and there are a wide variety of treatments available to treat this condition including bedwetting alarms, surgical procedures, as well as medications. However, despite the variety of treatments, there are many youngsters who do do not respond to these remedies. For example, some individuals experience side effects from medications, some people experience complications from surgery, some children do not respond well to bedwetting alarms, etc. Out of this group of individuals, a certain percentage may contend with this issue their entire life. According to research cited in Healthline, 1 to 2% of adults wet the bed (Healthline, 2018). The National Association of Continence (NAFC) states that 5 million adults wet the bed (NAFC, n.d.). It's possible these figures aren't a true accounting (and they could be significantly higher) due to the attendant stigma surrounding this issue.
In situations such as these, the prudent thing to do is have the youngster wear some form of protective undergarments to bed to maintain hygiene; for comfort (it's extremely uncomfortable waking up in wet pajamas and bedding, especially during wintertime), as well as to minimize or eliminate the wet bedding and clothing accompanying nighttime accidents. This article discusses what I feel are the most effective forms of protection to manage bedwetting, the stigma surrounding wearing protection, ideas to alleviate this stigma, as well as an idea I have for a reward system parents can set up to encourage their older child or teenager to wear diapers at nighttime. I feel this piece will help those parents who may be having difficulty finding a suitable product to manage their child or teenager's bedwetting as well as help those adolescents who may be having difficulty adjusting to wearing nighttime protection.
Protection for Managing Bedwetting:
Unfortunately, there is a tremendous amount of stigma associated with wearing protection, particularly the use of diapers to deal with the issue. This has prompted most companies to manufacture and market products that resemble regular underwear, believing they would be less stigmatizing for an older child or teenager to wear than a diaper. I feel that this is a bit disingenuous and their reasoning is flawed. In the first place, these products have basically the same design as a diaper, the only difference is they pull on like underwear instead of being applied with tape tabs. Second, I've heard people refer to these products as diapers (even though this is a misnomer). Third, although these products work for a large number of youth, there are many individuals who are heavy wetters and some of them have peed through this style of garment soaking both their bedding and pajamas. Fourth, tape tab style garments have certain advantages over pull-on style products. One advantage is that the tapes allow the user flexibility with adjusting the garments. This in turn allows for a more custom, secure, snug fit which prevents leaks (NAFC, n.d.). Another advantage is that they tend to provide more effective protection for managing heavier forms of incontinence such as bedwetting (L.L. Medico, 2018) I firmly believe that a youngster should wear a product that keeps them dry and comfortable (as well as maintain an appropriate level of hygiene) rather than one that is socially acceptable but does not provide adequate protection. If pull-on products do not provide effective protection, then parents should explore other options. The next section discusses these options.
Cloth and Disposable Diapers for Managing Bedwetting:
What many parents may not realize is that there are other styles of undergarments designed to fit older children and teenagers that wet the bed, including disposable fitted briefs and prefold style cloth diapers fastened by pins with plastic pants worn over top. In order to clear up any confusion parents may have when purchasing bedwetting diapers for their older child or teenager, I feel I'd be remiss by not pointing out the fact that plastic pants are also called “rubber pants” by many people even though this is a misnomer (at some point “rubber pants” became a generic term used to refer to all waterproof pants worn by babies, children, and adults, just like the brand names Kleenex and Band-Aid caught on when referring to all tissues and bandages). So when people in today’s day and age use the term “rubber pants” they actually mean plastic pants. According to the author of The New Diaper Primer” on the Incontinent Support website (incontinentsupport.org) “Rubber pants is a term carried over from the 40’s and 50’s.” Plastic pants are also called vinyl pants, vinyl being a type of plastic.
There are two styles of plastic pants – snap-on and pull-on styles. Snap-on plastic pants are generally used by individuals who are bedridden as it makes it easier to change the person after they've had an accident. If your child or teenager is not bedridden you can have them wear pull-on plastic pants over their diapers. At this point many parents may be saying things along these lines: “Pin-on diapers and plastic pants – they're so old school!” or “Cloth diapers, pins, and plastic pants – didn't they go the way of the dinosaurs?” Actually, there are still plenty of parents who use this style of diapering – there are some parents who prefer the snug fit that diaper pins provide. This snug fit (in conjunction with using the plastic pants) prevents the diapers from leaking. Additionally, there are many incontinent adults who use diapers fastened with diaper pins and covered by plastic pants. This form of protection seems to be especially popular with those adults that wet the bed, as evident by the many adult diaper manufacturers and suppliers that sell nighttime pin-on style cloth diapers and plastic pants.
