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D.R.I. Bedwetting Management System
D.R.I. (Diaper Remediation Initiative) is a management and motivational system whereby a chronic bedwetter is returned to diapers using techniques of mild creative shaming. It should be undertaken only after other methods have failed. It is assumed that medical interventions have been attempted have proved unsuccessful.
Responsibility for managing the problem is temporarily taken over by parents/caregivers or their designates in a manner that emphasizes practicality and convenience for the latter, rather than the concerns of the bedwetter, although those also are taken into account in a secondary manner. It is understood that a certain loss of independence, privacy and dignity is inevitable on the part of the enuretic child or youth, but there are usually commensurate gains in terms of practical management of the problem and in the eventual achievement of dryness.
Types of Diapers
For the parent or guardian contemplating returning a chronically bedwetting child or youth to diapers using the D.R.I. method, it is recommended that cloth diapers and plastic pants be chosen for the purpose.
Youth-sized cloth diapers are available in several styles; a pre-fold pin-on type is recommended (about a half-dozen to a dozen should be obtained) along with cloth baby diapers for use as liners/inserts as required. Youth sized plastic and rubber pants are also easily obtainable, both in snap-on and pull-on styles. Both are recommended, in plain white or translucent (in the case of plastic). Nursery prints are also available, but are not recommended, for reasons stated below. Four to six pairs of waterproof pants are ideal.
Although disposable diapers may be considered more convenient, for the purposes of the D. R. I. program cloth and plastic pants are preferable for the following reasons:
- They allow the enuretic youth to feel wetness after urination;
- The bulk between the legs and against the body serves as a constant reminder to the wearer that he is in diapers;
- Cloth diapers necessitate the use of accessories such as diaper pins, and plastic or rubber pants; for the purposes of DRI, more is better.
- Extra diapers can be added to increase absorbency and prevent leaks;
- Cloth diapers can't easily be hidden under night clothing;
- A multi-sensory experience for the enuretic is desirable and best served by wearing cloth; touch (bulk against the skin and a sense of wetness), sound (the crinkling of plastic or rubber pants), sight (bulkiness helps, whether or not clothing is worn over the waterproof pants), and smell (of plastic or rubber, baby powder, and a slight scent of urine eventually acquired by hand washed diapers). Thus four of the five senses are acutely engaged in the process.
Breaking the News
By the time the enuretic child or youth is informed of the decision to return him to diapers (for the sake of simplicity we will refer to the male gender, as most bedwetters are male), diapering supplies should already be on hand. These should include, at the least, diapers, pins, waterproof pants and baby powder. It is assumed that the youth's bed is already protected by a plastic sheet. Allowing him to examine the products beforehand will reinforce the fact that the decision is firm and final; and while reasons can be discussed, it should be emphasized to the youth that the decision is final and not negotiable. Allowing the enuretic at least a few hours to contemplate the inevitable return to diapers can ease the transition. If necessary, he should be informed that resistance will involve serious sanctions.
Reasons can include:
- Obviously, to prevent wet beds and odor;
- To improve sleep by eliminating the necessity to change sheets during the night;
- To lessen disruption to sibling room-mate (where applicable) and household;
- To reduce volume of laundry;
- To emphasize practical consequences of bedwetting;
- To supply incentive to attain dryness.
The enuretic should be informed that he will be expected to cooperate in the following regime: At a specific time each evening, (7 pm recommended) he will make himself available in his room for diapering. It will be emphasized that there are absolutely no exceptions to this new regimen; not visitors, not travel , nor any other excuse. Consistency is crucial.
It will be explained that others will be in control of the youth's enuresis until he is ready to control urination by himself. This will include parents or their designates including siblings, other family members, or 'babysitters'. (More on terminology below.)
Management, Not Punishment
It will be explained to the youth that being returned to diapers is an enuresis management strategy, not a punishment, and that management options will be at the discretion and convenience of the parent/caregiver. It will be emphasized that the purpose of the program is to help, not to treat him or make him feel like a baby. Hence plain diapers and waterproof pants should be employed, never nursery prints. Likewise items of clothing such as youth-sized onesies should be avoided.
