Materiały źródłowe

• #1 Evaluation and Treatment of Enuresis | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0815/p489.html

  Enuresis is defined as repeated, spontaneous voiding of urine during sleep in a child five years or older. Primary nocturnal enuresis almost always resolves spontaneously over time. Treatment should be delayed until the child is able and willing to adhere to the treatment program; medications are rarely indicated in children younger than seven years. If the condition is not distressing to the child, treatment is not needed. However, parents should be reassured about their child’s physical and emotional health and counseled about eliminating guilt, shame, and punishment. Enuresis alarms are effective in children with primary nocturnal enuresis and should be considered for older, motivated children from cooperative families when behavioral measures are unsuccessful. Desmopressin is most effective in children with nocturnal polyuria and normal bladder capacity. Patients respond to desmopressin more quickly than to alarm systems. Combined treatment is effective for resistant cases.

• #2 Bed-wetting – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685

  Bed-wetting also called nighttime incontinence or nocturnal enuresis means passing urine without intending to while asleep. […] If your child continues to wet the bed, treat the problem with patience and understanding. Lifestyle changes, bladder training, moisture alarms and sometimes medicine may help lessen bed-wetting. […] Most children outgrow bed-wetting on their own but some need a little help. […] Talk to your child’s doctor or other health care professional if: Your child still wets the bed after age 7. […] Bed-wetting can affect anyone, but it’s twice as common in boys as in girls. […] Although frustrating, bed-wetting without a physical cause does not result in any health risks. But bed-wetting can create some issues for your child, including: Guilt and embarrassment, which can lead to low self-esteem.

• #3 Enuresis Treatment & Management: Approach Considerations, Initial Management, Alarm Therapy

  https://emedicine.medscape.com/article/1014762-treatment

  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, and they frequently have issues of low self-esteem. […] 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 pharmacologic therapy. Nonmonosymptomatic enuresis may be more difficult and time-consuming to treat. […] 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) may respond to specific surgical interventions.

• #4 Bedwetting

  https://www.rch.org.au/kidsinfo/fact_sheets/bedwetting/

  Bedwetting is a problem for many school-age children and their families. The good news is that for many children the problem will resolve itself over time, or can be fixed through fairly simple treatment. […] Bedwetting alarms are thought to be the most useful and successful first-step to treat bedwetting. Research has shown these alarms will help 80 per cent of children to become dry, and most children will then stay dry. […] Most children with bedwetting do not need to take medication, but there are some occasions when it can be useful. Your doctor can advise you if this treatment is suitable for your child. […] Bedwetting alarms are considered the most successful first step to treat bedwetting. Medication is an option if alarms have not helped.

• #5 Evaluation and Treatment of Enuresis | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0815/p489.html

  Treatment of primary nocturnal enuresis should begin with educating the child and parents about the condition. The family should be reassured that primary nocturnal enuresis usually resolves spontaneously (15 percent annual cure rate). Secondary causes that were identified with the history, examination, or laboratory testing should be treated. Simple behavioral interventions are first-line treatment approaches. Arousal alarm systems and pharmacotherapy should be considered in older children who have greater social pressures and low self-esteem. […] Medication should be initiated in children seven years and older only if nonpharmacologic measures fail. Children who do not respond to one or more measures may benefit from combined treatment strategies (e.g., combining nonpharmacologic and pharmacologic treatment or multiple pharmacologic therapies). Children with persistent enuresis should be referred to a subspecialist. Presence of daytime wetting or abnormal voiding, straining or poor stream, genital abnormalities, or a history of urinary tract infections also indicates the need for referral.

• #6 Evaluation and Treatment of Enuresis | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0815/p489.html

  If primary nocturnal enuresis is not distressing to the child, treatment is not needed. However, parents should be reassured about their child’s physical and emotional health and counseled about eliminating guilt, shame, and punishment. Treatment of primary nocturnal enuresis should be delayed until the child is able and willing to adhere to the treatment program and is rarely indicated in children younger than seven years. It may take months for a treatment program to be successful; therefore, the child must be highly motivated. Daytime symptoms should be actively identified and managed before addressing primary nocturnal enuresis. Treatment is considered successful when the child achieves continence for 14 consecutive nights within a 16-week period. Nonresponse to treatment is defined as less than a 50 percent decrease in enuresis; a 50 to 90 percent decrease suggests a partial response.

• #7 Tips for overcoming bed-wetting – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/tips-for-overcoming-bed-wetting

  „Treatment usually isn’t necessary for primary bed-wetting or children under 7. A watch-and-see approach is usually the best option, as we can expect an 8% to 10% improvement every year the child grows. Most children outgrow bed-wetting on their own.” […] „There are things that parents can do to help a child with secondary bed-wetting or who is older than 7, including: […] Use a moisture alarm. These over-the-counter pads, also called bed-wetting alarms, are connected to a battery-operated alarm. This approach takes time, motivation and patience. It can take one to three months to see results, but this option is low-risk and may be a better long-term solution than medications.” […] „Try prescription medications. Occasionally, a child could be prescribed desmopressin as a short-term solution for bed-wetting. This medication retains water in the body, so the child’s bladder does not get too full overnight. There are a few possible side effects with medication, which should be discussed with your child’s health care team. The medication is more effective in older children, and the overall success rate is about 30%. Usually, other strategies, including time, are tried before medications.”

