408 Simple treatments effective for bedwetting in children

April 04, 2014

PEARLS 408, October 2013, written by Brian R McAvoy

Clinical question
How effective are simple behavioural interventions (rewarding dry nights with star charts, lifting and waking and bladder training) for nocturnal enuresis in children (aged up to 16 years)?

Bottom line
In single small trials, rewards, lifting and waking and bladder training were each associated with significantly fewer wet nights, higher full response rates and lower relapse rates compared with controls. Simple behavioural interventions appeared to be less effective when compared with other known effective interventions (such as enuresis alarm therapy and drug therapy with imipramine and amitriptyline). However, the effect of the drug therapies was not sustained at follow up, after completion of treatment. When one simple behavioural therapy was compared with another, there did not appear to be one that was more effective than another. Simple treatments have no side effects or safety concerns.

Caveat
The methodological quality of the 16 included trials was low. The sample sizes were small for most studies. In all but one study comparison, outcomes were reported by single trials only, precluding meta-analysis. The confidence intervals were wide and this was likely to obscure or overestimate treatment effects. Only 10 of the 16 studies gave information about the follow-up results, after the intervention was finished. Most studies had high attrition rates.

Context
Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition, which affects around 15% to 20% of 5-year-olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting in children are defined as interventions requiring a behaviour or action by the child that promotes night dryness and includes strategies which reward that behaviour.

Cochrane Systematic Review
Caldwell PHY et al. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Reviews, 2013, Issue 7. Art. No.: CD003637.DOI: 10.1002/14651858. CD003637.pub3. This review contains 16 studies involving 1643 participants.

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