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Simple behavioural interventions for nocturnal enuresis in children

  1. Patrina HY Caldwell1,*,
  2. Gail Nankivell2,
  3. Premala Sureshkumar3

Editorial Group: Cochrane Incontinence Group

Published Online: 19 JUL 2013

Assessed as up-to-date: 15 DEC 2011

DOI: 10.1002/14651858.CD003637.pub3


How to Cite

Caldwell PHY, Nankivell G, Sureshkumar P. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003637. DOI: 10.1002/14651858.CD003637.pub3.

Author Information

  1. 1

    The Children's Hospital at Westmead Clinical School, University of Sydney, Discipline of Paediatrics and Child Health, Westmead, Australia

  2. 2

    The Children's Hospital at Westmead, Physiotherapy, Westmead, NSW, Australia

  3. 3

    Royal Alexandra Hospital for Children, Centre for Kidney Research, Parramatta, New South Wales, Australia

*Patrina HY Caldwell, Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW, Australia. Patrinac@chw.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 19 JUL 2013

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Baker 1969 {published data only}
Bennett 1985 {published data only}
  • Bennett GA, Walkden VJ, Curtis RH, Burns LE, Rees J, Gosling JA, et al. Pad-and-buzzer training, dry-bed training, and stop-start training in the treatment of primary nocturnal enuresis. Behavioural Psychotherapist 1985;13:309-19.
Bhatia 1990 {published data only}
  • Bhatia MS, Dhar NK, Rai S, Malik SC. Enuresis: an analysis of 82 cases. Indian Journal of Medical Sciences 1990;44(12):337-42. [MEDLINE: 91231332]
Bryant 2003 {published data only}
  • Bryant C, Fairbrother G. Baseline results: randomised trial of bladder training vs enuresis alarm vs bladder training plus enuresis alarm among children with nocturnal enuresis (Abstract 12.09 PP). Proceedings of the joint meeting of the International Children's Continence Society (ICCS) and the Asia-Pacific Association of Pediatric Urology (APAPU), 2002 Dec 10-13, Hong Kong. 2002:80.
  • Bryant C, Fairbrother G. Randomised trial of bladder training vs enuresis alarm vs combined interventions in the management of nocturnal enuresis in children (Abstract). Conference unknown 2003. [: SR-INCONT34172]
El-Anany 1999 {published data only}
Fava 1981 {published data only}
  • Fava GA, Cracco L, Facco L. Positive reinforcement and enuresis. Italian Journal of Psychology 1981;8(2):149-52.
Fielding 1980 {published data only}
Fournier 1987 {published data only}
Hamano 2000 {published data only}
  • Hamano S, Yamanishi T, Igarashi T, Ito H, Murakami S. Functional bladder capacity as predictor of response to desmopressin and retention control training in monosymptomatic nocturnal enuresis. European Urology 2000;37(6):718-22. [MEDLINE: 20291060]
Harris 1977 {published data only}
Mehrotra 1980 {published data only}
  • Mehrotra SN, Liu L, Srivastava JR, Singh SB. Evaluation of various methods in treatment of enuresis. Indian Pediatrics 1980;17(6):519-22. [MEDLINE: 81166737]
  • Singh SB, Nigam A, Liu L, Mehrotra SN, Srivastava JR. Medical psychological and combined therapy in the cases of enuresis: a comparative study. Indian Journal of Clinical Psychology 1980;7:99-102.
Pretlow 1999 {published and unpublished data}
Ronen 1995 {published data only}
  • Ronen T, Rahav G, Wozner Y. Self-control and enuresis. Journal of Cognitive Psychotherapy: An International Quarterly 1995;9:249-58.
  • Ronen T, Wozner Y, Rahav G. Cognitive intervention in enuresis. Child & Family Behaviour Therapy 1992;14(2):1-14.
Turner 1970 {published data only}
Van Dommelen 2009 {published data only}
  • Van Dommelen P, Kamphuis M, Van Leerdam FJ, De Wilde JA, Rijpstra A, Campagne AE, et al. The short- and long-term effects of simple behavioral interventions for nocturnal enuresis in young children: a randomized controlled trial. Journal of Pediatrics 2009;154(5):662-6.
Van Hoeck 2007 {published and unpublished data}
  • Van Hoeck K, Bael A, Hirche H, Lax H, Van Gool J, Trouet D. Increasing functional bladder capacity in monosymptomatic nocturnal enuresis? A randomized controlled trial in 149 pre-pubertal children (Abstract number 545 (P)). Pediatric Nephrology 2007;22:1546.
  • Van Hoeck KJ, Bael A, Van Dessel E, Van Renthergem D, Bernaerts K, Vandermaelen V, et al. Do holding exercises or antimuscarinics increase maximum voided volume in monosymptomatic nocturnal enuresis? A randomized controlled trial in children. Journal of Urology 2007;178(5):2132-6.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Ayan 2007 {published data only}