• #8 Patient education: Bedwetting in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics

  Bedwetting education and advice […] – Bedwetting is common; it occurs at least once per week in 15 percent of five year olds. […] – Bedwetting goes away on its own in most children. […] – Bedwetting is not the child’s fault; children should not be punished for bedwetting. […] – Encourage the child to urinate regularly during the day and just before going to bed (a total of four to seven times). If the child wakes at night, take them to the toilet. […] – Avoid sugary and caffeine-containing drinks, especially in the evening. […] – It may be helpful to have the child drink most of their fluids in the morning and early afternoon to prevent overfilling of the bladder during the night. […] […] Behavior therapy for bedwetting […] Motivational therapy — Motivational therapy involves keeping a record of progress, with bigger rewards for longer periods of dryness. You and the child should agree about the reward in advance. For example, you might progress from a sticker on a calendar for each dry night to a favorite book for seven consecutive dry nights.

• #9 How to Stop Bed-Wetting: In Kids

  https://www.healthline.com/health/parenting/how-to-stop-bedwetting

  Bed-wetting is a common occurrence in many young children, even if they’ve been potty trained well during the daytime. In fact, 20 percent of 5-year-olds experience bed-wetting at night, which means as many as 5 million children in the United States are wetting the bed at night. […] The best way to treat bed-wetting is through long-term solutions that can help your child learn how to wake up when they need to go. […] While your first impulse might be to avoid discussions about bed-wetting and to wash the sheets in silence, such lack of acknowledgement can make things worse. The best thing you can do is to tell your child that accidents are OK, and reassure them that you will find a solution together. […] Eliminating drinks an hour before going to bed can help prevent accidents. […] Bladder training is a process where your child goes to the bathroom at set times, even if they don’t think they need to go.

• #10 Enuresis (Bedwetting) – familydoctor.org

  https://familydoctor.org/enuresis-bed-wetting/

  Enuresis (bedwetting) treatment […] Most children outgrow bedwetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: Behavior therapy and medicine. […] Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments you can try at home include: Limit fluids before bedtime. Have your child go to the bathroom at the beginning of the bedtime routine and then again right before going to sleep. Use a moisture alarm system that rings when the bed gets wet. This can teach your child to respond to bladder sensations at night. Create a reward system for dry nights. But do not punish your child when they have an accident. Ask your child to change the bed sheets when they have an accident. Bladder training—have your child practice holding their urine for longer and longer times during the day. This helps stretch the bladder so it can hold more urine.

• #11

  https://bpac.org.nz/bpj/2008/june/enuresis.aspx

  Nocturnal enuresis, or bedwetting, is a common condition which children usually grow out of. Advice to parents on simple behavioural strategies is usually the first step. The use of bed alarms with support offers the best chance of long-term success. The occasional, short-term use of desmopressin is also discussed. […] If the child and their family are motivated to try treatment, then the use of bed alarms with support offer the best chance of long-term success. […] Most children will outgrow bedwetting. For this reason most treatments are delayed until the child is at least seven years old. However treatment might begin earlier if the situation is perceived to be damaging the child’s self esteem or relationships with family and friends. […] Parents could be advised to: Ensure that the child empties their bladder well at bedtime. Improve the child’s access to the toilet (e.g. have them sleep on the bottom bunk, have a torch within reach). Use waterproof covers on mattress and duvet (especially for boys) and then absorbent layers over the mattress cover.

• #12

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=hw211687

  Motivational therapy for bedwetting uses praise, encouragement, and rewards to help a child gain bladder control. […] Motivational therapy can help children gain some degree of control over their bedwetting. But if it doesn’t help your child in 3 to 6 months, think about trying other methods. […] This therapy may involve a series of counselling sessions with a trained professional. During the sessions, the counsellor encourages the child to take responsibility for the bedwetting and to be very involved in the treatment. […] This treatment works best for children who want to take part in it. It may be used in combination with other treatments.

• #13 Motivational Therapy for Bed-Wetting | The Children’s Hospital at Montefiore

  https://www.cham.org/health-library/article?id=hw211687

  Motivational therapy for bed-wetting uses praise, encouragement, and rewards to help a child gain bladder control. […] Motivational therapy can help children gain some degree of control over their bed-wetting. But if it doesn’t help your child in 3 to 6 months, think about trying other methods. […] This treatment works best for children who want to take part in it. It may be used in combination with other treatments.

