Bedwetting alarm

A bedwetting alarm is a behavioral treatment for nocturnal enuresis.

The enuresis alarm methodology originated from French and German physicians in the first decade of the 20th century. Meinhard von Pfaundler, a German pediatrician made the discovery accidentally, with the original intention to create an alarm device that would notify nursing staff when a child had bed wetting and needed to be changed, showing the device to have a significant therapeutic advantages after a certain time of use. Despite early success, the treatment was not developed until the 1930s by two independent groups of psychologists: Orval Mowrer and Willie Mae Mowrer (1938) and John Morgan and Frances Witmer (1939). Mowrer used a modified Pfaundler alarm device with 30 children (ages 3–13 years) showing empirical success of the bell and pad method as a treatment for nocturnal enuresis, with the maximum time required to accomplish the treatment not exceeding two months.

The individual places the sensor (usually located in briefs or underwear) and turns the alarm device on (there are various types of alarms) before going to sleep. The enuresis alarm is triggered when a sensor in the sheets or night clothes becomes wet with urine, setting off an auditory signal with the intention of causing the individual to wake, cease voiding, and arise to void. Parents are advised to wake their child when the alarm is activated—otherwise, children are prone to turn it off and go back to sleep.

It is highly suggested that during treatment the alarm should be worn every night. The treatment effect and response are not immediate and treatment should be continued for 2–3 months or until the child is dry for 14 consecutive nights (whichever comes first). There may be cultural differences in its acceptability, as it may be highly disruptive for the household and may require a significant commitment of time and effort. The family must be motivated and adhere to this therapy if it is to be successful so they should be preemptively apprised of likely difficulties, but assured the first few weeks are the most troublesome. If necessary, doctors should monitor the child’s progress early to address any problems and facilitate adherence.

The enuresis alarm utilizes both classical and operant conditioning to provide a means of causing the sleeping individual to be regularly awakened immediately after the onset of urination so they can void in the toilet and prevent bed wetting.

The classical conditioning paradigm components for the bell and pad method are the following: The unconditioned stimulus (US) is the awakening stimulus or the alarm sound, the unconditioned response (UR) is the awakening response and sphincter contraction, the neutral stimulus (NS) is the feeling produced by bladder distention (feeling of having a full bladder), the conditioned stimulus (CS) is the feeling produced by bladder distention, and the conditioned response (CR) is the awakening response and sphincter contraction. Initially the individual experiences the alarm sounding (activated by urination) (US) eliciting the awakening response and sphincter contraction (UR) to wake up, stop urinating, and travel to the bathroom. After continued pairing of the alarm sound (US) with the feeling of a full bladder (NS), the previous NS of feeling a full bladder becomes the CS and elicits the waking response (CR) of waking up to go use the bathroom and urinate.

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Wikipedia