Intervention Review

Alarm interventions for nocturnal enuresis in children

  1. Cathryn MA Glazener1,*,
  2. Jonathan HC Evans2,
  3. Rachel E Peto3

Editorial Group: Cochrane Incontinence Group

Published Online: 20 APR 2005

Assessed as up-to-date: 27 FEB 2007

DOI: 10.1002/14651858.CD002911.pub2

How to Cite

Glazener CMA, Evans JHC, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002911. DOI: 10.1002/14651858.CD002911.pub2.

Author Information

  1. 1

    University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, UK

  2. 2

    Nottingham University Hospitals NHS Trust, Department of Paediatric Nephrology, Nottingham, UK

  3. 3

    University of York, NHS Centre for Reviews & Dissemination, York, UK

*Cathryn MA Glazener, Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要


Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15 to 20% of five year olds, and up to 2% of young adults.


To assess the effects of alarm interventions on nocturnal enuresis in children, and to compare alarms with other interventions.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 February 2007) and the reference lists of relevant articles.

Selection criteria

All randomised or quasi-randomised trials of alarm interventions for nocturnal enuresis in children were included, except those focused solely on daytime wetting. Comparison interventions included no treatment, simple and complex behavioural methods, desmopressin, tricyclics, and miscellaneous other methods.

Data collection and analysis

Two reviewers independently assessed the quality of the eligible trials, and extracted data.

Main results

Fifty six trials met the inclusion criteria, involving 3257 children of whom 2412 used an alarm. The quality of many trials was poor, and evidence for many comparisons was inadequate. Most alarms used audio methods.

Compared to no treatment, about two thirds of children became dry during alarm use (RR for failure 0.38, 95% CI 0.33 to 0.45). Nearly half who persisted with alarm use remained dry after treatment finished, compared to almost none after no treatment (RR of failure or relapse 45 of 81 (55%) versus 80 of 81 (99%), RR 0.56, 95% CI 0.46 to 0.68). There was insufficient evidence to draw conclusions about different types of alarm, or about how alarms compare to other behavioural interventions. Relapse rates were lower when overlearning was added to alarm treatment (RR 1.92, 95% CI 1.27 to 2.92) or if dry bed training was used as well (RR 2.0, 95% CI 1.25 to 3.20). Penalties for wet beds appeared to be counter-productive. Alarms using electric shocks were unacceptable to children or their parents.

Although desmopressin may have a more immediate effect, alarms appeared to be as effective by the end of a course of treatment (RR 0.85, 95% CI 0.53 to 1.37) but their relative effectiveness after stopping treatment was unclear from two small trials which compared them directly. Evidence about the benefit of supplementing alarm treatment with desmopressin was conflicting. Alarms were not significantly better than tricyclics during treatment (RR 0.59, 95% CI 0.32 to 1.09) but the relapse rate was less afterwards (7 of 12 (58%) versus 12 of 12 (100%), RR 0.58, 95% CI 0.36 to 0.94). However, other Cochrane reviews of desmopressin and tricyclics suggest that drug treatment alone, while effective for some children during treatment, is unlikely to be followed by sustained cure as almost all the children relapse.

Authors' conclusions

Alarm interventions are an effective treatment for nocturnal bedwetting in children. Alarms appear more effective than desmopressin or tricyclics because around half the children remain dry after alarm treatment stops. Overlearning (giving extra fluids at bedtime after successfully becoming dry using an alarm), dry bed training and avoiding penalties may further reduce the relapse rate. Better quality research comparing alarms with other treatments is needed, including follow-up to determine relapse rates.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Alarm interventions for nocturnal enuresis (bedwetting) in children

Night-time bedwetting is common in childhood, and can cause stigma, stress and inconvenience. The review of trials found 56 studies involving 3257 children. Alarm interventions reduce night-time bed wetting in about two thirds of children during treatment, and about half the children remained dry after stopping using the alarm. Alarms take longer to reduce bedwetting than desmopressin, but their effects continue after treatment in half the children who use alarms. So alarms are better in the long term than treatment with desmopressin or tricyclic drugs. Overlearning (giving children extra fluids at bedtime after successfully becoming dry using an alarm) and dry bed training (getting children to go to the toilet repeatedly and changing their own sheets when they wet) may reduce the relapse rate. There are no serious side-effects, which can occur with drug treatment. However, children need more supervision and time from other family members at first. There was not enough evidence with which to compare alarms with other non-drug treatments. Because some of the studies were of poor quality, better research comparing alarms with other treatments is needed, including follow-up to measure relapse rates.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要













共有五十六篇試驗文章研究符合搜尋的條件,包含了3257個小孩,其中有2412個使用鬧鈴治療。許多試驗的品質很差,且有很多比較的證據並不適當。大部分警報器的方式是聲音。若與沒有治療時的情形做比較,大約有三分之二的兒童使用警報器後不再尿床(失敗的RR:0.38, 95% 信賴區間:0.33 to 0.45)。有將近一半持續使用警報器的兒童在治療結束後也能保持不再尿床,而沒有接受治療的兒童則幾乎沒有人有改善(失敗或復發的RR:45 of 81 (55%) versus 80 of 81 (99%), RR:0.56, 95%信賴區間 0.46 to 0.68)。對於各種類型警報器之間的差異,或警報器與其他行為療法的差異,目前並沒有足夠的證據可以做出推論。使用警報器再加上反覆的學習(RR:1.92, 95%信賴區間:1.27 to 2.92)或是乾床訓練(dry bed training)(RR:2.0, 95%信賴區間:1.25 to 3.20)都可以使尿床的復發率更低。但懲罰尿床的兒童卻達到反效果。使用電刺激的警報器並不被小孩或他們的父母所接受。雖然使用desmopressin(抗利尿激素)可以達到立即的效果,但使用警報器在一個療程過後也能達到一樣的效果(RR:0.85, 95%信賴區間:0.53 to 1.37),但是從兩篇直接比較這兩個方法的小試驗來看,在結束療程後的相對效果尚未清楚。關於使用警報器同時合併desmopressin療法的益處,目前的證據仍兩極化。警報器與tricyclics的比較上,在療程中警報器並沒有比起使用tricyclics有顯著的效果(RR:0.59, 95%信賴區間:0.32 to 1.09),但往後其復發率較低(7 of 12 (58%) versus 12 of 12 (100%), RR:0.58, 95%信賴區間:0.36 to 0.94)。然而,其他考科藍實證醫學資料庫針對desmopressin及tricyclics的評論文章提出,單獨使用藥物即使對一些治療中的兒童有效果,但因為幾乎所有的兒童都會復發,並不被用來作為持續治療的方法。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