D.R.I. Bedwetting Management System
The Program
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.
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:
The Routine
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.
Diapering Supplies
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.
Terminology
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.
Diapering
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.
Caregivers
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.
Post Diapering
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.’
Teasing
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.
Babysitting
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’.
Sanctions
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.