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Treatment Methods

Unfortunately, many treatments are advertised on the internet and in health magazines with high price tags and little or no research to back them up. So what really works?

Bedwetting Alarms:
Various types of bedwetting alarms are available. The common feature of these alarms is that the alarm sounds in reaction to the first drop of urine as a result of the closed electrical circuit. In addition, they are all battery operated. Beyond this, there are substantial differences.
Basically, there are three types: alarms called buzzers that are connected to the body, wireless buzzers, and the “bell and pad” type.

Buzzers—Bedwetting Alarms that are connected to the body 
The bedwetting alarm is attached to the child’s pajamas and connected by a wire to a small moisture sensor, which is placed inside underwear near the child’s sexual organ.
It is inexpensive but has some disadvantages. Some of the alarms are unsafe. The metal sensor can become corroded because of the acidity of the urine (ph.) and may cause bruising to the skin. The child’s movement in bed can also cause skin irritation due to rubbing. Some children are resistant to wires connected to their body. As the alarm is attached to the body, the child can unintentionally disconnect it. In some cases, the sound emitted from the buzzer is not strong enough to activate the reflex system. Moreover, in some cases, the child’s blanket covers the alarm and dims its sound.
The wireless buzzers—Bedwetting Alarms that are not connected to the body
The difference from the typical wired buzzers is that wireless buzzers use a radio transmitter placed on the sensor plate on the lower abdomen near the child’s sexual organ. A radio receiver is installed in the alarm, which is attached to either the child’s pajamas or placed next to the child’s bed. When the child wets the bed, radio waves are transferred from the transmitter to the receiver, and the alarm is activated.
A simple question should be asked: Is it safe to place a radio transmitter near the child’s sexual organ?
Bell and pad alarms
Bell and pad bedwetting alarms are composed of two parts: the control unit (alarm) and a plastic detector pad, which is placed on the bed under the sheet. The pad is attached to the alarm by a slim wire, which does not disturb the user in bed. The bell and pad alarms are more efficient, safer, and more convenient than ordinary buzzers. This type of alarm costs more since as it is more expensive to manufacture compared with other types of alarms.

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Medication:
There have not been any new developments in pharmacology for bedwetting since the early eighties when the latest drug was developed. The drug, Desmopressin Acetate (marketed as DDAVP Nasal Spray, DDAVP Rhinal Tube, DDAVP, DDVP, Minirin, and Stimate Nasal Spray) is an anti-diuretic hormone that is most commonly prescribed for enuresis.
However, in 2007 the FDA posted an alert that Desmopressin intranasal formulations should no longer be prescribed for the treatment of primary nocturnal enuresis. Desmopressin works by limiting the amount of water that is eliminated in the urine. A healthy body needs to maintain a balance of water and salt (“sodium"). If the sodium levels fall too much (“Hyponatremia”), a person may have seizures and, in extreme cases, may die. Children treated with Desmopressin intranasal formulations for primary nocturnal enuresis were found to be particularly susceptible to severe Hyponatremia and seizures. 
Other drugs for enuresis are Imipramine and Oxybutinin. While the advantages of medication are its easy administration and that considerable progress is seen during the initial stages of drug usage, there are disadvantages. In addition to the side effects of the drugs, there is a very high relapse rate (60-90%) when the patient stops using the medication.

Alternative treatments:
A number of alternative treatments including Homeopathy, Reflexology, Acupuncture, Shiatsu, Hypnosis, Fluid absorbed diets and other methods have been tried but by and large they have not been shown to have successful outcomes.

Psychotherapy:
Psychotherapy has only been found to be effective when the primary source of the problem is a psychological one. The treatment in those cases does not focus on the enuresis itself but on the psychological causes for the behavior. Psychotherapy for a child without psychological factors for enuresis might cause damage as the lack of progress will increase the sense of failure and frustration.

Behavioral Treatment:
Behavioral Treatment is considered the most effective therapy for bedwetting. The child undergoes a learning process that is designed to teach him to activate the continence mechanism. The child sleeps with an enuresis alarm which starts to ring when the child starts to urinate. The purpose of the ringing is to activate the reflex system and create a learning process.
Unfortunately, many parents, who use this device, terminate the treatment after a short period of time because they claim that their child does not wake up when the buzzer goes off. This is a common misconception; the goal of the buzzer is not to teach the child to wake up at night but to teach him to restrain himself. When the child does not wake up, the buzzer acts on his subconscious reflex mechanism. The buzzer is an essential component, to measure the reflex response and asses the child response to the treatment.
Treatment with a bedwetting alarm is the only treatment that has been found to be effective with 40-50% of patients.


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