First-Line Treatment for Nocturnal Enuresis (Bedwetting)

Initial Assessment and Behavioral Interventions

The mainstays of primary therapy for nocturnal enuresis are bladder advice, the enuresis alarm, and/or desmopressin, according to The Journal of Urology 1
Establish regular voiding habits - children should void regularly during the day, and always at bedtime and upon awakening, as recommended by The Journal of Urology 3
Implement fluid management - minimize evening fluid and solute intake while encouraging liberal water intake during morning and early afternoon hours, as suggested by The Journal of Urology 4
Treat constipation if present - aim for soft bowel movements daily, preferably after breakfast; polyethylene glycol can help optimize bowel emptying, according to The Journal of Urology 4
Encourage physical activity, as recommended by The Journal of Urology 4

Enuresis alarm therapy has a success rate of approximately 66%, with more than half experiencing long-term success, however this fact is from Praxis Medical Insights and a better source is needed.

Desmopressin is an evidence-based therapy (grade Ia evidence) for nocturnal enuresis, according to The Journal of Urology 4
Approximately 30% of children are full responders and 40% have a partial response to desmopressin, as reported by The Journal of Urology 4
Desmopressin is most effective for children with nocturnal polyuria (nocturnal urine production >130% of expected bladder capacity for age), normal bladder reservoir function (maximum voided volume >70% of expected bladder capacity for age), or cases where alarm therapy has failed or compliance is unlikely, according to The Journal of Urology 4
Dosing recommendations for desmopressin include 0.2-0.4 mg taken at least 1 hour before sleep, or 120-240 μg taken 30-60 minutes before bedtime, as suggested by The Journal of Urology 4

Fluid restriction is essential with desmopressin - evening intake should be limited to 200 ml (6 ounces) or less with no drinking until morning, as recommended by The Journal of Urology 4
Polydipsia is a contraindication to desmopressin treatment, according to The Journal of Urology 4
Desmopressin combined with excessive fluid intake can cause water intoxication with hyponatremia and convulsions, as warned by The Journal of Urology 4
Nasal spray formulations are discouraged due to higher risk of hyponatremia, according to The Journal of Urology 4

Regular short drug holidays should be scheduled when using desmopressin to assess whether medication is still needed, as recommended by The Journal of Urology 4