  • Ayan S, Topsakal K, Gokce G, Gultekin EY. Efficacy of combined anticholinergic treatment and behavioral modification as a first line treatment for nonneurogenic and nonanatomical voiding dysfunction in children: a randomized controlled trial. Journal of Urology 2007;177(6):2325-9.
Bak 2007 {published data only}
  • Bak M, Serdaroglu E, Bicilioglu Y. Comparing desmopressin, alarm and combined treatments in nocturnal enuretic children (Abstract number 531 (P)). Pediatric Nephrology 2007;22:1542.
Barker 1979 {published data only}
Bouchard 1981 {published data only}
  • Bouchard M-A, Joly J, Cardinal J-F. Diurnal urinary retention in the treatment of enuresis: Comparison of univariate and multivariate analyses [Rétention urinaire diurne dans le traitement de l'énurésie: comparaison des analyses univariées et multivariées]. Canadian Journal of Behavioural Science 1981;13(1):53-64.
But 2006 {published data only}
  • But I, Varda NM. Functional magnetic stimulation: A new method for the treatment of girls with primary nocturnal enuresis?. Journal of Pediatric Urology 2006;2(5):415-8.
Chertin 2007 {published data only}
  • Chertin B, Koulikov D, Abu-Arafeh W, Mor Y, Shenfeld OZ, Farkas A. Treatment of nocturnal enuresis in children with attention deficit hyperactivity disorder. Journal of Urology 2007;178(4 Pt 2):1744-7.
Cohen 2006 {published data only}
  • Cohen HA. Treatment of enuresis nocturna by circular muscle exercise (Paula Method). http://clinicaltrials.gov/ct2/show/NCT00404638 2006.
Creer 1975 {published data only}
  • Creer TL, Davis MH. Using a staggered-wakening procedure with enuretic children in an institutional setting. Journal of Behavioural Therapy and Experimental Psychiatry 1975;6:23-5.
Doleys 1977 {published data only}
  • Doleys DM, Ciminero AR, Tollinson JW, Williams CL, Wells KC. Dry-bed training and retention control training: A comparison. Behaviour Therapy 1977;8(4):541-8.
  • Williams CL, Doleys DM, Ciminero AR. A two year follow-up of enuretic children treated with dry-bed training. Journal of Behavior Therapy & Experimental Psychiatry 1978;9(3):285-6.
Dong 1998 {published data only}
  • Dong WZ, Sun JH, Bi DC, Hao YH. Impulse direct current therapy for 45 cases with enuresis. Chinese Journal of Physical Therapy 1998;21(4):248.
Evans 2007 {published data only}
  • Evans J, Lottmann H. "Desmopressin response in the treatment of primary nocturnal enuresis in the United Kingdom" DRIP UK: an open-label, randomised comparative study of oral desmopressin versus enuresis alarm (Abstract number 225). Proceedings of the 37th Annual Meeting of the International Continence Society (ICS), 20-24 Aug, Rotterdam, the Netherlands. 2007.
Hagglund 1965 {published data only}
  • Hagglund TB. Enuretic children treated with fluid restriction or forced drinking. Annales Paediatriae Fenniae 1965;11:84-90.
Hanson 1988 {published data only}
Jiang 1996 {published data only}
  • Jiang HEXI. Cake-separated moxibustion for 108 cases of enuresis due to deficiency of the kidney-qi. Shanghai Zhenjiu Zazhi [Shanghai Journal of Acupuncture and Moxibustion)] 1996;15(2):16-7.
Jodorkovsky 2003 {published data only}
  • Jodorkovsky R. Treatment of primary nocturnal enuresis with hand therapy: A randomized, double-blind, placebo-controlled trial. Medical Acupuncture 2003;14(2):28-31.
Kawauchi 1998b {published data only}
  • Kawauchi A, Imada N, Tanaka Y, Yamao Y, Watanabe H. Effects of systematic treatment based on overnight simultaneous monitoring of electroencephalography and cystometry. European Urology 1998;33 Suppl 3:58-61.
Kroll 2006 {published data only}
  • Kroll P, Jankowski A, Makowiak J. The comparative study on selective alpha1-blocker and behavioural therapy in the treatment of discoordinated voiding in children. Przeglad Lekarski 2006;63(Suppl 3):226-8.
Lebedev 1995 {published data only}
  • Lebedev VA. The treatment of neurogenic bladder dysfunction with enuresis in children using the SKENAR apparatus (self-controlled energy-neuroadaptive regulator). Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 1995;Jul-Aug(4):25-6.
Li 1996 {published data only}
  • Li W, Xu YZ. Analysis of the effectiveness of catgut implantation at acupoint for enuresis. Shanghai Zhenjiu Zazhi [Shanghai Journal of Acupuncture and Moxibustion] 1996;15(4):23.
Li 2002 {published data only}
  • Li Z-H. Clinical research on the treatment of enuresis with electroacupuncture plus TDP irradiation. Shanghai Zhenjiu Zazhi [Shanghai Journal of Acupuncture and Moxibustion] 2002;21(4):28-9.