• #14

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?Hwid=hw213026

  Treatment for bedwetting usually isn’t a cure. The goal is to reduce the number of times the child wets the bed and to manage the wetting until it goes away on its own. Treatment may include: Motivational therapy. With this method, parents encourage and reinforce a child’s sense of control over bedwetting. Moisture alarms. These alarms detect wetness in the child’s underpants during sleep. They sound an alarm to wake the child. Desmopressin and tricyclic antidepressants. These medicines increase the amount of urine that the bladder can hold or decrease the amount of urine released by the kidneys. […] Treatment may help if bedwetting seems to be affecting your child’s self-esteem or affecting how your child is doing with schoolwork or getting along with peers. […] The best solution may be a combination of treatments. Below are some suggestions for treatment options according to the age of your child. Ages 5 to 8. Help your child understand that wetting the bed is a normal part of growing up. Encouragement and praise may be all that is needed to help your child wake up before wetting.

• #15 Treatment of Bladder Control Problems & Bedwetting in Children – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children/treatment

  Oxybutynin (Ditropan) is often the first choice of medicine to calm an overactive bladder until a child matures and outgrows the problem naturally. […] Changes in your child’s routines and behavior may greatly improve daytime wetting, even without other treatments. […] If your child’s provider suggests treatment, it’s likely to start with ways to motivate your child and change his or her behavior. […] The next steps include moisture alarms or medicine. […] For a bedwetting treatment program to work, both the parent and child must be motivated. […] Motivational therapy helps children gain a sense of control over bedwetting. […] Moisture alarms detect the first drops of urine in a child’s underwear and sound an alarm to wake the child. […] Moisture alarms work well for many children and can end bedwetting for good.

• #16 Bed-Wetting | Fact Sheet – ABCT – Association for Behavioral and Cognitive Therapies

  https://www.abct.org/fact-sheets/bed-wetting/

  About 15% of all elementary-school-age children wet the bed, and continued bed-wetting beyond the age of 5 is a problem that should be treated. […] Effective treatments are now available. […] Medication treatments produce a temporary reduction in wetting frequency so long as the child takes the medication. […] Behavior therapy with a urine alarm is the treatment of choice for simple bed-wetting. Over 50 years of research supports this claim. A permanent solution to bed-wetting can be expected for about 5 of every 10 children treated with a urine alarm. […] This treatment can be delivered by parents under professional supervision. […] The most common causes of failure with this treatment are not waking the child every time the alarm sounds and not continuing the treatment for the full period.

• #17 Behavioral Treatments for Bedwetting

  https://www.webmd.com/a-to-z-guides/behavioral-treatments

  Bedwetting alarms have become the mainstay of treatment. Up to 70%-90% of children stop bedwetting after using these alarms for 4-6 months. […] These alarms take time to work; and, for them to be effective, the child must want to use them. The child should use the alarm for a few weeks or even months before considering it a failure. Alarms along with behavior modifications are often tried first before using medication. […] Beware of devices or other treatments that promise a quick „cure” for bedwetting. There really is no such thing. Stopping bedwetting for most children takes patience, motivation, and time.

• #18 Enuresis Treatment & Management: Approach Considerations, Initial Management, Alarm Therapy

  https://emedicine.medscape.com/article/1014762-treatment

  If attention to the above preliminary management program for up to 3 months does not result in dryness, then either alarm therapy or pharmacologic therapy should be considered. Because neither therapy has been shown to be consistently superior to the other, the preliminary choice should be dictated by the clinical setting, the family preference, and the experience of the practitioner. […] Alarm therapy offers the possibility of sustained improvement of enuresis and should be considered for every patient. It is reported to alleviate bedwetting by increasing nocturnal bladder capacity or by providing enhanced arousal; it does not reduce nocturnal urine output. […] Desmopressin acetate is the preferred medication for treating children with enuresis. A Cochrane review of 47 randomized trials concluded that desmopressin therapy reduces bedwetting; children treated with desmopressin had an average of 1.3 fewer wet nights per week.

• #19 Nocturnal Enuresis (‘bedwetting’) in children | CUH

  https://www.cuh.nhs.uk/patient-information/nocturnal-enuresis-bedwetting-in-children/

  Nocturnal enuresis, the medical name for bedwetting, is involuntary wetting during sleep. […] The assessment and treatments are the same for children with primary or secondary nocturnal enuresis. […] Bedwetting alarms can help to strengthen the signal from the bladder to the brain. […] Children over the age of five years can be treated with medicine called Desmopressin which mimics the natural occurring vasopressin. […] It is therefore essential that any constipation is treated as resolving constipation often improves voiding. […] The aims of alarm treatment for bedwetting are to train the child or young person to recognise the need to pass urine and to wake to go to the toilet. […] Desmopressin is an artificial form of the naturally occurring hormone called vasopressin and works in a similar way to decrease and concentrate urine produced at night.

• #20 Bedwetting (Nocturnal Enuresis) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/bedwetting-nocturnal-enuresis

  The bedwetting alarm is a form of conditioning therapy to help your child begin to recognize the need to wake up to go to the bathroom. Bedwetting alarms consist of a sensor to detect wetness and an alarm to awaken the child. The alarm rings when your child starts to release urine. It works for 60 to 70 percent of children and requires a high level of commitment from the child and family. […] Desmopressin (DDAVP®) concentrates urine so that your child makes less urine at night and does not completely fill the bladder. DDAVP® is effective in about 50 percent of patients. […] We understand how stressful night wetting can be for you and your child. We will work with you to find the best treatment plan for your family. We will continue to follow your child in our DOVE program to maximize dry nights.

