Pediatric urologist shares management strategies for nocturnal enuresis


"I like to tell my patients, one of the first kind of treatments is actually reassurance," says Miriam Harel, MD.

In this video, Miriam Harel, MD, shares management strategies for nocturnal enuresis. Harel is an assistant professor of urology at Albert Einstein College of Medicine, Bronx, New York.


What are some management strategies for nocturnal enuresis?

I like to tell my patients, one of the first kind of treatments is actually reassurance - reassuring parents that this is, again, usually normal and will go away, also reassuring the children that there's nothing wrong and there's no reason to be embarrassed. If we don't find any underlying causes, then oftentimes the management might just be observation. If parents and children are comfortable with that, I tell a lot of families that bedwetting is usually not dangerous. The most potential danger is if it affects children's self esteem and lifestyle. If they're young enough where that's not a concern, then sometimes we'll just observe conservatively. If they are more interested in active treatment, one of the first things is, again, focusing on their daytime habits and setting them up for success at night. Some of the most important recommendations are what we call "timed voiding," which means that children should not wait too long to go to the bathroom during the day. For younger children, we usually recommend voiding every 2 hours, even if they don't feel the urge to void. Management of constipation is a huge factor in treating bedwetting; we actually find in about 20% of children who have constipation, their bedwetting may resolve with just management of constipation alone. Those are helpful conservative strategies to start with. If that's not sufficient and the children or parents are bothered by it, then there are some medications that we can add. The most common medication we use for bedwetting is called desmopressin. It's something that children would take 1 or 2 hours before bedtime, and it basically works to help limit urine production overnight. It's very safe if parents know to restrict their child's fluid intake at night, so that we don't affect the concentration of their electrolytes. But this can be effective in keeping children dry until they grow out of bedwetting. I always tell patients, most of us believe that this is not really a cure, but it's kind of like a band aid to help keep them dry while they're waiting to outgrow it. Many families are very happy just having that kind of temporary crutch. What I believe is the most effective treatment is using enuresis alarms. There are many different types of bedwetting alarms that specifically wake the child up when they start to urinate. It's important for parents to know that this is very different than just waking up their children randomly. A lot of parents try that, and it doesn't work and it kind of just makes everybody exhausted. The alarms are different because they are triggered by the actual wetness, and so over time, if the child gets up to then go to the bathroom, it teaches their brain and their bladder to communicate better and helps them grow out of the bedwetting faster. I believe that is a better long-term solution than medications; however, it does come along with much more effort not just for the child, but often for the parents who might have to wake their child up. Because again, part of this problem is that a lot of these children won't hear the alarm while they're sleeping.

This transcription was edited for clarity.

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