What are the treatment options for bedwetting?

Whether or not treatment is appropriate depends mostly on how much of a burden the bedwetting is to the. Bedwetting is not usually treated before the age of five years. Pediatricians then recommend getting a medical evaluation to rule out any physical causes.

The older children get, the more stressful the situation can become for them – many find bedwetting embarrassing and worry, for example, about sleepovers at friends’ houses or school trips. If bedwetting is troubling the child, treatment can be a good idea even if nighttime accidents are rare. But there is also little point in trying out treatment if the child doesn't want to, or isn't mature enough yet.

Patience and understanding are crucial. It can also be very reassuring for a child to know that sooner or later they'll be able to stay dry on their own and that other children go through the same thing.

To keep dry through the night, there are several options you can try out and even combine:

• Limit fluids in the evening: Pediatricians recommend that children focus on drinking fluids regularly and going to the bathroom during the day. Then they won't drink anything (or just a little) for the last two hours before bedtime. But children should be allowed to drink if they feel thirsty. Diuretic (urine-increasing), caffeinated and sugary drinks like cola or other should be avoided.
• Make sure the child goes to the bathroom before bedtime.
• Keep a reward chart to record dry nights. The child could mark the nights they stay dry with colorful stickers, for instance. For some children, receiving small rewards from time to time for sticking to mutual goals – like remembering to use the bathroom one last time before bed – can also boost their motivation.

Learning these kinds of behavioral techniques is part of a service is provided by specialists at urology clinics and practices that is sometimes referred to as urotherapy.

There is only little research on the benefits and possible disadvantages of these approaches for the treatment of bedwetting. But they are a simple way to help the child and to see if the problems improve. It is important that the child feels ready to cooperate.

It is also recommended that the child use the bathroom when they feel the urge to urinate. Doctors advise against “holding it” (delaying urination).

Electronic alarm systems detect moisture and then trigger an alarm. These alarms are only used at night, and are designed to wake the child as soon as the very first drops of urine come out. This way, the child can stop the urine flow and then go to the toilet.

Over time, this is supposed to help the child learn to keep the bladder muscle closed while sleeping or to wake up before the alarm goes off, before their bladder is completely full. Bedwetting alarms typically have to be used over a period of several weeks.

Some systems use an alarm tone, while others use a light signal or a vibration alarm.

Bedwetting alarm systems are available as underwear with built-in sensors, mats with built-in sensors, and mini-alarms that can be put inside the child’s underwear or pajamas. In Germany, the costs of an alarm system are covered by statutory health insurance plans if it is prescribed by a doctor and recognized as a medical aid.

Both parents and the child must be motivated and patient to use a bedwetting alarm. Not every child is ready to use an alarm system at night. It may be that the child doesn't even notice the alarm at the start of treatment. Then the parents need to wake the child until they are able to wake up on their own to the sound of the alarm.

There have been a large number of studies on bedwetting alarms such as special underwear and bed mats. A summary of the research shows the following:

• Without a bedwetting alarm, only 3 out of 100 children stayed dry for at least 14 nights in a row.
• With a bedwetting alarm, 22 out of 100 children stayed dry for at least 14 nights in a row.

These figures are only a rough guide though, because the studies left many questions unanswered.

Some children started wetting the bed again when they stopped using an alarm system. But most of them were still dry at night several weeks later.

Parents are advised to keep using the bedwetting alarm until their child has stayed dry at night over a period of two to four weeks – but generally not longer than 16 weeks. Sometimes it takes several attempts.

Successful treatment with an alarm is sometimes followed by a second training phase. In the second training phase, the child (who is then able to stay dry through the night) drinks more than usual in the hour leading up to their bedtime (about 0.2 liters more, the equivalent of a small glass of water). The idea is that they can learn to wake up quickly enough with a particularly full bladder, too.

Bedwetting problems can also be treated with medication. Two treatments have been shown to temporarily stop bedwetting in some children:

• Desmopressin
• Imipramine

Desmopressin is a synthetic form of a hormone, and imipramine is an antidepressant. Both need to be prescribed by a doctor.

When people decide to treat bedwetting problems with medication, desmopressin is commonly used. It causes fewer side effects than imipramine. The drug starts working quite fast, and can sometimes help after just a few days.

Desmopressin can be used if, for instance, other approaches have not been successful or the child is staying overnight at a friend's house or is on a class trip and wants to avoid wetting the bed. It is best to try out this medication in advance, to make sure that it works and that the dose is correct.

One disadvantage of medication is that it usually only works temporarily, while you take it. Some children start wetting the bed again after they stop taking it.

If desmopressin hasn’t had any effect after four weeks, the treatment should be stopped. Otherwise, the standard duration of treatment is three months. If the medication is taken over the long term, it is important to gradually reduce the dosage after three months and then to stop taking it for about a week. That way you can see whether the treatment is still needed – or whether the child is able to stay dry at night without any help.

Desmopressin works in a similar way to the hormone vasopressin, which is made naturally in the brain at night to reduce urine production.

Research has found the following:

• Without desmopressin, 10 out of 100 children have dry nights on at least 14 nights in a row.
• With desmopressin, 32 out of 100 children have dry nights on at least 14 nights in a row.

Children taking desmopressin tablets may experience side effects such as headaches, stomachaches, nausea, vomiting, dizziness or weight gain. These may be signs that the body is retaining too much water. To avoid side effects, children and teenagers who take the medication should stop drinking in the hour before they take it. You should also not drink more than one glass of water for eight hours after taking it.

When stopping treatment with desmopressin, it may be a good idea to gradually lower the dose over a few weeks. This can lower the risk of starting to wet the bed again.

Imipramine is a tricyclic antidepressant. Although it is mainly used in the treatment of depression, it has also been approved for the treatment of bedwetting. Imipramine shortens the dream phases of sleep (REM phases) and increases the production of vasopressin so that less urine is produced during the night.

It is about as effective as desmopressin, but leads to severe side effects. For this reason, doctors recommend this medication only in exceptional cases. The side effects include nausea, mood swings, and changes in heart rhythm.

Other medications and treatments have no proven effect on bedwetting. Complementary or alternative medicine therapies like medicinal plants, chiropractic treatment, homeopathy, hypnosis and acupuncture have not been shown to be effective for bedwetting.