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October 5, 2009
Enuresis is defined by the National Institute of Health as an involuntary discharge of urine. (http://www.nlm.nih.gov/medlineplus/mplusdictionary.html) A well known form of enuresis is nocturnal enuresis, also known as “bedwetting”. In a recent interview on MSNBC, Dr. Alan Greene said that children were generally considered bedwetters if they continued “to wet beyond the age of five or six, at least two nights a week”. (http://video.msn.com/?mkt=en-us&brand=msnbc&vid=2d13fbf9-fe59-43c1-b672-e6cfb002bd88) Children with nocturnal enuresis are typically very heavy sleepers and, consequently, they do not wake up when their bodies signal to their brains that they need to use the restroom. There are several methods for treating the condition; the most popular of which include medication, closely monitoring dietary intake, and bedwetting alarms. Tribute Marketing has a website, www.enuresisalarms.com, that markets DriSleeper bedwetting alarms, claiming they are the best treatment available for nocturnal enuresis. This paper examines the effectiveness of bedwetting alarms in the treatment of nocturnal enuresis.
II. What is the purpose of bedwetting alarms and how do they work?
The purpose of a bedwetting alarm is to train the child to wake up when he/she needs to urinate, as well as wake the parents of the child so they can assist. When children are asleep and their bladder fills, normally, the brain either signals the muscles to contract and hold the urine or the brain will wake the child up so they can use the restroom. In children with nocturnal enuresis, the brain has not fully developed and is unable to respond the body’s need to urinate. The bedwetting alarm attaches to the child’s underwear and sounds a loud alert tone as soon as the child begins to urinate. It is not uncommon for the child to initially sleep through this sound because bedwetters are often heavy sleepers. However, the alarm will wake a parent or sibling of the child who can assist them. As the brain becomes accustomed to waking the child after receiving the signal that the bladder is full, the child will wake up on his/her own when the alarm sounds. Eventually, the child begins to wake up before the alarm sounds and he/she is able to go to the restroom rather than wetting the bed. (http://video.msn.com/?mkt=en-us&brand=msnbc&vid=2d13fbf9-fe59-43c1-b672-e6cfb002bd88)
III. What are some alternative treatments to bedwetting alarms?
There are several alternatives to bedwetting alarms for treatment of nocturnal enuresis. One common treatment is the use of prescription medications. Desmopressin acetate is a medication used to reduce the amount of urine made by the body. The child takes the medication before going to bed, and the body is not able to produce enough urine throughout the night to fill the bladder, thus the child does not urinate. Another common prescription medication for bedwetting is a category of drugs known as tricyclic antidepressants (TCAs). Imipramine and desipramine are TCAs that prevent bedwetting, however, the way in which the drugs are able to accomplish this task is unknown. Though TCAs and desmopressin are both effective drugs, they are often criticized as a treatment for bedwetting because many children began to wet the bed again once they are no longer taking the medication. Many parents also do not use medications to treat their children because the drugs have several possible side effects including abdominal pain, nausea, and in some cases, seizures. (http://children.webmd.com/tc/bed-wetting-primary-nocturnal-enuresis-medications)
Alternatives to medication and alarms vary. One strategy is to closely monitor the dietary intake of the child during the later hours of the evening. For example, excluding soft drinks after dinner or eliminating beverages altogether an hour before bedtime. Another strategy is to wake the child multiple times throughout the night and have them try to use the restroom. Other treatments simply consist of positive reinforcement for a child who has a dry night. One reward system that is often used is a calendar in which the child can mark dry nights with a sticker. Other systems use rewards, such as a piece of candy, to encourage and support child’s efforts to stop wetting the bed. (http://children.webmd.com/tc/bed-wetting-primary-nocturnal-enuresis-treatment-overview)
IV. Who is presenting the product/information and why?
The DriSleeper bedwetting alarms are presented by Tribute Marketing, located in Attleboro, MA. There is no information listed on the website describing the credentials of the employees of Tribute Marketing that are selling and promoting the product. (www.enuresisalarms.com/index.html) The purpose of presenting the information on the business’s website is to persuade consumers that a bedwetting alarm is the most effective treatment for nocturnal enuresis and to sell the DriSleeper alarm by convincing the buyer it is the best type of bedwetting alarm available.
V. What claims are made?
On the website, enticing phrases such as “you do not have to wait for your child to outgrow bedwetting” and “help you child feel a sense of power and control” are used to sale the product. Tribute Marketing claims that bedwetting alarms have the highest success rate of all available treatments, that their product is an empowering, drug-free method to treat and cure nocturnal enuresis, and the DriSleeper alarm is the best value. They also claim that bedwetting alarms are the preferred treatment to medication and that those who use medication have a high relapse rate.
