Enuresis in Children
How Is Enuresis Treated?
Treatment may not be needed for mild cases of enuresis, because most children with this condition outgrow it (usually by the time they become teens). Knowing when to begin treatment is difficult, because it is impossible to predict the course of symptoms and when the child will simply outgrow the condition. Some factors to consider when deciding to begin treatment are whether the child's self esteem is affected by the wetting and whether enuresis is causing impairment in functioning, such as causing the child to avoid attending sleepovers with friends.
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.