What's Best For Bedwetting?

Bed alarms may be the most effective way to cure bedwetting, according to a new review of available bedwetting treatments.

But researchers Kelly Russell, BSc, and Darcie Kiddoo, M.D., FRCSC, from the University of Alberta in Canada, say the device can be difficult to use, and treatment with the drug desmopressin may be an effective alternative.

The results appear in Evidence-Based Child Health: A Cochrane Review Journal.

From 13 to 19 percent of boys, and 9 to 16 percent of girls over the age of 5 wet the bed during the night. Bedwetting resolves naturally in about 15% of those children each year, but researchers say 2 to 3 percent of adolescents continue to wet the bed and may require treatment.

Training First, Drugs Second, to Treat Bedwetting

In the study, researchers reviewed 230 studies on currently available treatments for bedwetting and compared their effectiveness in achieving 14 or more consecutive dry nights.

The results showed that training with a bed alarm was the most successful way to end bedwetting and prevent relapses after treatment ends. The alarm goes off when the child urinates. The goal is to get the child to associate the alarm with inhibiting urination so he will get up to use the toilet.

The alarms don't always wake the child, even though the rest of the house is roused. However, researchers say the treatment can still succeed if the family works together and wakes the child when the alarm goes off.

Similarly, researchers found behavioral treatments, like rewarding a child for a dry night, or taking him or her to the toilet late at night, may also work. But these methods can be very time-consuming and there was no evidence about their effectiveness.

Nonetheless, since there is no medical risk associated with behavioral treatments, researchers say they may be a reasonable first approach for parents before they seek professional help.

Desmopression Best Among Drug Options

Of the available bedwetting drug treatments, desmopression and tricyclic antidepressants were better than placebo at increasing the number of dry nights. But there was no evidence the benefit continues once treatment stops.

Researchers say there are concerns about overdosing with tricyclics. Therefore, desmopression is preferred.

Other available drug treatments, including indomethacin, diclofenac, and diazepam, may also reduce bedwetting, but researchers say they are potent drugs and should be considered only after other treatments have failed.

SOURCES: Russell, K. Evidence Based-Child Health: A Cochrane Review Journal, June 8, 2006; vol 1: pp 5-8. News release, John Wiley & Sons.
By Jennifer Warner
Reviewed by Louise Chang, M.D.
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