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How is Enuresis (Bedwetting) Treated?

There are many treatments for bedwetting, some work better than others. Often, treatment starts with simple changes like:

  • Reducing the amount of fluids your child drinks 1-2 hours before bed
  • Creating a schedule for bathroom use (changing toilet habits)
  • Wetting alarm devices
  • Prescription Drugs

These strategies may be tried one at a time, or together.

The following strategies have not been shown to help:

  • Stopping food and fluid intake
  • Night waking
  • Pelvic muscle exercises 
  • Alternative therapies

Reducing the amount of fluids your child drinks 1-2 hours before bed

Begin by encouraging your child to drink 1 or 2 extra glasses of water in the morning or at lunchtime. Then in the evening, your child should only drink to quench thirst. Try to prevent drinking 1 to 2 hours before bed. Also, limit or stop your child from drinking caffeinated and carbonated drinks like soda. 

Creating a schedule for bathroom use (changing toilet habits)

Bladder training is a way to set a bathroom schedule with your child. For example, have your child sit on the toilet five times each day and before bed, even if he/she says he/she doesn't have to go.

Bedwetting (enuresis) alarms

Bedwetting alarms have a special sensor that detects moisture in a child's pajamas or Pull-Ups® training pants. It triggers a bell or buzzer to go off with wetness. The child wakes with the alarm and tries to get up to go to the bathroom before having an accident. An adult will need to help, since most children who wet the bed sleep very deeply and do not wake up by themselves at first. The alarm works by "conditioning" a child to wake when it's time to urinate. This is behavioral-type therapy that is known to be very successful.

Bedwetting alarms work with a sensor in the child's pajamas or underwear that links to an electronic alarm. The alarm is either attached to the child's clothing near the shoulder or clipped to the waist. The alarm unit may also be wireless, and placed on the counter. When the sensor becomes moist, the alarm is triggered. Some alarms also have a vibration mode that shakes the device. The alarm wakes the child so he or she can get to the bathroom to urinate or finish urinating.

Success for alarm therapy depends on parents understanding that this is a learning process. There are stages that a child and parents must go through for best results. Without patience, parent and child frustration will lead to quitting. Please try not to give up.

In the first and second stage of therapy, parents must wake up with the alarm and then wake the child from bed. The child then gets up, goes to the toilet, and tries to urinate for couple of minutes. they should then clean themselves in the shower, change their bed sheet or put on new pull up. The parent should be supportive and help. Then the child will turn the alarm back on, and go back to bed. In the third stage of therapy, the child should be able to wake on his or her own when their bladder feels full. Once the child successfully reaches this stage, parents should ask the child to use the device for 2-3 more weeks to reinforce this behavior.
Everyone at this stage should feel proud and relieved.

Tips for success:

  • Choose 3-4 months when a simple home routine can be made for treatment.
  • Agree with the child on a date when therapy will begin.
  • Perform a few drills with the alarm during the day so the child knows what to expect and what to do. 
  • Keep a calendar in the child's room to monitor progress.
  • Do not punish your child for accidents. Punishment is counterproductive. Instead, offer rewards for cooperating with therapy and completing tasks.

Advantages:

  • Not a prescription medication, so there are no side effects
  • Low rate of recurrence after device is stopped upon successful treatment
  • If used the right way, the chances of success are about 75% after 1 to 2 months of nonstop alarm treatment. 

Disadvantages:

  • They require hard work and commitment from parents
  • They are not good for sleepovers.
  • They disturb siblings who share a bedroom
  • Many health plans do not pay for these devices, and they cost around $100

Drugs

Desmopressin acetate (DDAVP)

Desmopressin is made from the hormone "vasopressin".

In normal conditions, vasopressin is produced by the kidneys when the body tries to conserve water. For example, athletes secrete more vasopressin when they are active and sweating. Most people have naturally higher levels of vasopressin during sleep. That is part of the reason why we can sleep through the night without needing to pass urine. In many children with enuresis, this hormone surge is absent. DDAVP is available as a pill. It can be given an hour before going to bed for a period of 3-6 months, with a one week break. Because it works to decrease the volume of urine made, it is used with a schedule of drinking less fluid.

Advantages:

  • When it works, it works very well
  • Can boost confidence on sleepovers 
  • Can be used privately 
  • The cost is usually covered by most health plans

Disadvantages:

  • This drug works on less than half of the treated children 
  • The child's body can adapt with time and stop responding to the drug

Oxybutynin and Tolterodine

These prescription drugs stop the bladder from having spasms with overactive bladder symptoms. It is helpful when a child has small bladder capacity, by increasing that capacity.

Advantages:

  • The drug can be combined with desmopressin to become more effective. The medication is safe and well tolerated by children.

Disadvantages:

  • The drug doesn't work for everyone. It may 
  • Common side effects include dry mouth, constipation, and facial flush. If constipation becomes a problem, be aware that this can make bedwetting worse.

Imipramine

Imipramine is an anti-depressant medication that has been used for many years to treat children with bedwetting. It does not mean that depression is a cause for bedwetting. It is not clear how imipramine helps in this case, but it is believed to improve the child's sleep patterns and bladder capacity. Side effects can include irritability, insomnia, drowsiness, reduced appetite, and personality changes. Overdose can be deadly. This drug must be used and stored safely.

Finally, your health care provider should look for signs of constipation. Treatment with dietary advice and laxatives may be recommended. This may help with your child's bedwetting issue.

Treatments That Are Not Recommended

Stopping all food and fluids before bedtime

Many parents think that if their child stops eating and drinking several hours before bed, it will help reduce or eliminate the bedwetting. However, this rarely helps. It's a good idea to stop drinks 1-2 hours before bed and to always limit caffeinated and carbonated sodas. However, if a child is hungry or thirsty, it is okay to provide small amounts of food and water. (Note: Limiting drinks is needed for treatment with vasopressin drugs.)

Scheduled night waking

Before seeking medical care, many parents try waking a child during the night to take him/her to the bathroom. Some families try this more than once during the night. While it can be helpful in the short term, it is hard to continue over time. It is hard on family members and does not always work. Sometimes the child will still wet the bed

Pelvic floor muscle exercises

Adults with bladder control problems may find help with pelvic muscle exercises, like the Kegel. During these exercises, adults are asked to hold a full bladder and try to stop their urine stream. This effort does not usually help children. Children who hold their urine on purpose during the day may lead to problems with urgency, daytime wetting and even UTIs.

Alternative therapies

Homeopathy, herbal cures and chiropractic practices have not been found to help with children's bedwetting.