Most children will outgrow their nocturnal enuresis. But according to a medical article from the Journal of Paediatrics & Child Health, a child is considered “enuretic” if wetting occurs at least twice per week and “persists beyond the age of five years.”
The good news is that it has been proven that nocturnal enuresis (or bedwetting at night) can be cured. That’s good enough, but what’s better is the fact that there are several treatment options available. That means you’ll have more choices depending on the needs of the child.
Factors that Can Affect Results
Are you ready to put an end to your child’s incontinence?
Before we present the best bedwetting solutions available, you need to first understand that results vary from one patient to another. These variations are caused by several factors, which include the following:
– Child’s attitude
The patient’s attitude plays a very important role in the success of a bedwetting treatment. For starters, your child must want to achieve dryness overnight and put an end to the problem. Whatever method you choose, he must have appreciation of it by understanding how it works.
For instance, in the case of an enuresis alarm treatment option, the child must understand that for this method to work, he must not ignore the alarm when it goes off. Instead, he has to wake up to the alarm and relieves himself in the bathroom.
– Parent’s attitude
It also takes commitment on the part of the child’s parents (and siblings) for a treatment to succeed. Again, taking alarm therapy as an example, the early stages of this method can be quite difficult for the household. Especially during the first few nights, parents must be willing to help the child to wake up, unclip the alarm, and relieve in the bathroom.
And even though the child seems to have gotten the hang of using the alarm, he still needs continued support from the parents.
According to Jonathan H C Evans, a consultant paediatric nephrologist, “stressful early life events” can contribute to the development of nocturnal enuresis. Further, it’s possible that your child’s problem with bedwetting can be associated with a “poor self-concept or other psychological problems.”
Here are two very important recommendations to assure that your child is free from possible stressors. (Source: Journal of Paediatrics & Child Health)
- To maintain self-esteem, punishment and humliation should be avoided.
- Open communication between the child and parents is a must.
Different Types of Bedwetting Treatments
When we say “enuresis treatment,” we mean “self-awakening.” The treatment option can be likened to a training program. It teaches the brain to recognize a pattern so that eventually, the child acquires the skill of waking up to relieve himself in the bathroom unsupervised.
There are at least three bedwetting treatment options to choose from. Each has a different cure rate. Sometimes, if one method is not enough, a combination treatment is applied.
– Alarm Devices
An enuresis or bedwetting alarm is a battery-powered device that makes a sound, vibrates, and / or emits light when urine (or moisture) comes in contact with its sensor.
In general, there are two classifications of enuresis alarms – body worn and bed-side types. Wearable alarms are secured onto the bedwetter’s clothes, while bed-side types are ideal for patients who are comfortable with wires attached to them.
Another type of alarms that are gaining a fast following are the wireless types.
Here are some examples of enuresis alarms we’ve reviewed. These represent the types of alarms mentioned above.
- Body-Worn: Chummie Premium Alarm
- Bed-Side: Malem Ultimate Bed-Side
- Wireless: Rodger Wireless Bedwetting System
Are bedwetting alarms effective? The quick answer is “yes.” Read this to know more.
– Drug or Pharmacological Therapy
There are at least three drugs targeting enuresis – desmopressin acetate, impiramine hydrochloride, and oxybutynin chloride.
The most common pharmacological therapy for enuresis is with the use of a synthetic analogue of antidiuretic hormone called “desmopressin acetate.” Ideal for short-term use, desmopressin can be used alone or it can be combined with a bedwetting alarm for better results. In settings when alarms are not an option (e.g., camps and sleepovers), desmopressin treatment is a good alternative.
Another drug treatment option is using a trycyclic antidepressant called imipramine hydrochloride. According to this evidence-based case review, this drug’s mode of action is unclear but it’s effective against enuresis and that the effect is often immediate.
Some patients suffer from bedwetting because of detrusor overactivity. This overactivity is experienced when the patient’s spinal cord and bladder do not communicate effectively. Further, detrusor overactivity is often associated with those suffering from multiple sclerosis or a spinal cord injury. That said, a drug called oxybutynin chloride is used for the treatment of incontinence due to detrusor overactivity.
– Behavioral Therapy
Behavioral therapy involves strategies that gear towards modifying the behavior of the child so he can respond to
Awakening programs are an example of a behavioral therapy without the use of an apparatus. There are two general types of these programs – self-awakening and parent-awakening. An example of self-awakening takes the form of a rehearsal before bedtime. The parents and the child rehearse the events leading up to emptying the bladder in the bedroom. If self-awakening programs such as this don’t work, parent-awakening techniques are applied. As an example of a parent-awakening technique, parents can apply the “dry bed training” suggestion of Azrin and Thienes.
Another techniques is the use of a positive reward system. The child receives a reward (e.g., sticker, star) when he has had a dry night.
– Combination Therapy
With combination therapy, one or more treatment options are applied. For instance, alarm devices can be used with desmopressin.
Which Treatment Option is the Best?
In general, a combination treatment is the best option. For instance, in a study published at the Acta Paediatrica, authors Bradbury MG and Meadow SR found that a desmopressin-plus-alarm treatment option is 40% more effective than using an alarm alone.
But if you’d like to choose only one, here are some notes that can help you decide.
– In a paper by Schmitt BD published at the Pediatrics in Review, it was concluded that enuresis alarms have the “highest cure rate and lowest relapse rate of any intervention.”
– One study published in 1972 by Kolvin et.al. found that subjects who were given imipramine experienced an “almost immediate improvement” but that the improvement was poorly maintained when treatment stopped.
– In a study by Butler RJ et. al., it was found that body-worn alarms are as effective as their pad-and-alarm counterparts.