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>As a doctor, I have dealt long and extensively with >the topic of diaper discipline. Personally, I find >this form of education extremely helpful and support >it without any reservation. That's why I always try to >support interested parents with advice and support. >I've been following this forum for some time and there >seems to be a lively exchange here that I would like >to take part in. >I would like to make a few comments on the question of >how older children in particular can be put back into >diapers without major problems. > >In my opinion, diaper discipline and voluntary >incontinence are inseparably linked in older children. >However, one should be aware that artificially induced >incontinence is always a long-term decision. >A week or even just a weekend or something like that >isn't possible. Such a decision must always be made >for at least 3 months. > >Perhaps I should briefly explain the urethral tract to >avoid misunderstandings. >The bladder itself is a muscle, at the end of the >bladder there is a sphincter that is controlled >separately. >When you need to urinate, the sphincter relaxes and >the bladder contracts. Only the strong contraction of >the bladder creates a powerful jet. If only the >sphincter opened, it would be a long-lasting dribble. >If you now - in whatever way - ensure that the >sphincter always remains open, then you immediately >achieve what is known as droplet incontinence. >In principle you just have to stop the sphincter from >closing. This can be achieved mechanically with a >stent - this is a tube that always keeps the exit open >- or with medication. Good old Botox has proven to be >a good remedy. A few injections placed circularly into >the sphincter ensure that once the medication has >spread throughout the tissue, it weakens and no longer >closes. After the injection, the full effect takes >place within the next 12 hours. From then on, diapers >are unavoidable for at least the next 12 weeks. >It should be mentioned that the injections are very >easy in girls, but are much more difficult in boys >because of the much longer urethra and the associated >poor access to the sphincter. But there are solutions >here too. > >These comments may help some parents who are just >starting out in diaper training when it comes to how >to keep children in diapers for long periods of time.

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