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What doesn't help Punishments. The child is not doing it on purpose. Humiliation. Ditto. Teaching the child to "hold it till morning". Keeping the child thirsty. Diapers. They give the wrong message.
What about drugs? Two drugs are commonly used for the treatment of bed wetting.  They are both effective, but only while the child is taking them.  Nearly all children go back to wetting the bed once they stop the drug.  There is no drugstore shortcut to curing bed wetting. Desmopressin:-   This has recently become available in India.  It is a synthetic form of the hormone ADH (anti diuretic hormone), and reduces the production of urine.  It is taken as a spray up the nose at bedtime, and is effective for 10-12 hours.  About 70% of children benefit, and abot a quarter are completely dry while taking the drug.  It has a high relapse rate after stopping treatment, but is useful for short term use (for example, when the child has to attend a camp). Imipramine   This drug is taken an hour before bedtime.  About 70% of children benefit from its use; they have lesser wet nights a month, and lesser wetting accidents per night.  Most children relapse after treatment is stopped.  The drug has frequent and serious side effects.
Comparison of treatments for bed wetting   Cure rate Relapse rate Risks Alarms 70% 10% None Parent awakening Up to 90% 20% None Imipramine 10-60% 90% Serious Desmopressin 12-65% 90% Mild

Treatment of Bed Wetting
(Nocturnal Enuresis)

Bed wetting can be a terrible problem for a growing boy (or girl, of course, though the disorder is comparatively uncommon among them).  As he grows up, there are more and more opportunities and requirements for him to spend nights away from home, and the child with this problem has to find excuses all the time.  Even within the home, the teasing and humiliation can be merciless.

If an underlying cause  is found, treatment directed to it can usually stop the bedwetting.  Urgency (the inability to hold back the urine when the bladder is full) can be helped by drugs.  Similarly, bladder stones can be removed, urinary infections treated, and constipation relieved.  Treatment of diabetes is often difficult in children, but is essential.

A medical evaluation by a pediatrician is helpful.  Many of the diseases that lead to excessive urine production can be identified.  Sometimes, a few laboratory tests may be needed.  Only a few children have an underlying cause for bedwetting.

While treating the problem, it is very important to preserve the child's self esteem.  Punishments, public ridicule, and teasing can lead to long lasting mental scars.

General Treatment

• Set the correct goal.    The child has to learn to wake up at night and go to the toilet to pass urine.  Children who try to learn to "hold it till morning" will rarely be successful.  Similarly, attempts to make less urine by reducing liquid intake in the evening will also be unsuccessful.
  The basic defect is the lack of perception of a full bladder, or a failure to wake up with this sensation.  A child is fully cured of bed wetting only when he learns to wake up and go to the bathroom.  
• Make it easy.    The bathroom should be nearby and easy to reach.  A nightlight can be a great help.  Some children do well with a plastic urinal near the bed, or a potty seat.
• Involve the child.     All too often, the child starts thinking of the enuresis as his parents' problem.  Let the child know that only he can solve the problem.  Involve him in the midnight or morning cleanup, which can be a good disincentive against wetting the bed.
• Avoid excessive fluids     The child should not have a large amount of fluids after dinner.  Caffeine containing drinks (colas and coffee) stimulate the production of urine.
• Empty the bladder     This sounds obvious, but some children need to be reminded to use the toilet before going to bed.  A device like a written notice near the bed can help.
• Incentives     Rewards should be given for the child's staying dry by waking in the night and going to the tolet.  Staying dry by holding the urine till morning is a less satisfactory achievement, because these children have not overcome the primary problem.
• Maintain a record     This is the only way to measure progress.  A diary or calendar should be used to record dry nights and wet ones.  

Parental waking

This has been found to be very effective.  The parents have to awaken the child a few hours after he has fallen asleep, and encourage him to walk to the bathroom and pass urine there.  It is very important that the child should awaken fully, and be able to walk independently to the bathroom.

The parents should try the minimal stimulus that wakes the child (turning on th light, calling the child's name, using a whistle or rattle, shaking the child's shoulder, etc).  If the child is difficult to wake or confused, try again after 20 minutes.

The child should be awakened each night at the parents' bedtime for several nights.  This should be done till the child awakens quickly to sound, after which self awakening should be tried.  A more intensive parental awakening program, described by Azrin and Thienes, has been reported to have a success rate of 92%.

Alarms

Alarms have the highest success rate of all bed wetting therapy, but are not easily available in India.  They sound an alarm when the child first passes urine, and wake the child.  Over time, it is believed, the child learns to anticipate the alarm, and wakes up when his bladder is full.

Some children sleep so deep that the alarm is not able to wake them.  A parental waking program for a few days, so that the child learns to wake up to sound, can help such children.

For more information on causes and basics of bed wetting, visit the Bed wetting page.

Last revision: July 15, 2007

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