Previous Issues

Enuresis alarms, bedwetting and incontinence
- Malem Medstat® -

FALSE ALARMS

False alarms, when a bedwetting device alarms without wetness, are annoying. False alarms also slow progress towards dryness. The failure of an alarm to signal wetness is equally bad. Wetness with no alarm to wake the person  results in the loss of an opportunity to train that person to avoid wetting in the future. 

When using MALEM® alarms false alarms and non-alarms with wetness are unusual when instructions are followed. They can be minimised by thoroughly reading the instructions included with every MALEM® Alarm. If there is a false alarm reread the instructions should the reason not be obvious to you - and take the steps recommended to avoid  any more.

Here  are some of the reasons for false alarms and non-alarms when using body-worn alarms - such as the MALEM® Alarm.

Alarm Set Ups: The alarm box should be secured firmly. The MALEM® body-worn alarms provide a safety pin to attach the alarm box to
the outside of a close fitting top, night-dress or T-shirt.  Place the alarm over or  very close to the collar bone (clavicle). The wetness sensor must also be secured, either between two pairs of pants (sometimes a strip of sticky tape over the connecting lead adds stability) OR between the layers of a mini sanitary pad/panty liner - which is then worn inside the pants.  The wetness sensor should be positioned so that it is easily and quickly activated by wetness from urine. The wetness sensor must not be in contact with skin and should be separated  by one or more pairs of pants or by the sanitary pad/liner. If the wetness sensor is too close to the skin it may be activated by sweat. Sweaty persons or those living in hot conditions need to take especial care that there is enough thickness between the skin and the wetness sensor. Some parents make a "pocket" for the wetness sensor from towelling. 

The sensor wire must also be anchored in the correct position. The MALEM® alarm provides a  “crocodile clip” to attach to the waist band of the pants. This clip when used should ensure that the sensor stays in place and does not move out of position - with the possibility that the alarm will not go off when urine "leaks" - a false negative alarm i.e. wetness but no alarm.

When using a body-worn alarm the sensor wire should run from the wetness sensor inside the clothing worn above the waist - night-dress, pyjama top or T-shirt. The wire should come out from under the clothing close to the entry point of the connecting wire into the alarm.

Alarms can alarm  without wetness, i.e. give false alarms,  when the batteries are low or if incorrect batteries are used. If in doubt try a change of batteries (batteries are easy to change in MALEM® alarms). 

When replacing batteries always change all three batteries, not just one or two.  Make sure the batteries  are of the type recommended. The correct batteries can be obtained by mail order or by Internet order from MALEM®/Medstat®, or by quoting the correct specification from the instruction sheet to a pharmacist, photographic shop or hearing aid service. When putting the batteries in the holder always hold the batteries by the side, or with tweezers, and  never with fingers front and back

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Most experts now agree that refusing to allow a child all drinks in the period before bedtime does not reduce bedwetting.

Some experts urge children to drink lots of fluids for a period BEFORE using an alarm. This is to try and increase the amount of urine held in the bladder before emptying.  It is usually suggested that these extra fluids are taken during the day, with only "normal" amounts of fluid in the period just before bedtime. This programme of lots of fluids in the daytime should continue when an alarm is being used at night. 

Fluid loading before bed is now recommended by many experts when a child has been dry for 14 consecutive nights while using a wetness alarm system.  Research indicates that children who are encouraged to drink more at night-time (thereby overloading the system) will be more likely to remain dry in the future. Extra drinks before bed may cause a return of wetting (with alarms if an alarm is fitted - which it should be)  for a short period of time. This return of wetting is only while the the bladder “learns” to hold the extra  amount of urine. The alarm must continue to be fitted each night during this period of fluid loading, until there has been another 14 dry nights without wetting despite the fluid loading (or follow the programme suggested by your enuresis advisor).

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If you would like to write a little story or poem about how bedwetting as a person feels, or about how you became “Boss of Your Bladder” and
achieved dryness, we would love to hear from you.

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The following letter came to us  from a mother in New Zealand who has been trialing the MALEM® Alarm with her son.  MALEM® alarms are  distributed in New Zealand by the company REM Systems® of Auckland.:

“I am writing to let you know how delighted we are with the MALEM® alarm you supplied us with four weeks ago.  George has now been consistently dry at night for two weeks and is incredibly pleased with himself. George is ten years old and started wetting at night about three or four years ago.  We initially used “pull ups” thinking that he  would grow out of wetting and then when it became obvious that he wasn't going to, we visited a paediatrician.  Our paediatrician recommended the use of an alarm, but could not recommend any alarm in particular. We have tried two different types of alarms bought from  pharmacies, both of which had sensors encased in plastic which clipped on to underpants or to a pad sitting on the pants.  Neither alarm proved  reliable.  They seemed to need a great deal of urine to set them off and frequently did not go off at all despite very wet pants.  Progress was non-existent. My final step, which on reflection should have been my first, was to ask the  Auckland Hospital Enuresis Department to recommend an alarm. They put me on to you at REM® and I was very grateful that you offered me the MALEM® alarm on trial. 