There are a number of features of prefold style pin-on cloth diapers that make them an ideal choice with managing heavier forms of incontinence such as bedwetting: you have a great deal of flexibility with adding more padding to increase the absorbency of the diaper; there's a large amount of flexibility with fitting different body types, and you have a great degree of latitude in terms of folding and fitting the diapers. As the Protex Medical website says - “Using diaper pins, you have the ultimate control over how the cloth folds around your leg openings and waist for maximum protection and comfort.” The author of “The New Diaper Primer” has this to say regarding cloth diapers for use at bedtime: “You will benefit from the comfort and security each night with a dry comfortable bed” and “Cloth diapers become favorites for secure night wear.” If you’re washing the diapers and plastic pants all at once you’ll need to purchase a diaper pail. When purchasing pins you should use diaper pins with the plastic heads, not regular safety pins. Regular safety pins can come undone and stick your child or teenager.
In addition to prefold cloth diapers covered with plastic pants, there are “disposable briefs”, also known as adult diapers. Adult diapers are form fitting undergarments that have the same look, fit, and design as baby diapers such as Pampers, Luvs, and Huggies – they have an “hourglass” shape, tape tabs for fastening the garments, elastic leg gathers designed to prevent leaks, a waterproof outer cover made of cloth or plastic, and most have an elastic waistband also designed to prevent leaks. For additional absorbency you can add booster pads (also known as “diaper doublers”) to your cloth and disposable diapers. Also, it's a good idea to cover the bed with a waterproof sheet or pad for additional protection in case the child or teenager leaks through their diaper. There are several styles of reusable covers available for this purpose – there are rubber sheets, which are typically made with flannel on the top and rubber on the back, plastic sheets (also known as vinyl sheets), as well as quilted pads with a waterproof backing that have flaps on them which you tuck in on the sides of the bed (which are called “saddle style” sides by some manufacturers). You can also purchase disposable underpads. Some of these also have “saddle style” sides.
As far as what style of diapers to have your child or adolescent wear to bed – pin-on cloth diapers covered with plastic pants, or disposable tape-on diapers – I recommend using both types and alternating their use for a number of reasons: one, you save money on disposable diapers, two, you cut down on the load of diapers and plastic pants you have to wash each week, three, since you're not laundering the diapers and plastic pants as much they'll last longer, fourth, some parents prefer using disposable diapers when they’re on vacation or visiting a relatives house (particularly in the latter case as you can be more discreet about the bedwetting and diaper use), and finally some individuals find cloth diapers and plastic pants too hot to wear during warmer times of year such as spring and summer and switch to disposable diapers during that time.
Many people however are reluctant to use these types of undergarments because of the stigma surrounding wearing diapers. I come at this from a unique vantage point which has colored my thinking on this issue to a significant degree. I'm one of the millions of adults who continue to have nighttime accidents. To manage my bedwetting I have to wear diapers to bed every night. I wear adult size prefold style cloth diapers fastened with diaper pins and covered with an adult size pair of pull-on style plastic pants. I also use adult size disposable diapers with tapes. Finally, I have the bed covered with a plastic sheet for added protection. The next section discusses the stigma surrounding older children, teenagers, and adults wearing diapers for bedwetting. In the conclusion I talk about ways we can deal with this stigma.
The Stigma Surrounding Wearing Diapers for Bedwetting:
For the longest time, the public have sounded the alarm on this topic – they view diapers as a symbol of babyishness and denigrate those individuals who need to sleep in diapers every night. The image of diapers as being infantile is due in large part to the proselytizing of the medical community. For decades, the majority of medical professionals including pediatricians, child psychologists, physicians, as well as other members of the health care profession have counseled against the use of diapers and/or plastic pants for bedwetting children over the age of 4 (unless they're a special needs youth) proclaiming that only babies wear diapers. As a result of this hue and cry, most bedwetting individuals wouldn't be caught dead wearing a diaper. Wearing a diaper to bed is akin to Hester Prynne wearing the scarlet letter, except in this case a bedwetting child, teenager, or adult will have to wear a D for diaper. I maintain that it’s more babyish not wearing a diaper to bed if it’s necessary. By not protecting themselves at night when the circumstances warrant it, the child or adolescent is not taking responsibility for managing the problem which is not acting in a mature fashion.
