Treatment of Bed Wetting (Enuresis)

Dr. Parang Mehta, MD.

Bed wetting sounds like a minor embarrassment, but it can be a terrible affliction for a growing boy (or girl, of course, though the disorder is less often seen among them). As children grow older, there are often situations where they have to spend a night or more away from home. For the child with this problem, each such opportunity requires an excuse to avoid it. Even within the home, the teasing and humiliation can be a daily ordeal.

An underlying cause  should be looked for, but is quite rare. If one 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.  Bladder stones, urinary infections, and constipation can be treated. The treatment of bedwetting should start with a medical evaluation by a pediatrician.  Sometimes, a few laboratory tests may be needed.

General Treatment

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.

Parental waking

Parents should awaken the child a few hours after he has fallen asleep, and encourage him to walk to the bathroom and pass urine there.  Carrying him, or helping him to walk to, the bathroom, is ineffective.  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 the 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.  Parental waking methods have a high long-term success rate, since they address the underlying problem of inability to waken.

Alarms

Alarms also have a high success rate, since they also teach the child to wake.  They sound an alarm when the child first passes urine in the bed, 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 can train the child to the point that the alarm can take over.

Comparison of treatments
for bed wetting

  Cure rate Relapse rate Risks
Alarms 70% 10% None
Parental
awakening		 Up to 90% 20% None
Imipramine 10-60% 90% Serious
Desmopressin 12-65% 90% Mild

This Doesn't Work

What about drugs?

Drugs provide relief only while they are being taken. Useful for camps and sleepovers

Drugs have a very small role to play in the treatment of bedwetting. Two drugs are commonly used for the treatment of bed wetting.  They are both effective only while the child is taking them.  Nearly all children go back to wetting the bed once they stop the drug.  Unfortunately, there is no drugstore cure for bedwetting.

Desmopressin:   is a synthetic form of the hormone ADH (anti diuretic hormone), and reduces the production of urine.  It is taken as a tablet or as a spray up the nose at bedtime, and is effective for 10-12 hours.  About 70% of children benefit, and about 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:   is an oral drug used originally for the treatment of depression. Taken an hour before bedtime, it helps children have lesser wet nights a month, and lesser wetting accidents per night.  About 70% of children benefit from its use, but almost all children relapse after treatment is stopped.  The drug has frequent and serious side effects.

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

Last Revision: May 20, 2020