Ma 2007 {published data only}
  • Ma J, Zhang Y-W, Wu H, Jiang F, Jin X-M. A randomized controlled clinical trial for treatment of children with primary nocturnal enuresis. Zhonghua Er Ke Za Zhi [Chinese Journal of Pediatrics] 2007;45(3):167-71.
McConaghy 1969 {published data only}
  • McConaghy N. A controlled trial of imipramine, amphetamine, pad-and-bell conditioning and random awakening in the treatment of nocturnal enuresis. Medical Journal of Australia 1969;2(5):237-9. [MEDLINE: 69296582]
Naitoh 2005 {published data only}
  • Naitoh Y, Kawauchi A, Yamao Y, Seki H, Soh J, Yoneda K, et al. Combination therapy with alarm and drugs for monosymptomatic nocturnal enuresis not superior to alarm monotherapy. Urology 2005;66(3):632-5.
Ozden 2008 {published data only}
  • Ozden C, Ozdal OL, Aktas BK, Ozelci A, Altinova S, Memis A. The efficacy of the addition of short-term desmopressin to alarm therapy in the treatment of primary nocturnal enuresis. International Urology & Nephrology 2008;40(3):583-6.
Paschalis 1972 {published data only}
  • Paschalis AP, Kimmel HD, Kimmel E. Further study of diurnal instrumental conditioning in the treatment of enuresis nocturna. Journal of Behavior Therapy & Experimental Psychiatry 1972;3:253-6.
Reed 1994 {published data only}
  • Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary noctural enuretic children (Abstract). Proceedings of the National Conference on Chiropractic & Pediatrics. 1993:64-82.
Renjing 2004 {published data only}
  • Renjing L. Therapy of children with nocturnal enuresis using tuina. Chinesische Medizin 2004;19(2):63-9.
Seabrook 2005 {published data only}
  • Seabrook JA, Gorodzinsky F, Freedman S. Treatment of primary nocturnal enuresis: A randomized clinical trial comparing hypnotherapy and alarm therapy. Paediatrics & Child Health 2005;10(10):609-10.
Terakye 1997 {published data only}
  • Terakye G, Buldukoglu K. Childhood enuresis: application of Orem's Self-Care Practice Model to home visits in Turkey. Journal of Pediatric Nursing 1997;12(3):193-7. [MEDLINE: 97342228]
Tuygun 2007 {published data only}
  • Tuygun C, Eroglu M, Bakirtas H, Gucuk A, Zengin K, Imamoglu A. Is second-line enuretic alarm therapy after unsuccessful pharmacotherapy superior to first-line therapy in the treatment of monosymptomatic nocturnal enuresis?. Urologia Internationalis 2007;78:260-3.
Van Hoeck 2008 {published data only}
  • Van Hoeck KJ, Bael A, Lax H, Hirche H, Bernaerts K, Vandermaelen V, et al. Improving the cure rate of alarm treatment for monosymptomatic nocturnal enuresis by increasing bladder capacity--a randomized controlled trial in children. Journal of Urology 2008;179(3):1122-1126; discussion 1126-7.
Van Kampen 2009 {published data only}
  • Van Kampen M, Lemkens H, Deschamps A, Bogaert G, Geraerts I. Influence of pelvic floor muscle exercises on full spectrum therapy for nocturnal enuresis. Journal of Urology 2009;182(4 Suppl):2067-71.
Vasconcelos 2006 {published data only}
  • Vasconcelos M, Lima E, Caiafa L, Noronha A, Cangussu R, Gomes S, et al. Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study. Pediatric Nephrology 2006;21(12):1858-64.
Vasconcelos 2007 {published data only}
  • Vasconcelos M, Lima E, Oliveira E, Filqueiras M, Vasconcelos R, Colozimo E. Predicting factors of success of a training program in children with dysfunctional elimination syndrome (DES): a multivariate analysis (Abstract number 540 (P)). Pediatric Nephrology 2007;22:1545.
Wang 1994 {published data only}
  • Wang J-X, Liu F, Wei J. Clinical observation on 32 cases of functional enuresis treated with acupuncture at Baihui (Gv 20). World Journal of Acupuncture-Moxibustion 1994;4(4):5-8.
Wang 1999 {published data only}
  • Wang JR, Zhang BF. Comparative study on treatment of nocturnal enuresis by needle-embedding, acupuncture, and catgut-embedding. Zhongguo Zhen Jiu [Chinese acupuncture & moxibustion] 1999;19:608.
Wang 2007 {published data only}
  • Wang QL, Xu H, Bi YI, Cao Q, Ruan SS. A randomized control trial (RCT) study of biofeedback and DDAVP in children with primary nocturnal enuresis (Abstract number 484 (P)). Pediatric Nephrology 2007;22:1531.
Xiao 1997 {published data only}
  • Xiao LF. 42 cases of enuresis treated by point injection therapy. Shanghai Zhenjiu Zazhi 1997;16(1):22.
Yamanishi 1988 {published data only}
  • Yamanishi T, Igarashi T, Murakami S, Murayama N, Kamura K, Yasuda K, et al. A comparative study of the effects of drug therapy and bladder training therapy (Japanese). Urologic Transactions 1988;34(1):102-6. [MEDLINE: 88238207]

