Treatment Options for Nocturnal Enuresis

Nocturnal enuresis – commonly called bedwetting – is generally caused by a combination of common physical problems. These problems can affect individuals in different combinations, and each type of problem has a different level of how it can affect the wetting. The order of importance for the common causes of wetting is:

Failure of sleep arousal (also called “deep” or “heavy” sleep, it prevents waking up from a full bladder)
Small bladder capacity
Irregular bowels (constipation)
Not enough of the hormone desmopressin (which allows the kidneys to make too much urine at night)
Food sensitivities
Birth defects (which require surgery)

The following information is intended to provide general guidance on how bedwetting is treated. Other types of wetting (for example, wetting in someone who has had a urinary tract infection) should be followed up by your doctor. While he may prescribe treatments similar to those below, there are important differences with the cause of the problem, and a healthcare professional is in the best position to help.

Points to Consider Before Starting Try for Dry
While there is nothing wrong with going straight to Try for Dry, you may want to first try some or all of these tips and tricks for learning dryness. They are all aimed at teaching dryness and can help some children with “milder” bedwetting get to dry without an alarm program. These activities are also discussed in the book Getting to Dry.

Promote thinking about nighttime dryness in daily activities. This can include reading books on the topic (available at local bookstores) and discussing the benefits of being dry (such as attending sleepovers).

Make sure your child is getting enough sleep. An overly tired child may sleep so deeply they don’t notice the bladder signals. This can make it difficult for them to learn how to become dry.
Keep your child from drinking too much close to bedtime.
Encourage your child to urinate immediately before going to bed.
Avoid allowing an older child to sleep in absorbent undergarments such as diapers and pull-ups.
Once or twice during the night, carry the child to the bathroom to urinate (this is known as Scheduled Lifting).

Do not be discouraged if these tricks do not help – moving onto Try for Dry is a great next step.

Prescription Medication By Itself
It is generally understood that use of prescription medication will “cure” wetting, but only while the medication is being taken. In other words, most patients return to wetting once they stop taking the medication. The success of the Try for Dry system is attributed to the focus on alarm use with helper treatments such as medication. This is called a “multi-modal” approach, and attacking the problem in more than one way makes remission of wetting more dependable and relapses less frequent.

Choosing the right medication is essential. While medication is not the mainstay of treatment, it is important. We believe that prescription medications can be useful tools to help achieve dryness when the right medication is used for the right reason. For example, if constipation is contributing to the wetting problem, including a prescription to help regulate the bowels (or over the counter laxatives) is more appropriate than relying only on one that calms bladder contractions or restores kidney-related hormone balance.

Enuresis Alarm By Itself
An enuresis alarm is a small device worn by the patient that has a sound alarm and features a moisture sensor attached to the underwear. The alarm activates when the first drops of moisture touch the sensor, thus alerting the need to empty the bladder in the toilet. If the child sleeps too deeply, the alarm alerts the parents to the need to wake the child and possibly carry them to the bathroom.

Alarm-based programs are recognized by the medical community as the only therapy which is capable of affecting a permanent "cure" for bedwetting. However, they are not used frequently because they have a reputation for being cumbersome and labor intensive with a time to dryness around 6 months, which is too long. Combining the alarm with helper treatments, as done in the Try for Dry system, eliminates the problems of the old alarm stereotype by making the entire process easier and reducing the time to dryness to about a month.

Try for Dry
The Try for Dry system combines the benefits of an alarm treatment with helper treatments, which research demonstrated results in a faster and more permanent cure for bedwetting.

Surgery as a Solution to Wetting
If a child is diagnosed with incontinence as opposed to enuresis then neither the techniques listed above for learning dryness, medications nor an alarm-based program such as Try for Dry can solve the problem. When a physical abnormality is suspected or found to be the cause of the wetting, your doctor will probably refer you to a specialist to discuss surgical options.