Enuresis

Treatments

Counseling and Medication   

Treatment Summary: :Not all treatment requires counseling; however, a combination of medication and behavior-modification techniques would greatly enhance the treatment for enuresis. Medications used for enuresis include, anti-depressants and desmopressin (brand name DDAVP). Limiting the amount of liquids a child consumes prior to bedtime is a behavior-modification technique. 

• Reference: Fletcher, Teresa B. (Jan 2000). Primary nocturnal enuresis: A structural and strategic family systems approach. Journal of Mental Health Counseling. Vol 22, Iss 1, pg 32-45 

• Submitter: William Miller 

Bell and Pad Alarm 

Treatment Summary: A pad with a wetness sensor is placed in the child’s bed, connected to a bell that sounds at the first sign of wetness. When the bell rings, the child must then get out of bed and go to the bathroom instead of continuing to wet the bed. This method is successful in part because it associates bedwetting with the unpleasantness of being awakened and inconvenienced in the middle of the night. 

• Reference: Nevius, T., Eggert, P., Evans, J., Macedo, A., Rittig, S., Tekgul, S., et al. (2010). Evaluation of and treatment for monosymptomatic enuresis: A standardization document from the international children’s continence society. The Journal of urology, 183 (2), 441-447. 

• Submitter: Bobbi King 

The Enuresis Alarm combined with Dry Bed Operant Conditioning 

Summary of Treatment:  In the article referred below, a plausible treatment for children with nocturnal enuresis is an Enuresis Alarm.  The Enuresis Alarm is a urine-sensitive pad that sounds an alarm awakening the child when urine touches the pad.  The Enuresis Alarm is attached to the child’s underwear when going to sleep. There is a 70 percent success rate of diminishing enuresis if it is used for 12 to 16 weeks.  Dry bed operant conditioning is a reward system that positively reinforces the child when awakening to a dry bed.  Using both methods together is preferable. 

• Reference: Geroski, A. M., & Rodgers, K. A. (1998). Collaborative assessment and treatment of children with enuresis and encopresis. Professional School Counseling, 2(2), 128-134. 

• Submitted By: Jason Wells 

Desmopressin 

Summary of Treatment: Desmopressin is an oral medication that is used in the treatment of enuresis and has been found to be an effective treatment in the clinical reduction of the frequency of episodes (Fera, Lelis, Glashan, Pereira, & Bruschini, 2011). Desmopressin is an antidiuretic and temporarily reduces the production of urine which results in the decrease of bedwetting incidents. The medication cannot be taken during times when the individual receiving the medication is ill, has an infection, vomiting or diarrhea because of risks of dehydration and electrolyte imbalance. Research found that a significant reduction of the average number of enuretic-free nights was reported with the use of desmopressin (p = 0.036) with no notable influences in reduction based on gender or family history of enuresis with the average percentile of improvement being 34.3%. There were no reported adverse effects to the medication. The researchers suggest that there is a need for longitude studies to determine long term effectiveness of treatment with desmopressin (Fera & et al., 2011). 

• Reference: Fera, P., Lelis, M. S., Glashan, R. Q., Pereira, S. G., & Bruschini, H. (2011). Desmopressin Versus Behavioral Modifications as Initial Treatment of Primary Nocturnal Enuresis. Urologic Nursing, 31(5), 286-289.  

• Submitted by: Crystal Riley