Initial treatment

Bedwetting alarms

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

  • the child or young person or you do not want to try it or

  • the healthcare team thinks that it is unsuitable.

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.

Box 1 Using an alarm

You and the child or young person may need a considerable amount of advice and support in learning how to use an alarm. You should agree with the healthcare team about how this should be obtained.

The healthcare team should explain:

  • how to set, use and maintain the alarm, and how to manage problems

  • that it may take a few weeks before a response to the alarm develops and it may take many weeks to achieve dry nights

  • how to return the alarm when you no longer need it.

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.

Using an alarm with rewards

You and the child or young person should be told about the benefits of using the alarm with a reward system for agreed behaviour, such as waking up when the alarm goes off, going to the toilet after the alarm has gone off, and returning to bed and resetting the alarm. You and the child or young person should decide your roles and responsibilities together.

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:

  • fast or short-term improvement is the priority

  • you or the child or young person do not want to try an alarm or

  • the healthcare team decides that an alarm is not suitable.

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).

Box 2 Using desmopressin

If desmopressin is offered for bedwetting the healthcare team should explain:

  • how the drug works in the kidneys to reduce the amount of urine produced during the night

  • that many children and young people will have a reduction in wetness, but many will start to wet the bed again after treatment is stopped

  • that it is important that your child or the young person does not have a drink (or only has small sips) from 1 hour before it is taken until 8 hours after taking it

  • that it should be taken at bedtime

  • how to increase the dose if needed

  • that it should be taken for 3 months at a time, and further treatment can be given.

Questions you might like to ask about treatment

  • Who will be treating my child? Does my child need to have treatment?

  • Why have you decided to offer this particular treatment? Are there other options?

  • How will the treatment help my child? What effect will it have on their bedwetting and everyday life?

  • What sort of improvements might we expect and when should they start?

  • How long will it take to have an effect?

  • How long will treatment last?

  • Are there any potential problems or side effects?

  • Will the bedwetting start again when treatment is stopped?

  • What should I do if the bedwetting doesn't improve?

  • Are there different treatments that my child could try?

  • Does the current treatment need to be altered?

(Please note that a child or young person may want to ask such questions for themselves.)

  • Information Standard