The attributes that make the MALEM®  alarm stand out from the others we tried are as follows:

1. The safety pin with which it is attached to the pyjama top or T-shirt is simple and versatile.  The previous system involved sewing Velcro to a specific top.
2. The sensor on the MALEM® alarm is extremely sensitive.  George would be woken after no more than a drop of urine.  Perspiration from fingers would set it off and we had to ensure that underpants were bone dry from the drier before
attaching the alarm. I sewed a cotton pocket onto a couple of pairs of underpants in the appropriate spot.  This fitted the sensor snugly but to ensure that it wasn't pulled out by accident, I attached the wire above the pocket with a Velcro patch.  This system worked well and George managed it himself. 
3. The noise the alarm makes is different each time it sounds  ensuring that there is no chance of getting used to it and sleeping through. 
(Editor's note - this mum uses the MALEM® multitone alarm (the yellow one). Other MALEM® alarms, including the original MALEM® brown alarm, do have just a single noise and are  also very effective. One of our experts comments:-  “I know of no research comparing the same noise each night with a different noise each night.  Most of the 25 years experience is with the original MALEM® alarm that always has the same noise.  The newer alarm can be set to give the same sound each night.  What wakes a particular child is correct for that child”.) 

newsletter continued in next column......   top

I have no hesitation in recommending the MALEM® alarm and have phoned our paediatrician to give him details of it.  I would gladly give further details of our experience with it to anyone who might be considering using it. 
You have an excellent product.

Yours  sincerely,

H. M. -  NZ   "

Another Wet Note......a new use for old alarms

When incontinence has been fixed and the alarm is not needed it most often gets put into a drawer and forgotten (a good thing to do for 12 months as bedwetting can come back and is usually quickly fixed by using the alarm again. It could be that the alarm should then be passed on to a friend or relative - or kept for the next generation. When writing this the rain came down and soaked the washing of the line. If I had hung a MALEM® alarm on the line I would have been told that it was raining. And the author (who is one of those who MUST obey.......) would not be in deep trouble later today with she who MUST be obeyed. We must try that idea out when the rain stops (and so watch in the next version of dry news for a report................).

How is it possible to have a “civil” war?

If most car accidents occur five miles from home, why doesn't everyone just move 10 miles away?

If all those psychics know the winning lottery numbers, why are they all still working?

Ever stopped to think, -  and forgotten to start again?

Time is what stops everything happening at once.

Why is abbreviation such a long word?

It is the policy of the Enuresis Advisory Service to recommend that patients find and accept help from a Professional Health Carer.  It has been our experience, and that of others, that patients who accept help and informed guidance from a
Health Care Professional have a much higher success rate in managing  an enuretic problem
than those who do not seek support. Give the Enuresis Advisory Service a ring on our Free Call number - 1800 803 756.  We have a
national database of  Health Care Advisers and Professionals who manage and treat enuresis.
Do have your child examined by your GP for possible physical problems  and have the urine
examined and checked in  a lab for infections.

Do not be misinformed, ALL CHILDREN DO NOT ALL GROW OUT OF BEDWETTING.  In fact, at The Enuresis Advisory Service, we
have given advice to adults who still suffer with enuresis in their twenties and forties. Sad but true. 

Generally speaking, by the age of 5, if your child is motivated to become dry, active management of the problem is recommended. 
Why wait until children are older if there can be earlier progress with simple strategies, which may or may not need to include the use of a wetness alarm. There is a reluctance among some doctors and paediatricians to recommend  management of bedwetting with an alarm before the age of seven. Many doctors and other health professionals have, however, chose  to introduce a MALEM® alarm for their own children at or around five, and sometimes when even younger!  There are many accounts of success at these younger ages. Sometimes the reaction of the younger child to an alarm going off suggests that for that child,  who shows distress, it may be better to wait until they are older. Another possibility is to consider using  the new "wireless" MALEM® WetNo alarm. With this  WetNo wireless alarm (see below) it is Mum or Dad (or other caring person) doing the waking and not an alarm (the alarm  is used to wake or alert the adult doing the "training)".

NEW PRODUCTS FROM MALEM
 

LOOK NO WIRES!!

The most recent alarm  to become available from MALEM® is a wetness alarm without wires - a wireless alarm - called the MALEM® "Wee-No". This is now being evaluated in Australia and New Zealand, both to help with assessment of those with enuresis and for the management of specific children, e.g. those with deafness who do not hear the sound of an alarm (and may not wake with the alternative MALEM® alarm for deaf children  - the green alarm that vibrates rather than make a noise). The MALEM® "Wee-No"  wireless alarm may also have an important role in helping the younger child become dry, at an age when to have an alarm sound off is still too frightening. With the MALEM® "Wee-No" alarm Mum, Dad or other carer can be alerted to wetness, and come to a child to fix it at once. They can also get the child to wake close to the time of wetting  and so help develop night-time dryness.

Our experts are expecting to find that the  "Wee-No" is very useful in the initial evaluation of bedwetting. The wetness sensor, which is about the size of a 50 cent coin, can be placed in the pants at night time. When there is wetness an alarm will sound in the room where the parent or carer has placed the alarm unit. The alarm unit is  the size of a pocket camera and is supplied with both a belt attachment and has a flat bottom for a bedside position. After a few nights of use there will be information available on how often there is wetting and at what times. This information will allow professional advisors to detect those children who may need a less standard approach to a problem, perhaps because a child wets several times each night. (The "Wee-no" is available for sale from the Enuresis Advisory Service or for hire from some clinics).  

Detecting wetbeds or wetpants? 

The MALEM® alarm was the first body-worn alarm with a small body-worn wetness sensor that detects wet pants as well as wet beds.  There are many clinics that continue to promote the alternative alarm, the "bell and" pad", which uses an "in-bed" wetness sensor (pad) that is fitted between the sheets and is connected to a bedside alarm. MALEM® have now released a new "in-bed" wetness sensor. The MALEM® "in-bed"  wetness sensor, the MALEM® Bed-Mat, is fitted between the sheet and the under sheet. The wires from the MALEM® "in-bed" sensor can then be connected to any of the range of MALEM® alarms, placed on a bedside table or at the head of the bed. This new release  is to supply those clinics who still prefer the "bell and pad" method of treating enuresis, but have not liked the price of the "bell and pad" units, these are close to $A1000 to purchase. MALEM® alarms for this purpose will still be around $A100.