• #21 Evaluation and Treatment of Enuresis | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0815/p489.html

  Pharmacologic therapies are not curative, but they decrease the frequency of enuresis or temporarily resolve symptoms over time until spontaneous resolution occurs. Options include anticholinergic agents (oxybutynin [Ditropan], hyoscyamine [Levsin]); tricyclic antidepressants (imipramine [Tofranil], desipramine [Norpramin]); and desmopressin (DDAVP). Of these therapies, only imipramine and oral desmopressin have been approved by the U.S. Food and Drug Administration for the treatment of enuresis in children.

• #22 Bed-wetting: Tips to Help Your Child | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1015/p560-s1.html

  Enuresis (EN-yur-EE-sis) is the medical term for bed-wetting during sleep. Bed-wetting is fairly common among children, and is often just a stage in their development. It is more common in boys than girls. Many children grow out of it without treatment. You may want to consider treatment if bed-wetting occurs after age five, although medicines are typically not used until age seven. […] Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are two kinds of treatment: behavioral therapy and medicine. Behavioral therapy helps teach your child not to wet the bed. Some behavioral treatments include: […] Alarm systems (bed alarms) are the best treatment for bed-wetting, but can take time and work. […] Your doctor may give your child medicine if he or she is seven years or older, and if behavioral therapy (such as alarm therapy) has not worked. Medicines aren’t a cure for bed-wetting, but may stop it while your child grows and develops to a point where it no longer happens.

• #23 Bed-wetting – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-wetting/diagnosis-treatment/drc-20366711

  Depending on your child’s situation, the health care professional can check for any underlying cause of bed-wetting. A treatment plan can be made based on: […] If treatment is needed, talk about options with your child’s health care professional. Together you can decide what will work best for your child. […] If lifestyle changes are not successful or if your child is upset or worried about wetting the bed, other treatments may be helpful. […] Options for treating bed-wetting may include moisture alarms and medicine. […] If lifestyle changes do not help your child stay dry, your child may be prescribed medicine for a short period of time to stop bed-wetting. […] Certain types of medicine can: […] Desmopressin is an oral tablet. It’s only for children 6 years or older. […] If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan XL) may help reduce bladder contractions and increase how much urine the bladder can hold. […] Sometimes your child may be prescribed more than one type of medicine. But there are no guarantees that medicine will work, and medicine does not cure the problem. Bed-wetting typically starts again when medicine is stopped.

• #24 Medications to Treat Bed-wetting: | National Kidney Foundation

  https://www.kidney.org/medications-to-treat-bed-wetting

  DDAVP is a drug to treat children with bed-wetting. Although DDAVP does not cure the condition, it does help treat the symptoms while the child is on the drug. Numerous studies report reduction in the number of wet nights. […] Imipramine has been used successfully for many years to treat children with bed-wetting. Complete dryness has been reported in 10-50% of patients. Some children who are not completely dry show significant improvement. […] Anticholinergic drugs, such as oxybutynin (Ditropan) or hyosyamine (Levsinex), reduce or stop bladder contractions and increase bladder capacity. Anticholinergics may be helpful for children who have daytime wetting due to bladder contractions and/or small bladder capacity. […] Drug therapy of bedwetting is best thought of as a treatment, not a cure. Therefore, most children require long-term treatment to prevent a return of bed-wetting.

• #25

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?Hwid=hw213026

  If your child still wets the bed, a moisture alarm may help. Also, a medicine such as desmopressin can be helpful for occasional overnight events such as camp or sleepovers. […] If consistent use of moisture alarms doesn’t work, the doctor may suggest medicine, counselling, or both. […] Medicines that either increase the amount of urine that the bladder can hold (bladder capacity) or decrease the amount of urine released by the kidneys may be used to treat bedwetting. These prescription medicines may be used to control bedwetting for a little while.

• #26 Treatment of Bladder Control Problems & Bedwetting in Children – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children/treatment

  Your child’s doctor may suggest medicine when other treatments haven’t worked well. […] Desmopressin (DDAVP) is often the first choice of medicine for bedwetting. […] Changes in your child’s routines may improve bedwetting, when used alone or with other treatments. […] Your patience, understanding, and encouragement are vital to help your child cope with a bladder control problem. […] For children who wet the bed, the following practices can make life easier and may boost your child’s confidence. […] Let your child know that bedwetting is very common and most children outgrow it.

• #27

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Nocturnal-Enuresis-in-Teens.aspx

  Desmopressin (DDAVP) helps to reduce the amount of urine your body makes. […] An additional medication, oxybutynin, has been shown to be helpful, especially in patients who do not respond to DDAVP alone and can be given in combination with it. […] Never wait to talk about bedwetting with your pediatrician to find a solution that works best for your child and your family.

