Bedwetting (Primary Nocturnal Enuresis)
Treatment Overview
Most children gain bladder control over time without any treatment. Bedwetting that continues past the age that most children have nighttime bladder control—typically at 5 or 6 years of age—also will usually stop over time without treatment. If not, home treatment may be all that is needed to help a child stop wetting the bed. Home treatment may include:
- Monitoring when and how much your child drinks. Give your child most of his or her needed fluids in the morning and afternoon.
- Restricting your child's intake of caffeine, especially at night.
- Having your child use the toilet before going to bed.
- Reminding your child to get up during the night to go to the bathroom.
- Letting the child help solve the problem, if he or she is older than 4.
- Offering your child disposable nighttime training underpants. Don't force a child to wear them, but if you are both comfortable with using them, there is no reason not to.
- Praising and rewarding the child for dry nights.
If home treatment is unsuccessful, if the child and parents need assistance, or if the bedwetting may be caused by a medical condition, medical treatment may be helpful. The goal of medical treatment is to decrease the frequency of bedwetting and to increase the child's use of the toilet at night if needed. Eventually bedwetting will stop completely, but this may not happen immediately after treatment.
- Treatment is considered successful if the child remains dry for 14 nights in a row within 16 weeks of treatment.
- Treatment is considered a complete success if the child does not have any accidental wettings for 2 years after treatment.
- Children who have an increase in accidental wettings after treatment are considered to have relapsed. A relapse is defined as more than 2 wet nights in 2 weeks. The most likely time for a child to relapse is within the first 6 months after treatment. If a child relapses after stopping a successful therapy, that same therapy usually is repeated.
Medical treatment for bedwetting may include:
- Education for the parents and child about what is normal and expected for children as they grow and about how the urinary system works.
- Motivational therapy. This method involves parents encouraging and reinforcing a child's sense of control over bedwetting.
- Moisture alarms that detect wetness in the child's underpants during sleep and sound an alarm to wake the child.
- Imipramine and desmopressin medicines. These medicines, which increase the amount of urine that the bladder can hold or decrease the amount of urine released by the kidneys, may help some children.
Treatment for bedwetting is based on the:
- Child's age. Some treatments work better than others for children of a specific age group.
- Child's and parents' attitudes about the bedwetting. If gaining bladder control is seen as a normal process, it is usually easier for the child to stop bedwetting.
- Home situation. If the child shares a bedroom with other children, certain techniques to arouse the child, such as dry-bed training or some moisture alarms, may not be practical.
Treatment for bedwetting may be helpful if bedwetting is affecting a child's self-esteem, performance in school, or relationships with peers.
For more information, see:
What about treatment for daytime wetting?
Accidental daytime wetting may be a normal part of a child's development, or it may indicate a medical condition. If your child has any symptoms of a medical condition, he or she should be evaluated by a health professional.
What To Think About
Studies show moisture alarms to be the most effective single treatment for bedwetting.
Medicines for bedwetting are usually used in combination with other methods of treatment. They are not as successful as other treatments in helping children gain complete bladder control, so medicines should be used after other measures have been tried first. Medicines may be most helpful in the following situations:
- To help older children control bedwetting for short periods of time, such as for camp or overnight trips
- To treat bedwetting that is related to a stressful event, such as the divorce of the child's parents or the birth of a sibling
Often a child who has responded successfully to treatment will begin to wet again after treatment has stopped. However, most children who relapse can be treated successfully with a repeat of the original program, especially if that program is based on behaviour modification, such as using a moisture alarm.
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| Author: | Amy Fackler, MA Debby Golonka, MPH Carrie Henley | Last Updated: January 11, 2007 |
| Medical Review: | Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Peter Anderson, MD, FRCS(C) - Pediatric Urology | |
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