This widespread attitude by both the public and healthcare community (which in my opinion is antiquated as well as contraindicated) is emblematic of the concept of “phantom tyrants” discussed by the author Stanley Schmidt in an editorial of his entitled “Signs of Respect.” According to Schmidt, “phantom tyrants” are “impersonal forces that presumably originate with identifiable actions by individual people but then take on a life of their own and continue to dictate people's behavior whether or not an individual would independently choose them. We commonly know them by such names as “custom” or “fashion.” ” One example of a phantom tyrant he mentions is the custom of men taking off their hats upon entering a building. Another example is not wearing white after Labor Day. I feel the expectation that a bedwetting child past the age of 4 should not wear a diaper to bed is a perfect example of a “phantom tyrant.”
In tandem with custom and fashion, there are ingrained guidelines we have regarding various milestones (both cognitive and physical) in a person's life. We tend to have certain preconceived notions about our child's growth process and if they deviate from that in the slightest we become alarmed. For example, children should talk by a certain age, they should walk by a certain age, they should read by a certain age, etc., and while it is true that we should have reasonable parameters established for these situations in order to rule out the possibility of cognitive and/or physical disabilities, the same reasoning shouldn't be applied in my opinion to the use of cloth diapers and plastic pants or disposable diapers for the management of bedwetting with older children, teenagers, and adults. In this case an approach tailored to the specific individual is warranted.
Another factor that plays a role in our aversion to using diapers to manage bedwetting with older children, teenagers, and adults is status quo bias. The author Shane Parrish in his book Clear Thinking: Turning Ordinary Moments into Extraordinary Results refers to this bias as the “inertia default”. Here’s what he has to say regarding this: “The inertia default pushes us to maintain the status quo. Starting something is hard but so is stopping something. We resist change even when change is for the best.” He uses the following example of inertia in action: “Inertia is evident in many of our daily habits, such as when we stick to the same grocery store brand, even if a new superior one appears on the market.” He has the following insightful thing to say which I feel is relevant to this topic: “One reason we resist change is that keeping things the way they are requires almost no effort. This helps explain why we get complacent. It takes a lot of effort to build momentum but far less to maintain it. Once something becomes “good enough”, we can stop the effort and get decent results. The inertia default leverages our desire to stay in our comfort zone, relying on old techniques or standards when they’re no longer optimal.”
Another theory I have for why diapers are called babyish has to do with the parents’ attitudes. The parents themselves may feel embarrassed about their older child or teenager still needing diapers at night. It’s such a competitive world out there and parents feel pressured to do anything they can to help their child get a leg up on the competition. Having a child or adolescent in diapers may make them feel the child or teen is not “up to snuff.” These parents may then feel ashamed: “What would my neighbors think if they found out my teenage son and daughter still need to sleep in a diaper every night? They’re such babies! I hope I don’t forget to take the plastic pants down from the clothesline before they come over! So much for going to Harvard!”
Last, but not least, there’s the commercial for Huggies pull-up training pants whose motto is - “I’m a big kid now.” The implicit (or not so implicit) assumption being that only babies wear diapers.
What has always puzzled me is this – the public doesn't bat an eye as far as the following groups use of diapers – the elderly; special needs youngsters such as those suffering from autism, cerebral palsy, and other conditions; individuals suffering from neurodegenerative disorders such as dementia, Alzheimer's, MS, Parkinson's and similar disabilities, but look down on those individuals that choose to wear diapers to manage their bedwetting. Perhaps it's because the aforementioned disabilities have symptoms accompanying them which frequently render these individuals helpless just like an infant. This in turn makes it more socially acceptable for them to wear a diaper, as opposed to a “normal” youngster or adult suffering from bedwetting. I think it's high time we disabuse ourselves from this outmoded and archaic way of thinking.