• #28 Pediatric Bedwetting (Nocturnal Enuresis) | Memorial Hermann

  https://memorialhermann.org/services/conditions/pediatric-bedwetting

  Imipramine (an antidepressant known as Tofranil) helps in a little more than 50% of bedwetters, but it can cause mood changes and nightmares. Oxybutynin chloride (Ditropan, a bladder antispasmodic) also is effective in half the children but may cause facial flushing, irritability, and even heat exhaustion (making it essential that children drink plenty of water in the summer months. DDAVP (a synthetic version of vasopressin, an important regulatory hormone that our bodies normally produce) may be prescribed. DDAVP recycles water from the urine back into the bloodstream so less urine is made at night. Children should be followed carefully when on any of these medications and dosages should not be increased without careful instructions from the doctor.

• #29 Enuresis Treatment & Management: Approach Considerations, Initial Management, Alarm Therapy

  https://emedicine.medscape.com/article/1014762-treatment

  Combination of alarm therapy with desmopressin therapy has been reported to result in dryness not achievable with either therapy alone. […] A Cochrane review of 64 randomized trials concluded that imipramine is effective in reducing bedwetting; children treated with imipramine had one fewer wet night per week. […] Children should be instructed to drink a liberal amount during the day, to maintain good hydration throughout the day, and to drink enough to prevent thirst when they arrive home from school and at bedtime. […] Children should be assessed several months after the initial appointment to monitor progress and to fine-tune the treatment recommendations.

• #30 Tricyclics and related drugs for treating bedwetting in children | Cochrane

  https://www.cochrane.org/CD002117/INCONT_tricyclics-and-related-drugs-treating-bedwetting-children

  Tricyclics have been used to treat bedwetting since the 1960s. […] The most commonly used tricyclic for treating bedwetting is imipramine. Compared to placebo, tricyclics reduce bedwetting by about one night per week during treatment and about a fifth of the children achieve 14 dry nights. However, most wet again once the tricyclics are stopped. […] There was evidence that tricyclics are effective at reducing the number of wet nights during treatment, but do not have a sustained effect after treatment stops, with most children relapsing. In contrast, there was evidence that alarm therapy has better short- and long-term outcomes. […] Tricyclics are more effective than placebo, particularly for short-term outcomes. […] Imipramine combined with oxybutynin is also more effective than placebo.

• #31 Bedwetting in Children & Teens: Nocturnal Enuresis | National Kidney Foundation

  https://www.kidney.org/kidney-topics/bedwetting-children-teens-nocturnal-enuresis

  Nocturnal enuresis is bedwetting at night, common in kids and teens. It often resolves on its own. Treatments include alarms, meds, and lifestyle changes. […] It’s important to work with your child’s doctors to find possible causes and solutions. […] Yes. However, treatment for bedwetting first depends on if it is caused by something like stress, which would need to be managed first. Overall, children who take an active part in their treatment have a better chance of decreasing or stopping the bedwetting. […] Research shows that about half of children who properly use enuretic (bedwetting) alarms will stay dry at night after a few weeks. […] There are only two medicines that have been approved for bedwetting: imipramine and desmopressin. […] Treating the constipation is often the first step to treating the bedwetting in these cases.

• #32 Treatment for Bedwetting | Brown University Health

  https://www.brownhealth.org/centers-services/childrens-rehabilitation-services/treatment-bedwetting

  Pediatric pelvic floor rehabilitation is a behavioral- and exercise-based treatment approach to bedwetting. A child should be at least six years old when referred to physical therapy for bedwetting. Following a physical therapy assessment and completion of a bladder elimination log, the child is scheduled for three follow-up sessions for behavioral modifications, biofeedback, and a nighttime waking program. […] Behavioral modifications include: Robust daytime fluid intake before 4 p.m., Daytime voiding schedule approximately every 2 hours, Nighttime fluid restriction (unless the child participates in nighttime sports, or in high humidity), Healthy diet and bowel habits. […] External surface electrode biofeedback is also used for neuromuscular re-education of the pelvic floor muscles to address proprioception, coordination, and relaxation of the pelvic floor muscles in order to improve daytime bladder emptying and sensation.

• #33 Treatment for Bedwetting | Brown University Health

  https://www.lifespan.org/centers-services/childrens-rehabilitation-services/treatment-bedwetting

  Pediatric pelvic floor rehabilitation is a behavioral- and exercise-based treatment approach to bedwetting. […] A child should be at least six years old when referred to physical therapy for bedwetting. Following a physical therapy assessment and completion of a bladder elimination log, the child is scheduled for three follow-up sessions for behavioral modifications, biofeedback, and a nighttime waking program. […] Behavioral modifications include: Robust daytime fluid intake before 4 p.m., daytime voiding schedule approximately every 2 hours, nighttime fluid restriction (unless the child participates in nighttime sports, or in high humidity), and healthy diet and bowel habits. […] External surface electrode biofeedback is also used for neuromuscular re-education of the pelvic floor muscles to address proprioception, coordination, and relaxation of the pelvic floor muscles in order to improve daytime bladder emptying and sensation.

