Bedwetting in under 19s

Bedwetting alarms

An alarm should be offered as initial treatment for bedwetting if advice on drinks, toilet use and rewards is not successful, unless:

Alarms may not be the most suitable treatment if the child or young person wets the bed infrequently (only once or twice a week), if you are finding the bedwetting difficult to cope with, or if the priority is for fast or short-term improvement.

If the child or young person has a hearing impairment, an alternative type of alarm (such as a vibrating alarm) may be offered.

Alarms detect when wetting starts at night (through a sensor either worn in the pants or inside a mat under the sheet) and make a noise and/or vibrate to wake the child or young person. This helps the child or young person to recognise when they need to pass urine. Gradually they may learn to hold on or wake before the alarm goes off, and so eventually stop wetting the bed. The healthcare team should explain these aims, how to use the alarm (see box 1) and that alarms are often successful over time.

The healthcare team should explain that alarms are not suitable for everyone, and should assess whether they are suitable for your family. A lot of effort, involvement and commitment is needed. You may need to help the child or young person to wake up and go to the toilet when the alarm goes off, and your sleep may be disrupted for many weeks or months. You will also need to record progress, for example noting if and when the child or young person wakes to the alarm and how wet the bed is.

The healthcare team should assess progress with an alarm within 4 weeks. If there are no signs of an early response (such as smaller wet patches, waking to the alarm, the alarm going off later or less often, and fewer wet nights), alarm treatment should be stopped. If there are signs of an early response you should continue with the alarm until the bedwetting has stopped for at least 2 weeks of uninterrupted dry nights. If bedwetting starts again you can start using the alarm again immediately.

If bedwetting continues after 3 months of using an alarm, the healthcare team will assess whether you should keep using it. It should only be continued if the bedwetting is still improving and you and the child or young person want to continue.

Desmopressin treatment

An alarm may not always be the most suitable initial treatment. A drug called desmopressin (see box 2) should be offered to treat bedwetting if:

Children and young people should not have any drinks after they have taken desmopressin, so if they would find it difficult not to drink during the night it might not be suitable for them. If the child or young person has sickle cell disease and is offered desmopressin, advice should be offered about stopping desmopressin during a sickle cell crisis.

If offered desmopressin, the child or young person should not need to have blood and urine tests or have their weight and blood pressure checked.

If the bedwetting does not completely stop after 1 to 2 weeks of desmopressin treatment, the healthcare team may suggest that the dose is increased.

The healthcare team should assess progress with desmopressin treatment after 4 weeks. If there are signs of an early response (smaller wet patches, wetting the bed fewer times per night and fewer wet nights) or the bedwetting has stopped, desmopressin should be continued for 3 months.

If the bedwetting has not responded or only partially responded after 4 weeks, the healthcare team may suggest that the desmopressin tablets are taken earlier (1 to 2 hours before bedtime) and continued for 3 months, but only if the child or young person can manage without drinks during the night, starting from 1 hour before taking the tablets. Alternatively, if there are no signs of a response, the healthcare team may suggest that desmopressin treatment is stopped.

After 3 months of desmopressin treatment, if bedwetting has improved but not stopped completely, the healthcare team may advise continuing treatment, as bedwetting may continue to improve for up to 6 months.

Alternatively, if desmopressin has only been partially successful, the healthcare team may offer an anticholinergic drug to take with desmopressin (see anticholinergics combined with desmopressin).