It's unfortunate that the majority of individuals suffering from bedwetting find it demoralizing and demeaning wearing a diaper when ultimately wearing one will make their lives significantly better – they'll be much more comfortable waking up in a dry bed, it'll make cleanup easier, wearing the diaper ensures you'll sustain a proper level of hygiene, and if you're an adult that wets the bed and you're in a relationship, your partner/significant other will also be happy you're sleeping in a diaper because they'll wake up dry as well. Here's what one adult has to say on the matter: “At night I wear a fitted brief, which is an adult diaper. Initially it was very upsetting, but it gets better with time. Wearing a diaper keeps me dry, my bed dry, my girlfriend dry, and I get a good night's sleep. It took me a while to get over the hump of accepting that this was what I had to wear to bed, but eventually I got over it. Now it is just a thing I do at night, no different than brushing my teeth and flossing. The best thing to do is accept that you have the condition and take steps to manage it. Look into products like mattress protectors, bed pads, or even diapers. I’m 29 and know how frustrating it is. But I’ve accepted that diapers are my best option for me. Trust me, taking off a wet diaper in the morning is WAY better than having to launder sheets and clothes.” Finally, here’s a few more comments from adults who manage their bedwetting by wearing diapers to bed. Hopefully these remarks will make children and teens feel less ashamed about this issue:
• “I’m in my 60’s now but pretty much have the same attitude about diapers. [I’m] a lifelong bedwetter that has worn cloth diapers and plastic pants pretty much forever.”
• “The point of this story is that there’s no reason to be embarrassed by nighttime incontinence or having to wear protection to prevent bedwetting. My journey continues and I won’t be giving up on seeking treatment. For now, wearing a diaper to bed is just an ordinary part of the routine, and I don’t feel it’s a hardship at all.”
• “If your bedwetting is treatable, see the necessary doctors and get it treated. However, if it’s chronic and not going away, acceptance and management with good diapers are the keys. “Suffering” is optional. I recommend just getting on with your life. Incontinence in general and bedwetting in particular are nuisances that need not ruin your life unless you let them. So don’t let them do so.”
• “I have been wearing cloth diapers and plastic pants for my bedwetting for most of my adult life.” - Mike D
Reward System to Encourage Older Children and Teenagers to Wear Overnight Diapers:
If your older child or teenager balks at the idea of wearing diapers overnight, you can implement a reward system to encourage and motivate them to wear the diapers on a trial basis. By implementing this system the child or adolescent will not feel you’re treating them like a baby by putting them back in diapers, and ultimately they’ll feel more comfortable and secure wearing the nighttime diapers. Here is how the system will work. Have the child or teen choose three things they really like - such as a video game, a book, and a cell phone (if your budget permits). If they wear the diapers to bed for 10 nights they would get the video game, if they wear them for 11 to 20 nights they would get the book, and if they wear the diapers for the whole month they would get the cell phone. It should be impressed upon the youngster that they don’t have to wear the diapers in a row - some children or teenagers might get discouraged and skip wearing the diapers. To use the video game as an example the child or teenager doesn’t have to wear the diapers 10 nights in a row - as long as they wear them 10 nights out of the month. That’s the important thing.
The parents can set up a chart in the room so both the youngster and parents can monitor their progress. Verbal encouragement is an important component of the system. For example the parents can say something along these lines: “We’re really proud of you for wearing the diapers at night. We know it’s no fun wearing them but just keep in mind that people of all ages (including many adults) also wear diapers to bed. Plus keep in mind the presents you’ll earn for wearing the diapers and plastic pants.” It’s my contention that after a suitable period of time the child or teenager will get used to wearing the diapers during the night - they’ll feel so comfortable waking up in a dry bed that they can than be weaned off the reward system. At that point they’ll view wearing the diapers as just a normal part of their bedtime routine such as brushing their teeth. It may take several months for them to get acclimated to sleeping in the diapers every night. Even though I mentioned this at the beginning I think it bears reiterating - it’s crucial to use verbal encouragement in conjunction with the rewards.
The following is another example of something you could say to the child or adolescent: “You shouldn’t feel ashamed that you have to start wearing diapers again. This is a common problem and many people use diapers to keep them comfortable and secure. It’s much better sleeping in a diaper then waking up in yucky wet sheets and PJs.” You should also stress that they only have to wear the diapers at night so no one but their immediate family will know they’re wearing them. One thing that many bedwetting youngsters have to contend with is teasing by their siblings - “Johnny has to sleep in a diaper every night” or “Susie sleeps in diapers every night - maybe she should sleep in a crib too!” If the bedwetting child or teenager has siblings the parents need to impress upon them that any teasing will not be tolerated and they’ll be consequences if they do tease them.
