What can cause treatment with a bedwetting alarm to fail?

The first enuresis alarm was developed by Hobart and Willie Mowrer in 1938—76 years ago! It became one of the most common treatments for bedwetting. Today, hundreds of different types of enuresis alarms are being sold over the counter. In fact, the concept sounds very simple—the child will start to wet during sleep, and the bedwetting alarm sounds. The child has to wake up and go to the bathroom to empty their bladder, and so he will eventually learn to wake up by himself. If it is so simple, though, why do so many “do it yourself” treatments with an enuresis alarm fail?

Sometimes, unfortunately, they fail even when supervised by professionals.

Although the alarm fails for various reasons, most treatments fail because people do not understand basic concepts and technical issues.

The following scenario is common: the child wets the bed, and the alarm sounds. The entire family wakes up except the enuretic child, and the parents feel that treatment with the alarm is useless. This is so wrong. In this post, I’ll analyze the causes for failure.

The learning process: The alarm isn’t meant to teach the child to wake during sleep. It is intended to teach the child to identify the sign from the bladder to the brain. To stay dry at night, the child doesn’t need to wake up. He can learn to control himself by contracting the sphincter muscle, and this will relieve pressure. The alarm also works on the behavioral concept of “learning by avoidance”—if you want to avoid waking up at night to go to the bathroom, don’t wet the bed.

Continuity of the learning process: Two crucial elements are involved: the alarm should be activated, and parents should go to his room whenever the child wets the bed. In addition, the time between wetting and his going to the bathroom should be as short as possible. He must go immediately and will learn to connect the wetting accident with the unpleasant need to wake up. When a long interval ensues between the wetting act and emptying the bladder, no learning occurs because the child’s brain can’t make the connection between the two acts.

Causes that affect the learning process

• Parents don’t hear the enuresis alarm.

• The child disconnects it and continues to sleep.

• Parents forget to connect the alarm before bedtime.

• The child accidentally disconnects the alarm before it sounds.

• When a wearable bedwetting alarm is used, the child might cover it with his blanket and it will not be sound.

• The alarm is activated because of sweat and humidity. Those false alarms disturb the learning process. Very few bedwetting alarms have a sensitivity control that can be adjusted to avoid false alarms.

• Parents wake the child and take him to the bathroom voluntarily and not because of a bedwetting accident. This will strongly affect and confuse the learning process. The child should go to the bathroom only as a result of a bedwetting accident.

The treatment’s dynamic

During treatment, we may encounter different situations:

• The child refuses to sleep with an object attached to his body.

• The child doesn’t wake to the alarm.

• The child refuses to go to the bathroom.

• The child becomes hysterical when the alarm sounds.

• The child keeps wetting the bed every single night.

• The child manages to be dry for a while and then relapses.

These are just a few examples out of many that parents might confront during treatment. Since they don’t understand the process, they might respond in an inappropriate way, which can even aggravate the situation.

Parents’ attitude

Parents should acknowledge that the child doesn’t wet on purpose. When he wets the bed, he is miserable. Parents should never show disappointment. Such a reaction will strongly affect the child’s self-confidence and his belief in his ability to become dry. Many times a child will experience a wet night following a long stretch of dryness. This is quite normal, but when parents show their disappointment, it breaks the child and might cause a severe relapse. Parents should be there for the child and be supportive and encouraging.

Assessing progress

The obvious sign of progress is a dry night, but even when the child has a wet night, progress can be evaluated by the time of wetting, the size of the urine spot (the reflex response), the number of wetting accidents, and the waking response to the alarm. Knowing how to evaluate those parameters will enable us to make an accurate prognosis. Sometimes, even when the child has not had even a single dry night, an enuresis expert can predict good results based on these parameters.

Treatment length

Treatment with a bedwetting alarm should be short; otherwise, the child will get used to the alarm and will not respond to the process. The average time is 3 to 5 months. The treatment shouldn’t exceed 8 months. Continuing treatment will be considered as just “more of the same” and only lead to frustration and exhaust the child and the parents.

Treatment efficiency

When monitored by a professional who is an expert in CBT of enuresis, treatment with a bedwetting alarm as a stand-alone treatment will produce a 40%–50% success rate.

When the treatment combines other learning techniques, in addition to the alarm and being tailor-made for the patient, the success rate is more than 90%.

To sum up

Should you decide to do the treatment with a bedwetting alarm by yourself, you must know how to do it. Bear in mind that if the treatment fails, it will have a negative effect on future treatment.

Many types of alarms are available. Be sure to choose a reliable one with a strong loud speaker. Make sure that the wireless alarm has no radiation hazard, and check with your child to see if he is willing to sleep with an alarm attached to his lower abdomen (if not, choose the bell and pad bedwetting alarm) and insist on sensitivity control.

Always prefer a treatment program that is multimodal and tailor-made for the patient.