VI. What evidence is offered in support of the claims made?
Tribute Marketing offers research they, themselves, have done on the effectiveness of bedwetting alarms and cite scientific research as sources. The report also includes a note that is was written by Dr. Anthony Page, though no information about who Dr. Page is or how he can be contacted is presented. (http://www.enuresisalarms.com/report.htm) A link to the Children’s Hospital Boston’s website is provided as a resource. (http://www.childrenshospital.org/az/Site622/mainpageS622P0.html) The hospital, located in Boston, MA, describes bedwetting and briefly describes possible treatments. Though bedwetting alarms are suggested as a possible treatment, there is no evidence on the hospital’s website that supports Tribute Marketing’s claim that bedwetting alarms are the best available treatment. Another link to support the claims made about the effectiveness of bedwetting alarms is an article written by two nurse practitioners. (http://respiratory-care-sleep-medicine.advanceweb.com/Editorial/Content/Editorial.aspx?CC=7709) This article cites Dr. Sandra Hassink, the program director of the enuresis clinic at Alfred l. du Pont Hospital for Children in Wilmington, Delaware, and Albert Bourbon, PA-C, from the Las Vegas Clinic for Children and Youth, as medical professionals who support the use of enuresis alarms and both claim they are currently the best treatment available. In support of their claim that medication is not as effective as a bedwetting alarms, they cite a scientific paper (Glazener and Evans, 2002). (http://www.enuresisalarms.com/index.html) Finally, to support the claim that the DriSleeper alarm is the best value, Tribute Marketing compiled a chart comparing their product, feature by feature, with 5 other top brands. (http://www.enuresisalarms.com/bed-wetting-alarm-reviews-comparison-chart.htm) However, this data has not been updated since July 10, 2004.
VII. Does scientific research support these claims?
The scientific community has conducted many experiments to determine the most effective treatment for nocturnal enuresis, how the various available treatments work, and to determine the longevity of the behavioral changes. A meta-analysis conducted by the Cochrane Database combined the data of fifty trials to determine the effectiveness of bedwetting alarms, TCAs, and Desmopressin in treating children that wet the bed. (Glazener et al., 2005) The study found that bedwetting alarms were the most effective in treating nocturnal enuresis and the effects continued after the end of the treatment. Desmopressin and TCAs were found to have an immediate effect, but most of the children relapsed after the drugs were no longer administered. The meta-analysis also considered combinations of treatments in which they found the combination of desmopressin and bedwetting alarms showed no more effectiveness than the use of only the bedwetting alarm and the combination of a bedwetting alarm and TCAs was more effective than the use of the bedwetting alarm alone.
Another study examined the affect of bedwetting alarms on storage capacity of the bladder in children who wet the bed one time each night. (Taneli el al., 2004)There were 28 children over 7 years old included. The study found that after using the bedwetting alarms for 12 weeks, the children’s bladder storage capacity was increased by about 1/3 the original storage capacity. This indicates that children using bedwetting alarms do have a positive physiological response to the stimulus.
A randomized control trial was conducted in 2005 that compared the effectiveness of bedwetting alarms, desmopressin, and combined treatment in children who wet the bed. (Fai-Ngo et al., 2006) One group was treated with only bedwetting alarms, another with only desmopressin, and a third group was given both treatments. After 12 weeks of treatment, the study found that the frequency of bedwetting episode decreased the most in the combined group and the least in the bedwetting alarm group. However, in after a 12 week follow up, the bedwetting alarm group had the least number of relapses and the desmopressin group had the most. This indicated that bedwetting alarms were more effective than medication in producing long term results.
In a study conducted in 2004, six Cochrane Reviews were used to compare the effectiveness and longevity of bedwetting alarms, desmopressin, and reward systems. (Glazener et al., 2004)The researchers concluded that the first treatment should be a reward system because it is the simplest, but is sometimes ineffective because it requires the parent to take the be very involved in the process. They also found that bedwetting alarms are the best treatment for long term results, though desmopressin is very effective for a quick fix. This study also warns parents about the possible side effects of medications used to treat their children.
Though Tribute Marketing’s website offers little evidence to verify the identity and credentials of the owners of the company, the scientific research supports their claim that a bedwetting alarm is currently the most effective treatment on the market today with the most longevity for the treatment of nocturnal enuresis. If a child requires treatment beyond the use of positive reinforcement, a bedwetting alarm should be used instead of desmopressin or TCAs.
Fai-Ngo Ng C., Wong, S.N., Hong Kong Childhood Enuresis Study Group (2005). Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children. Pediatric Nephrology, 20(2):163-169.
Glazener, C.M., Evans, J.H., Pedro, R.E. (2004). Treating nocturnal enuresis in children: review of evidence. J Wound Ostomy Continence Nurse, 31(4):223-234.
Glazener, C.M., Evans, J.H., Pedro, R.E. (2005). Alarm interventions for nocturnal enuresis in children. Cochrane Database System Review, 18(2):CD002911.
Taneli, C., Ertan, P., Taneli, F., Genc, A., Günsar, C., et al. (2004). Effect of alarm treatment on bladder storage capacities in monosymptomatic nocturnal enuresis. Scandinavian Journal of Urology and Nephrology, 38(3):207-210.
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