Bedwetting in under 19s

Why this is important

It is not known which of the elements of multicomponent treatments (for example dry‑bed training and retention‑control training) are clinically effective and cost effective for treating bedwetting in children and young people under 19 years old. Data from randomised controlled trials of dry‑bed training and retention‑control training suggest that the treatments may be clinically effective. However, certain elements of the multicomponent treatments studied are not acceptable as a form of treatment due to their punitive nature. Further research is needed to establish which elements could be used effectively to treat bedwetting.

Research should:

Outcomes of interest include: the number of children who achieved 14 consecutive dry nights, the number of children who remain dry at 6 months and 2 years after treatment, the mean number of wet nights after treatment, the change in the number of wet nights, the psychological effect of treatment, psychological effects (self‑esteem, self‑concept, PinQ - a continence‑specific paediatric quality‑of‑life measurement tool), quality of life measures and drop outs.

Why this is important

The evidence base for management of bedwetting is poor. Studies are inadequately powered, symptoms are poorly defined and study populations are commonly children seen in secondary and tertiary centres. Follow‑up periods are often inadequate.

Research should provide:

Why is this important?

There are relatively few studies that focus upon the psychological impact and health‑related quality of life of children who experience bedwetting. In addition, studies of effectiveness have focused on the achievement of dryness as the primary outcome rather than how treatment might affect social and psychological aspects as well as the quality of life of children and young people and their families.

Research should:

Quality‑of‑life research of children and young people with bedwetting pre‑ and post‑treatment would also be very useful to inform further economic evaluation work.

Why this is important

Many families consider the use of complementary and/or alternative medicine (CAM) as a treatment option when conventional treatment 'fails' or in order to avoid drug or other treatments. There is very little evidence about the efficacy of many CAM treatments, but the use of CAM is widespread and increasing across the developed world. There is a clear need for more effective guidance for health professionals, so that they can give evidence‑based advice to patients about what does and does not work and what is and is not safe, and for the public.

Research should:

Outcomes of interest include: self‑esteem, number of dry nights, permanent or temporary nature of increased number of dry nights, quality of life, costs and social engagement.

Why this is important

There is evidence that, for an important minority of children, wetting and soiling problems persist into late childhood and sometimes beyond puberty, but their prevalence is not clearly known. It has also recently been reported that in children who experience more frequent bedwetting (more than three times a week) it is more likely to persist into late childhood and adolescence. These studies suggest that, contrary to popular belief, wetting and soiling problems do not always resolve with increasing age. If wetting and soiling problems remain unresolved or untreated they can become socially and psychologically debilitating. There are no longitudinal cohort studies examining the impact of wetting and soiling on a wide range of outcomes in adolescence relating to mental health, education/school attainment, relationships with parents and peers, social activities and goals/aspirations for the future. Persistence of wetting and soiling problems into adolescence is likely to be accompanied by ridicule and bullying by peers and increasing intolerance from parents, especially if they believe that their child is to blame for the problem. Such reactions can only serve to exacerbate the young person's distress and may lead to delays in seeking help. In particular, teenagers who are unsuccessfully treated in childhood are often reluctant to seek help for wetting or soiling due to the severe embarrassment associated with the problem, and others may simply believe that no help is available.

Research should:

Outcomes of interest include: the examination of mental health, psychosocial and educational outcomes and whether adolescents who have combined wetting and soiling are at increased risk of negative outcomes compared to those with wetting or soiling alone.