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Call For Papers


Robert A Pretlow, MD   eHealth International, Inc. - USA

educational objective: understand that the Internet can serve as a useful tool for gathering information from individuals with medical conditions. (Internet in primary care)

Background/Purpose: Enuresis (wetting) affects an estimated 200-300 million children, teenagers, and adults worldwide. Incontinence likewise affects millions of individuals. In many patients, if not most, the cause of the condition cannot be found. Dealing with enuresis and incontinence is therefore frustrating for parents and healthcare providers. An interactive website was created to learn more about enuresis issues and to promote a new miniature ultrasound device that monitors bladder volume. This website rapidly expanded into a global website on enuresis, receiving approximately 60,000 users per month.

Materials and Methods: A multiple-choice questionnaire (poll) was implemented on the website to assess the interest of enuretic individuals in a bladder volume alarm device that would awaken the person in the night when their bladder volume was at the point where enuresis typically occurred, so that they could get up and use the toilet. A surprising result to this questionnaire was that 63% of those responding (n = 128) indicated that they would rather sleep in a diaper than wake up and use the toilet in the night. In light of this result, further questionnaires about diapers were implemented on the website, such as, “How do you feel about wearing diapers for bedwetting protection?”, “Do you feel that diapers should be stopped occasionally?”, and, “Do you ever wet on purpose, so that you can wear diapers?” Additionally, postings from a message board forum on enuresis were categorized and tabulated.

Cookies were used to minimize hacking of the questionnaires and to avoid a user answering the same questionnaire more than once. Additionally, user IP addresses were logged, and answers with duplicate IP addresses were deleted.

Results: A startling result to the questionnaire, “How do you feel about diapers as protection for nighttime wetting?” was that 50% of respondents answered that diapers were a “comfort” to them, and that they did not want to ever stop wearing diapers (n = 179). Those choosing this answer included ages 8 to 61. Only 16% agreed that, “diapers should be stopped every so often for a few days, to provide motivation to learn to stop wetting at night.” In response to a questionnaire, “If an alarm did not help your nighttime wetting (like an alarm clock or a wetness alarm), why do you think it did not help?”, 49% chose, “I never want to stop wearing diapers, so I really don't care if an alarm can help me to stop wetting at night” (n = 89). A final questionnaire asking, “Have you ever wet on purpose, so that you can wear diapers?” is still in progress at this writing, but preliminary results (n = 40) indicate that more than 50% of children and teenagers wet on purpose to justify wearing diapers. Postings on a message board enuresis forum (n = 1767 postings, over a period of 26 months) corroborate the results of the questionnaires. Approximately fifty-percent of postings indicate an attraction to diapers. Individuals expressing attraction to diapers typically ask, “Is there someone else out there like me?” Moreover, some users state that the reason they finally stopped wetting was, “… because I was tired of diapers.”

Discussion: Diaper "fetish", which is a sexual attraction to diapers, appears to be quite common. A search on the term, “diaper fetish” with the Google search engine produces 25,700 results. Emotional attraction to diapers, which is called "infantilism", appears to be nearly as common. Searching on the term, “infantilism” with the Google search engine produces 12,000 results. Web testimonials of individuals with infantilism say that diapers induce a feeling of "security". Emotional attraction to diapers may also be associated with fantasizing about infancy and even using other infantile items such as pacifiers, baby bottles, car seats, cribs, etc.

In light of our questionnaire results and the fact that emotional attraction to diapers and diaper fetish appear to be quite prevalent on the Internet, it can be argued that these behaviors are a significant cause of enuresis and incontinence. Emotional attraction to diapers and diaper fetish should, therefore, be included in the differential diagnoses of enuresis and incontinence.

Medical science seems to be unaware of these behaviors. A search via Medline (U. S. Library of Medicine) on infantilism and diaper fetish produces no articles on the phenomena. Therefore, until the Internet came along, emotional attraction to diapers and diaper fetish were apparently “closet” behaviors, similar to previously closet behaviors like cross-dressing. The Internet has allowed individuals with these behaviors to come forth out of the closet, without having to reveal their identities.

The causes of diaper attraction behaviors and whether they are harmful to affected individuals or to society were not part of this study. Nevertheless, when working up a patient with enuresis or incontinence, a psychiatric consultation may be indicated in order to rule out diaper attraction as the cause. Potentially hazardous procedures and treatments may thereby be avoided. Moreover, underlying psychological problems may be revealed.

Conclusion: The Internet, because of its anonymity, can serve as a useful tool for gathering information from individuals with medical conditions, particularly conditions with social stigmas attached. This conclusion is, of course, based on the assumption that Internet users are representative of society as a whole. Nevertheless, information gathered via the Internet may result in discovery of previously unknown causes of such conditions. Further refinement of this new investigational tool is warranted.

Key Words: enuresis, incontinence, diaper, infantilism, fetish

disclosure: The commercial product/service "Website for enuresis" is presented. Commercial interests include: eHealth International,Inc. shareholder .