Treatment Options

How is it treated?

Nocturnal enuresis is typically not treated until the patient is at least five years of age. More important than age when determining when to treat, is the child?s readiness to receive treatment. If the child is not ready, the therapy is less likely to be successful. There are two basic types of treatment: behavior modification and drug therapy.

Behavior modification therapies include bedwetting alarm, positive reinforcement, and responsibility training.

• Bedwetting Alarm: These alarms are triggered to go off when the child wets the bed. The child, when awoken, will then either get up and finish voiding in the restroom or hold it until later. Most alarms that are available will emit a sound when they go off, however, there are alarms available that will vibrate instead. The vibrating alarms are useful in situations where the child is sharing a room with another sibling by preventing the awakening of others. The bedwetting alarm may need to be used for up to 16 weeks before symptoms resolve. After 14 dry nights in a row, the alarm should no longer be needed. Bedwetting alarms have proven to be the most effective treatment of nocturnal enuresis. They are also associated with the lowest percentage of patients who, after stopping treatment, return to wetting the bed.

• Positive Reinforcement: There are a couple different methods used in positive reinforcement. One method involves the child placing stickers on a chart for every dry night he or she has. The child is working toward a preset number of stickers. The other method uses connect-the-dots. The child gets to connect two dots for every dry night, with the goal of completing the picture. For both methods, once the child reaches the preset number of stickers or completes the picture, the child is given a prize.

• Responsibility Training: This method requires the child being given a responsibility that is age appropriate and a consequence of wetting the bed. It is important that the child does not feel like he or she is being punished. When the child wets the bed the assigned task is carried out. Taking the sheets off of the bed may be appropriate for younger children, while washing the sheets may be fitting for an older child.

• The main drugs used to treat bedwetting are desmopressin (DDAVP), imipramine, and oxybutynin (Ditropan).

• Desmopressin (DDAVP): Desmopressin is the first-line drug therapy for patients who experience nocturnal enuresis. It is a man-made form of vasopressin, an anti-diuretic hormone. It helps to decrease the amount of urine that is produced.

• Imipramine: Imipramine is a tricyclic antidepressant that can be used to treat nocturnal enuresis. It works by decreasing the bladders ability to contract (or get smaller) this allows for the bladder to get fuller before needing to void. Imipramine also works by decreasing the depth of sleep that patients have during the last third of sleep. This will make it easier for the child to be awakened when he or she has the urge to go to the restroom.

• Oxybutynin (Ditropan): Oxybutynin is an anticholinergic medication that works to relax the muscles of the bladder. It is most effective in patients that not only have wetting problems at night, but also during the day.

• Other general measures that should be taken to help with the treatment of nocturnal enuresis include: children maintaining a voiding diary, improved access to the toilet, discontinue fluids 1 or 2 hours before bedtime, encourage voiding prior to going to bed, and preserve the child?s self-esteem.

• Parents and children should be aware that it takes time for the treatments to be effective. If one treatment does not work one of the other treatments or a combination of treatments may be tried. Whichever treatment is chosen follow-up, support, and encouragement are important components of therapy.

• After successful treatment and discontinuing of therapy there is still a possibility that the patient will rebound and begin wetting the bed again.

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