• #34 Bedwetting 101: How PT Can Help! | Associates in Pediatric Therapy

  https://kidtherapy.org/helpful-articles/bedwetting-101-how-pt-can-help/

  Bedwetting is a significant issue in our children today, affecting 15% of girls and 22% of boys worldwide. […] Many medical professionals agree that consistent nighttime wetting after the age of 6 years old is cause to seek additional information and treatment. […] If a child is wetting overnight beyond age 6, any anatomical abnormalities of the urologic and neurologic systems should be ruled out. […] Constipation is the leading cause of prolonged bedwetting in children. […] Physical therapists with pelvic floor specific training can help with bedwetting in a majority of cases! 60-70% of children who wet the bed have pelvic floor muscle insufficiency, meaning the muscles of the pelvic floor lack the strength and endurance to maintain continence throughout the night. […] Pelvic floor PTs can help with improving daytime bladder habits, ensuring that a child’s bladder can be fully emptied before going to bed. […] If your child struggles with bedwetting, pelvic floor physical therapy may be beneficial.

• #35

  https://www.restorationspt.com/blog/physical-therapy-for-bedwetting-and-other-urinary-fecal-accidents/

  Bedwetting as well as urinary and fecal accidents is not an illness! Daytime/night time wetting can be considered more of a normal variation of bladder control rather than a diseased state. […] According to the International Childrens Continence Society (ICCS), treatment is not only justified but mandatory. This is where pediatric pelvic physical therapy comes in. […] Pediatric Pelvic Physical Therapy is a highly specialized area of rehabilitation that can address urinary/fecal accidents among other things. This type of physical therapy utilizes unique intervention techniques to address any tightness, weakness, or coordination issues present in the pelvic floor and pelvic girdle muscles that are typically impaired and contribute to urinary or fecal leakage. A Pediatric Pelvic Physical Therapist works closely with your pediatrician, urologist, gastroenterologist, or referring physician to normalize urinary/bowel habits, reduce urinary/fecal accidents, and reduce medications utilized to restore bowel and bladder functioning.

• #36

  https://www.restorationspt.com/blog/physical-therapy-for-bedwetting-and-other-urinary-fecal-accidents/

  Here is brief list of typical interventions utilized at pediatric pelvic physical therapy to treat bed wetting as well as urinary/fecal accidents: […] Myofascial Release – Manual therapy techniques to abdominal and pelvic girdle muscles that can tighten up or spasm and contribute to urinary or fecal retention which can eventually lead to leakage […] Postural Education – Teaching patients Proper Peeing/Pooping Posture to ease and assist with complete evacuation of bladder and bowels […] Breath Work – The diaphragm (muscle that assist with controlling breathing) and pelvic floor muscles work together to generate pressure, relax anal/urethral sphincters, and lengthen the pelvic floor muscles when urinating or having a bowel movement. These are often uncoordinated in children with fecal or urinary leakage

• #37 Pediatric Incontinence (Enuresis) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/bedwetting

  Biofeedback: Special sensors are placed on the skin near the anus to measure the strength of the pelvic floor muscles. Using computerized graphics and sounds, biofeedback therapy can help children perform exercises to strengthen the muscles. […] Urotherapy: The child is taught to go to the bathroom using a schedule and to use proper voiding and bowel movement techniques. In up to 50 percent of the cases, urotherapy can solve incontinence without further intervention. […] Medications: We use medications as little as possible. But when needed, several classes of medications are utilized such as anticholinergics (oxybutynin and solifeneacin), alpha blockers (tamsulosi and terazosin), beta 3 agonists (mirabegron) and even medications that act on the central nervous system. […] Counseling: Our program team works directly with experts at Yale Medicine Child Study Center because cognitive and behavioral therapy can help some children to modify behavior in order to manage the incontinence. […] Surgery: Sometimes an anatomical problem needs to be corrected surgically by a urologist.

• #38 Psychological treatments for the management of bedwetting – Nocturnal Enuresis – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK62702/

  National Clinical Guideline Centre (UK). Nocturnal Enuresis: The Management of Bedwetting in Children and Young People. London: Royal College of Physicians (UK); 2010. (NICE Clinical Guidelines, No. 111.) […] Bedwetting itself may be a source of low self-esteem and bedwetting has been associated with emotional and behavioural disorders. Bedwetting is for example more common in looked-after children. Psychological treatments might be of benefit to the management of emotional or behavioural problems in their own right but the GDG were interested in whether psychological treatments might be appropriate for some subgroups of children with bedwetting for the management of the bedwetting itself. […] Psychotherapy, cognitive therapy, counseling were the interventions included in the evidence review of the effectiveness of psychological interventions.