Finally, if the parents feel a certain form of protection would best manage their bedwetting but the child or teenager resists they should explain to the child or teenager why they chose that particular garment. Different styles of incontinence undergarments are suitable for different levels of incontinence.Also, some people are side sleepers and need diapers that are effective in that particular circumstance. The parents should say something along these lines - “We realize you’d prefer to wear pull-ups to bed, but you have problems with side leakage and diapers are more effective for dealing with this issue.” By explaining your reasoning the youth will not feel you’re treating them like a baby and that your decision is not some arbitrary one. This will go a long way in making the youngster feel less embarrassed about wearing the diapers.
Conclusion:
I have written a fair amount on this topic and one of the primary motivations for doing so is to help children, teenagers, and adults feel less embarrassed and ashamed about wearing diapers to bed every night. The audience for my writings are those individuals who have not been able to find a cure for their bedwetting and therefore must resort to wearing protection to bed. It causes me a great deal of consternation that the shame of wearing diapers is so endemic (particularly among those individuals that wet the bed). I think diapers should be viewed no differently than other medical equipment such as wheelchairs, eyeglasses, hearing aids, breathing machines, portable oxygen, CPAP machines, insulin pumps, and other items. My rule of thumb and philosophy as far as wearing diapers is concerned is very simple - if you need them, you need them. Period. You’re never too old to wear a diaper.
I think one way to decrease the stigma of wearing diapers to bed (and hopefully eliminate it entirely at some point) is to rethink our relationship with diapers as well as our preconceived notions regarding them, and one way to do this is to redefine the word “diaper.” Traditionally, the word “diaper” was defined as a garment worn by babies. If I was responsible for writing the definition of diaper I’d say something along these lines: “An absorbent, waterproof, protective undergarment made of either reusable or disposable material which is drawn up between the legs and fastened at the waist by tape tabs, diaper pins, or other methods. It is designed to be used for several purposes: for managing episodes of incontinence experienced by babies and young children before they are potty-trained; for providing protection for children, teenagers, and adults that experience incontinence due to various medical conditions; as well as providing protection for children, teenagers, and adults that wet the bed.” I think this description describes the situation more accurately.
Another way to reduce the stigma of wearing diapers to bed is to consider the sanitary aspects of wearing the diaper. It’s important to instill in youngsters at an early age the adoption of various sanitary practices such as covering your mouth when you cough or sneeze, washing your hands after going to the bathroom, wearing a band-aid if you have a cut, and similar habits. It’s no different with a problem such as bedwetting - in this case the diaper can be viewed as a band-aid for the bladder. Finally, if the youngster is wearing diapers and plastic pants to bed, the garments can be viewed in the same manner as a raincoat, rain suit, or umbrella - all of these items sole purpose is to keep the user dry. Since people have no problem using these items to prevent themselves from getting wet it should be no different with wearing diapers and plastic pants to prevent the bed from getting wet. These are just some of the ways we can reduce the stigma of wearing nighttime diapers. I think it also helps to have a sense of humor about it - it’s good to remember that we’re all in the same leaky boat and diapers are the life jackets we need to use. I hope this article helps all the millions of children and teenagers suffering from this issue realize that this is a common problem and that there are millions of adults all over the world who also have to go to bed diapered because they wet their beds every night.
References
Healthline “Causes of Bed-Wetting in Adults and How to Treat It” healthline.com/health/ adult-bed-wetting Updated October 26, 2018
NAFC Adult Bedwetting (Sleep Enuresis). https: //nafc.org/adult-bedwetting/
NAFC “Ask the Doc: Protective Underwear or Adult Absorbent Briefs - What’s the Difference?”
nafc.org/bhealth-blog/ask-t... difference/.
L.L. Medico “Adult Diapers: Tab Style Briefs vs. Pull Ups and Why Knowing the Difference Is Important” llmedico.com/blog/adult-dia... is-important/. November 18, 2018
Protex Medical “Prefold Cloth Flat Diapers” myprotex.com/collections/pr... diapers.
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