Jain and Bhatt’s article suggests that a provider obtain a thorough history, physical examination, reviews a voiding diary to see how much their bladder can hold throughout the day, and urinalysis. No other testing is needed if the patient does not have daytime urinary symptoms or other red flags.
There are two treatment modalities: pharmacologic and non-pharmacologic.
Non-Pharmacologic can be very successful.
Motivational therapy with fluid restriction 2 hours before bed and voiding before bed. Monitor dry nights and give positive reinforcement. Child should be encouraged to participate in morning clean up. Do NOT punish for wet nights. The authors noted that 15-20% of kids can become dry with these simple measures.
Alarm therapy has the highest cure rate. This is an alarm attached to the underwear that alarm when it gets wet. Please see my affiliate links on my product page. The alarm must be used every night for up to 16 weeks. After 14 dry nights, the child is considered cured. In the studies reviewed in this article, 71% of patient were dry. Interestingly, starting alarm therapy in the winter has a decreased effectiveness. Perhaps, parents and patients are more likely to get up if they’re not freezing.
The most commonly used medications in bedwetting are Desmopressin (DDAVP), Oybutynin (ditropan), and Imipramine. We’ll cover medications in alternative posts.
Jain, S., & Bhatt, G. C. (2016). Advances in the management of primary monosymptomatic nocturnal enuresis in children. Paediatrics and International Child Health, 36(1), 7-14. doi:10.1080/20469047.2015.1109254