Treatment Options for Enuresis

Initial Assessment and Specific Treatments

The American Academy of Child and Adolescent Psychiatry recommends urologic referral for children with daytime wetting, abnormal voiding, history of urinary tract infections, or genital abnormalities 3, 4
Constipation or fecal impaction should be treated as they can cause mechanical pressure on the bladder 3
Sleep apnea should be evaluated and treated, as surgical correction of upper airway obstruction can lead to improvement or cure of enuresis 1, 3
Psychological factors should be addressed when enuresis begins during periods of stress 1, 5

The American Academy of Child and Adolescent Psychiatry recommends education and demystification about enuresis for parents and children 3
Ensuring parents do not punish the child for enuretic episodes is crucial 1, 3
Journal keeping or dry bed charts can be an effective supportive approach 2
Fluid restriction before bedtime and night awakening to void can also be helpful 2, 6
Conditioning therapy with a modern, portable, battery-operated alarm has a success rate of approximately 66%, with more than half experiencing long-term success 6
The American Academy of Child and Adolescent Psychiatry recommends implementing conditioning therapy with a written contract, thorough instruction, frequent monitoring, and overlearning and intermittent reinforcement before discontinuation 1, 6, 7

Desmopressin, a synthetic analogue of antidiuretic hormone, decreases nighttime urine production and has a success rate of 10-65% with relapse rates up to 80% 1, 3
The American Academy of Child and Adolescent Psychiatry recommends desmopressin for children with nocturnal polyuria and normal bladder capacity 8
Imipramine has a dosage of 1.0-2.5 mg/kg as a single bedtime dose and effectiveness of 40-60% with relapse rates up to 50% 1, 7

The American Academy of Child and Adolescent Psychiatry recommends re-evaluating for undetected NMNE and considering anticholinergic agents for children who don't respond to first-line therapies 8
Combination therapy, such as desmopressin plus anticholinergic agent, may be more effective than desmopressin alone 1, 3

Treatment effectiveness should be monitored with a 2-week baseline record of wet and dry nights 3, 4
Bladder-stretching exercises have inconsistent evidence of effectiveness 1, 5
Hypnotherapy, dietary manipulation, and desensitization to allergens lack empirical evidence of efficacy 1, 5