• #39 Psychological treatments for the management of bedwetting – Nocturnal Enuresis – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK62702/

  One study showed there was no statistically significant difference in the number of children who achieved 14 consecutive dry nights between children treated with psychotherapy (6 to 8 sessions over 3 months) and children treated with enuresis alarms. Relative risk 0.3, 95% CI 0.07, 1.28. Children had a mean age of 9.79 years and had 3 to 4 months of treatment. […] One study showed children treated with a 3 step program were more likely to achieve 14 consecutive dry nights compared to children treated with imipramine. Relative risk 1.71, 95% 1.07, 2.74. Children had an age range of 6 to 11 years and had 6 months of treatment. […] One study showed children treated with cognitive behaviour therapy were more likely to be dry for 3 consecutive weeks compared to children who had no treatment. Relative risk 28.05, 95% CI 1.80, 437.40. Children in the trial had a mean age of 10.05 years and had treatment for 18 weeks.

• #40 Psychological treatments for the management of bedwetting – Nocturnal Enuresis – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK62702/

  The GDG considered that bedwetting can be associated with emotional behavioural problems and the attention to these problems may be the appropriate course of action for some children and young people rather than concentrating on treatments for bedwetting. […] The available evidence on psychotherapy as treatment did not describe the psychotherapy adequately and no details were given about how it addressed bedwetting. The RCT was in a severe wetting population and the GDG considered insufficient evidence for recommending psychotherapy. […] The GDG were interested in the RCT which described use of CBT in a population with severe bedwetting. The components of CBT that were described are consistent with models used in clinical practice. The CBT was quite intensive and the GDG considered it a promising intervention but the study was small and not powered enough to show effect. CBT might be a modality of treatment suitable for some children and young people but the evidence was inadequate to make a broad recommendation. A research recommendation has been made to evaluate the effectiveness of psychological therapies, particularly CBT. […] Consider involving a professional with psychological expertise for children and young people with bedwetting and emotional or behavioural problems.

• #41 When Does My Child Need Treatment For Bedwetting?: Center Point Medicine: Pediatric Hypnosis and Counseling

  https://www.centerpointmedicine.com/blog/when-does-my-child-need-treatment-for-bedwetting

  If a comprehensive evaluation reveals that your childs bedwetting is the product of an underlying medical condition (i.e., constipation, diabetes, ADHD), treating or managing that condition can reduce or resolve nighttime incontinence. […] Given that most cases of pediatric bedwetting arent related to a medical issue, however, the typical treatment plan for most kids centers on behavioral therapies and counseling. […] Counseling can help your child better cope with any emotional distress they may have because of bedwetting, including stress, guilt, anxiety, and feelings of low self-worth or confidence. […] We also find that a combined approach incorporating hypnosis as a supportive therapy can help kids learn how to wake themselves from a deep sleep when they need to urinate so they can wake up dry regularly.

• #42 Pediatric Incontinence (Enuresis) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/bedwetting

  Most children have accidents while learning to toilet-train, but the vast majority do so only rarely and the problem usually goes away on its own. Yet, sometimes daytime urinary incontinence or bedwetting (called nocturnal enuresis) persists. And when that happens, its a good idea to get the problem checked out by a pediatric urologist. […] Help is available, including: […] Transcutaneous Electrical Nerve Stimulation (TENS): This is a pain-free and non-invasive treatment. Following the doctors instructions, the child or parent places an inexpensive, handheld device on the sacral area of the lower back. The device sends an electrical signal through the nerves, located near the surface of the skin, to the brain. These electrical signals can interrupt reflexes that impede proper bladder function.

• #43 Treatment of Bedwetting in Children | Psychology Today

  https://www.psychologytoday.com/us/blog/understanding-hypnosis/202202/treatment-of-bedwetting-in-children

  Bedwetting in children can occur because of a physical abnormality, psychological problem, or because of slow maturation of the body. […] Treatment for bedwetting includes moisture alarms, hypnosis, and medications. […] Hypnosis therapy for a dry bed varies depending on the affected child’s age. […] Usual treatments for keeping the bed dry including moisture alarms that are triggered as soon as the child starts to urinate, which gives the child an opportunity to awaken and use the restroom. […] Short-term use of medications for bedwetting should be a last resort because of their potential side-effects. […] Use of hypnosis is another viable alternative. […] When children report a period of dryness earlier in life, hypnosis treatment can be focused on uncovering and dealing with the probable underlying psychological stressor.

• #44 Treatment of Bedwetting in Children | Psychology Today

  https://www.psychologytoday.com/us/blog/understanding-hypnosis/202202/treatment-of-bedwetting-in-children

  Usually, children demonstrate improvement with their bed drying within a few weeks of their use of hypnosis, and in many cases they become completely dry within 3 months. […] Treatment for bedwetting involves considering whether the problem is caused by a physical abnormality, psychological problem, or because of slow maturation of the body. Therapy is based on addressing the underlying cause of the bedwetting, for which age-appropriate hypnotic suggestions often are useful.

• #45 Advances in Treatment of Nocturnal Enuresis in Children | IntechOpen

  https://www.intechopen.com/chapters/69092

  Desmopressin is an arginine vasopressin analog that enhances the reabsorption of water by the distal convoluted tubules and collecting ducts of the kidney and inhibits the secretion of aldosterone. […] Anticholinergic drugs are widely used for the management of NE since they can bind to choline receptors and produce antagonistic activity against acetylcholine and consequently relieve detrusor overactivity. […] Although a large amount of evidence has shown the effectiveness of conventional treatment including alarm and pharmacotherapy on NE, these approaches cannot meet all the needs of the children and their parents. […] Acupuncture, as a component of traditional Chinese medicine, has been used to manage a number of chronic diseases. […] Herbal therapy is an important component of traditional medicine.

