Enuresis in Children
How Is Enuresis Treated? continued...
When treatment is used, therapy aimed at changing behavior is most often recommended. Behavior therapy is effective in more than 75% of patients and may include:
- Alarms: Using an alarm system that rings when the bed gets wet can help the child learn to respond to bladder sensations at night. The majority of the research on enuresis supports the use of urine alarms as the most effective treatment. Urine alarms are currently the only treatment associated with persistent improvement. The relapse rate is low, generally 5% to 10%, so that once a child's wetting improves, it almost always remains improved.
- Bladder training: This technique uses regularly scheduled trips to the bathroom timed at increasing intervals to help the child become used to "holding" urine for longer periods. This also helps to stretch the size of the bladder, which is a muscle that responds to exercise. Bladder training is typically used as part of an enuresis treatment program.
- Rewards: This may include providing a series of small rewards as the child achieves bladder control.
Medications are available to treat enuresis, but they generally are only used if the disorder interferes with the child's functioning and usually are not recommended for children under 6 years of age.
Medications may be used to decrease the amount of urine produced by the kidneys or to help increase the capacity of the bladder or. Drugs commonly used include desmopressin acetate (DDAVP), which affects the kidneys' urine production, and imipramine (Tofranil), an antidepressant which has also been found useful for treating enuresis.
While drugs can be useful for managing the symptoms of enuresis, once they are stopped, the child typically begins wetting again. When choosing medications for children, the side effects and cost need to be considered; the medications may help improve the child's functioning until behavioral treatments begin to work.
What Is the Outlook for Children With Enuresis?
Most children with enuresis outgrow the disorder by the time they reach their teen years, with a spontaneous cure rate of 12% to 15% per year. Only a small number, about 1%, continues to have a problem into adulthood.
Can Enuresis Be Prevented?
It may not be possible to prevent all cases of enuresis -- particularly those that are related to problems with the child's anatomy -- but getting treatment as soon as symptoms appear may help reduce the problems associated with the condition. Being positive and patient with a child during toilet training may help prevent the development of negative attitudes about using the toilet.