While basic supplies will consist of items mentioned above, other useful additions will include a change pad, a diaper pail, diaper rash ointment, baby wipes, and medical gloves (for changing wet diapers). Ideally, the enuretic's equipment will include a back-saving change table. A roughly six-foot long folding worktable is inexpensive and ideal for the purpose, and can be fitted with a blanket and the youth's change pad. A shelf can easily be added to run below between the legs, and can hold diapers and other supplies. If discretion is desired, a long enough blanket can conceal the diapering supplies; however, it is recommended that they remain in plain sight.
The enuretic youth should never be called a 'baby' or 'infant' or otherwise denigrated because of his enuresis. On the other hand, euphemisms should be avoided. His diapers should be straightforwardly referred to as such, and other equipment should be referred to by name, i.e. change table, diaper pail, etc. It is permissible to refer to his plastic or rubber pants as 'baby pants' because of the wide use of the term in the vernacular.
At the appointed time, the enuretic youth will position himself upon the change table. At this point he will be wearing just a tee-shirt. A diaper will have been prepared by combining a youth diaper and one or more triple folded (lengthwise) cloth baby diapers. The diaper will be powdered, and slipped under the youth's backside. Powder will be applied to his frontal diaper area, and then the diaper will be raised between his legs and tightly secured back to front with one diaper pin on either side. Then plastic or rubber pants will be applied, taking care to ensure that the diapers are fully covered. He will then be free to remove himself from the change table and rejoin the family. If pajamas or track pants are permitted he can then put them on, although it is recommended that the youth's diapers and waterproof pants should remain uncovered.
Who does the diapering in the family is a matter for parents to decide. However, as an aim of the program is to make the task as easy as possible on the caregivers, it is recommended that diapering be a shared function among family members and their designates. Older or younger siblings can easily handle the task, and extended family members or friends can also be called upon at times. In the absence of a same sex caregiver, it is permissible for a member of the opposite sex to handle the youth's diapering, as long as the act is carried out to near-professional nursing standards, as it should always be. Disciplinary authority can be accorded to each caregiver, or they can report to a central figure.
The diapered youth will be expected to carry on as normally as possible prior to bedtime. He will not be allowed to 'hide', but might be asked to do chores such as hand-laundering and hanging diapers on a rack to air-dry, rinsing his diaper pail, etc. He will be expected to answer any questions posed by visitors in a truthful and straightforward manner. For example, 'I'm wearing diapers to help manage a problem I have with enuresis.'
If siblings are involved, there is bound to be some teasing on their part or on the part of their friends. This is to be discouraged, but some inevitable minor teasing might serve as a motivation to become dry.
Once diapered, the youth needs to be supervised by a family member or other caregiver. This might sometimes lead to conflicts, for example if a sibling is forced to stay home to 'babysit', but that is part of the shared family burden. It is permissible, in some instances, to ask family friends to undertake the task, or even someone unknown to the diapered youth, as long as professionalism is involved. Disciplinary authority to be in accordance with same under 'Caregivers'.
Even before being returned to diapers, the enuretic youth must understand that his cooperation is required and expected, and that failure on his part to submit to the process will bring severe sanctions, along with forced compliance. These can consist of anything from lost privileges, to threats of, or actual spankings. Most parents/caregivers who have had to resort to spanking a youth for non-compliance have not had to repeat the punishment. The youth quickly learns that he is in a double no-win situation—spanked, then diapered. Severe sanctions should be reserved for only the most serious infractions—non-cooperation in the diapering process, and unauthorized removal of diapers.
Frequency of Wetting
While each case is different, studies have shown that once returned to diapers, the average youth will initially wet more often. Thus thrice weekly wet beds might translate to five or even seven nights of wet diapers. The phenomenon is not completely understood (perhaps shame, perhaps security), but it is known that after approximately three months, the dryness achievement rate approaches that of untreated enuretics, then quickly overtakes it. About 80% of youth in the D.R.I. program achieve dryness within six months. The program is suspended when a youth has been dry for thirty consecutive nights. The plastic sheet is retained for some time longer. Diapering supplies may be donated or requested at the address below.
© 2008 D. R. I. Inc. Reprinting permitted.
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