What are the treatment options for enuresis?

Updated: Mar 26, 2020
  • Author: Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg); Chief Editor: Marc Cendron, MD  more...
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Answer

The most important reason for treating enuresis is to minimize the embarrassment and anxiety of the child and the frustration experienced by the parents. Most children with enuresis feel very much alone with their problem. Family members with a history of enuresis should be encouraged to share their experiences and offer moral support to the child. The knowledge that another family member had and outgrew the problem can be therapeutic.

Preliminary management focusing on behavioral modification and positive reinforcement is often helpful. The only therapies that have been shown to be effective in randomized trials are alarm therapy and treatment with desmopressin acetate or imipramine. Nonmonosymptomatic enuresis may be more difficult and time-consuming to treat. [19, 20]

Bladder training exercises are not recommended, because they have not been shown to be effective. With this therapy, the child is asked to ingest large quantities of fluid and to hold the urine in the bladder without voiding until uncomfortable. A therapeutic approach that involves (a) teaching a child not to respond normally to the sensation of a full bladder and (b) prescribing a therapy that is inherently painful is fundamentally without merit. The results of studies that report on this therapy are either methodologically flawed or demonstrate no improvement.

Enuresis is not a surgically treated condition. Treatment usually is not recommended for children younger than 6 or 7 years. However, ectopic ureter and obstructive sleep apnea (OSA) respond to specific surgical interventions.

Referral to a pediatric otolaryngologist or a pediatric sleep specialist may be appropriate if OSA is suspected.

Patients with primary enuresis (PE) are asked to keep a diary and should return for evaluation on a monthly basis to assess their progress.


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