• #46 Patient education: Bedwetting in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics

  Complementary and alternative therapies — Several complementary and alternative therapies have been tried in children with nocturnal enuresis, including acupuncture, chiropractic maneuvers, and hypnosis. However, there are not enough data from scientific studies to know if these therapies are effective. Complementary and alternative treatments are not recommended for children with bedwetting.

• #47 Bedwetting | Caring for kids

  https://caringforkids.cps.ca/handouts/behavior-and-development/bedwetting

  Whether you and your health care provider decide to treat the bedwetting or simply wait for your child to outgrow it, be sure that your child knows that bedwetting is not a bad behaviour or laziness. Don’t ever punish your child for bedwetting. It is not their fault. Your comfort and support are very important.

• #48 Bedwetting (Enuresis) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/enuresis.html

  Bedwetting usually goes away on its own, but may last for a while. […] It can be embarrassing and uncomfortable for your child, so it’s important to provide emotional support until it stops. […] Try to have your child drink more fluids during the daytime hours and less at night (and avoid caffeine-containing drinks). Then remind them to go to the bathroom one last time before bedtime. Many parents find that using a motivational system, such as stickers for dry nights with a small reward (such as a book) after a certain number of stickers, can work well. Bedwetting alarms also can be helpful. […] When your child wakes with wet sheets, don’t yell or punish. Have your child help you change the sheets. Explain that this isn’t punishment, but it is part of the process. It may even help your child feel better knowing that they helped out. Offer praise when your child has a dry night.

• #49 Bedwetting in Children & Teens: Nocturnal Enuresis | National Kidney Foundation

  https://www.kidney.org/kidney-topics/bedwetting-children-teens-nocturnal-enuresis

  It is very important to remember that bedwetting is not your child’s fault or that its under their control. Family members and friends should not shame or punish the child. Instead, focus on working with your doctor to figure out the cause and taking steps that can help. […] Bedwetting almost always goes away on its own. Most children will grow out of it by the late teens or sooner. Secondary enuresis may go away when the cause is found. It is either treated, or it gets better on its own. If bedwetting has not stopped in the late teens, your child should see a doctor.

• #50 Bedwetting: Causes, Diagnosis & Treatment – Dr. Helena Taylor Clinic

  https://helenataylorclinic.com/bedwetting-causes-diagnosis-treatment/

  Your dedication to helping your child tackle bedwetting is just as important, if not more so, than their own commitment. Working together comes with the promise of achieving a rewarding result: say goodbye to those night-time accidents and hello to peaceful slumber! […] In most cases, bedwetting is a normal part of development and will resolve on its own over time. However, there are some cases where you should seek medical advice: […] 1. Bedwetting persists beyond the age of 7-8 years. […] 2. Your child is experiencing other symptoms, such as painful urination or frequent urination. […] 3. Your child has suddenly started bedwetting after a period of being dry at night. […] 4. Your child is experiencing emotional distress or social problems as a result of their bedwetting. If you are concerned about your child’s bedwetting, speak to our paediatric team at Dr. Helena Taylor clinic. We can help determine if there is an underlying medical condition that needs to be addressed.

• #51 Bedwetting in children

  https://www.nhs.uk/conditions/bedwetting/

  Bedwetting is common and often runs in families. It can be upsetting, but most children and young people will grow out of it. See a GP or school nurse for advice. […] If your child keeps wetting the bed, a GP will be able to suggest options such as: a bedwetting alarm, medicine to reduce how much pee your child makes at night. […] The GP will check if treatment is helping. They’ll also be able to offer support if you are finding it hard to cope. […] If these treatments do not work, your child may be referred to a specialist.

• #52 Bed-Wetting in Children Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/bed-wetting-children/

  Counseling (psychotherapy) may be helpful for the child who has secondary enuresis or for bed-wetting that is caused by emotional stress. Psychotherapy involves talking with a trained counselor. The counselor helps the child identify and deal with the stress that may be causing the bed-wettings. The goal is to reduce or help manage the stress or to prevent stress from occurring. […] Treatment may be helpful if bed-wetting seems to be affecting your child’s self-esteem or affecting how your child is doing with schoolwork or getting along with peers. […] The best solution may be a combination of treatments. Below are some suggestions for treatment options according to the age of your child. Ages 5 to 8. Help your child understand that wetting the bed is a normal part of growing up. Encouragement and praise may be all that is needed to help your child wake up before wetting.

• #53 Bedwetting (Enuresis) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/enuresis.html

  Also let the doctor know if your child is under a lot of stress, if you’re feeling frustrated with the situation, or if you could use some help. In the meantime, your support and patience can go a long way in helping your child feel better about and overcome the bedwetting. […] Remember, the long-term outlook is excellent and in almost all cases, dry days are just ahead.

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