Dear Bob,

We are a coed resident camp. Our campers start at age seven or eight and often stay until age 15. One of our 15-year-old female campers, who is about to start her last year as a camper, started wetting her bed five years ago soon after her mother died. At first everyone seemed to think this was a reaction to her profound loss. However, there has been no change in her bed-wetting in the five years since. At camp our staff is so good about changing her sheets discretely and getting everything back in order that I doubt her cabin mates know. At least we have no reason to suspect they know. I would say that out of 14 nights at camp she might wet her bed nine or ten times. When asked about it, her father says that she’s been through a lot and more or less explains it away.

My question to you is, is there anything we can do to help her? I can’t imagine how a teenage girl must feel having a secret like this. Furthermore, this is her last eligible year as a camper. Next year she could come back as a counselor-in-training (CIT), but we couldn’t have her in a cabin with campers with this habit. Any advice?

— Hanging Out to Dry

Dear Dry,

Bed-wetting is certainly a common enough behavior at camp; and bed-wetting in reaction to a loss, which is a form of regression, is also not so unusual. What is unusual is how long this behavior has persisted. One observation I have is that everyone, from your staff to her father, has made it so comfortable for this young lady that she has had no incentive to change what has obviously become a habit for her. While I understand that her father may be trying to protect her from the pain of her loss, which if I were to speak with him I would certainly acknowledge, he — and by extension, you — are not doing her any favors by helping her avoid what will become an increasingly embarrassing problem for her as she gets older. After all, how can she stay over at a friend’s house knowing she might wet her bed? And, as you point out, how could she possibly return to your camp as a potential CIT if she has this problem?

The challenge, of course, is how to have this conversation in a way that is respectful and least embarrassing to her. This requires some skill. Again, the person at your camp who has the best relationship with her would probably have the best chance of crafting a careful conversation with her. I would start simply by “joining” with her — talking about her time at camp or any other nonthreatening topic. Once the conversation is going I would validate her for her positive traits. Not knowing this girl makes it hard for me to offer examples that are specific to her, but they might be how thoughtful she is with others, how outgoing she is, how great a friend she is, and so on. If the person speaking with her has known about the bed-wetting issue, as it seems several staff members have, then it would be pretty easy to ask about it. It might be as simple as, “You and I both know you’ve had that nagging bed-wetting problem. I can only imagine how challenging that must be for you. I think you’ve been incredibly brave about coming to camp in spite of what could be so embarrassing to you. I wonder if there is any way we could help you with that?”

First of all, I would guess that after her initial caution and concern about feeling ashamed, she might well be grateful that someone is finally talking to her about it openly and respectfully. My experience is that most kids, even while resisting a conversation — usually out of fear of being shamed — are relieved to have an interested, respectful, caring adult draw them out about whatever it might be that is haunting them, especially if it is done skillfully and in a way that honors them, as I have suggested in the preceding dialogue. Furthermore, in the 15-year-old’s case, if she can talk about the drawbacks of the problem — not being able to stay over at a friend’s house and the fear of her problem coming to the awareness of her friends at camp — it might help motivate her to try a technique that could help her.

The method I have in mind is very simple, but it involves her trusting her counselors. It can also be used with many campers who have a tendency to wet their bed. Here’s how it works:

  1. Have her and her counselors create a secret signal that only they understand. The signal, which could be a certain phrase or hand movement, is her way of telling her counselors that she has to go to the bathroom to urinate.
  2. Once she is awake in the morning she should avoid urinating until she is actively aware that she has the urge to go. At that point she should signal her counselor.
  3. The counselors will then have her wait for four minutes before she relieves herself.
  4. Over successive days the number of minutes she has to wait increases by two minutes. Continue until the total wait time is ten minutes.
  5. Encourage her frequently and discretely during this trial period because, if she is like most children with a longstanding bed-wetting problem, she will forget to signal her counselor and miss the opportunity to benefit from this routine.

What this “telling and holding” protocol does is twofold: 1) It actually strengthens the sphincter muscle, which may or may not have less tone than other kids’ her age; and 2) it fortifies the neural pathway between the brain and the sphincter. Over time this will help her maintain better control at night.

Another option she could explore would be to speak with her doctor about exploring the possibility of using a medication for treatment of her nocturnal enuresis. While I am not a medical doctor and, I presume, neither are you, her doctor can decide whether such a medication intervention would be safe and appropriate.

I have one other thought about this young lady’s lingering bed-wetting habit. Not knowing this young lady makes it harder for me to size up what she might actually need. However, what crosses my mind is the degree to which she has grieved and been allowed to grieve the loss of her mother. Very often the trauma of such a loss is so great that families try and “move on” without giving themselves the permission to acknowledge that loss and grieve it. I have known some surviving parents in such situations who may not only be trying to shield their child from pain, but may be avoiding their own pain. If this is the case, the persistent bed-wetting is almost like the psyche’s way of insisting on the chance to heal by signaling that “all is not right” in this young lady’s mental world. Having the chance to cry and feel sad, which is an affect entirely different from depressed, may just be what this young lady needs. While it is difficult to be at camp and feel such grief about so intimate a relationship, having some safe time with a trusted counselor might be something she would respond well to without it adversely affecting her time at camp.

Bob Ditter is a licensed clinical social worker specializing in child, adolescent, and family therapy. “In the Trenches” is sponsored by American Income Life Insurance.