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Rodriguez 1984 {published data only (unpublished sought but not used)}
  • Rodriguez J, Parraga J, Leon JM. Comparative efficacy between three procedures for the treatment of enuresis (Kimmel behavioural approach, pharmacological and mixed techniques). Análisis y Modificación de Conducta 1983;9(20):111-31. [: SRINCONT29667]
Unuvar 2005 {published data only (unpublished sought but not used)}
  • Unuvar T, Sonmez F. The role of urine osmolality and ions in the pathogenesis of primary enuresis nocturna and in the prediction of responses to desmopressin and conditioning therapies. International Urology & Nephrology 2005;37(4):751-7.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
APA 1980
  • American Psychiatric Association. Functional enuresis. Diagnostic and Statistical Manual of Mental Disorders. 3rd Edition. American Psychiatric Association, 1980.
Azrin 1973
Bakwin 1971
Bakwin 1973
  • Bakwin H. The genetics of enuresis. In: Kolvin I, MacKeith RC, Meadow SR editor(s). Bladder control and enuresis. London: William Heinemann Medical Books, 1973.
Blackwell 1989
  • Blackwell C. A guide to enuresis: A guide to treatment of enuresis for professionals. Bristol: ERIC, 1989.
Bower 1996
Brooks 2003
Butler 1988
  • Butler RJ, Brewin CR, Forsythe WI. A comparison of two approaches to the treatment of nocturnal enuresis and the prediction of effectiveness using pre-treatment variables. Journal of Child Psychology & Psychiatry & Allied Disciplines 1988;29(4):501-9. [MEDLINE: 89109292]
Butler 1994
  • Butler RJ, Redfern EJ, Holland P. Children's notions about enuresis and the implications for treatment. Scandinavian Journal of Urology & Nephrology. Supplementum 1994;163:39-47. [MEDLINE: 95183920]
Butler 2000
  • Butler RJ, Holland P. The three systems: a conceptual way of understanding nocturnal enuresis. Scandinavian Journal of Urology and Nephrology 2000;34(4):270-7. [DOI: 10.1080/003655900750042022]
Creighton 1990
De Jonge 1973
  • De Jonge GA. Section II: Epidemiology of enuresis: Chapter 4 - Epidemiology of enuresis: A survey of the literature. In: Kolvin I, MacKeith RC, Meadow SR editor(s). Bladder control and enuresis. London: William Heinemann Medical Books, 1973:39-46.
Deshpande 2012
Devlin 1991
Djurhuus 1992
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Egger 1997
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Eiberg 1995
Fitzwater 1992
Forsythe 1974
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Forsythe 1989
  • Forsythe WI, Butler RJ. Fifty years of enuretic alarms. Archives of Disease in Childhood 1989;64(6):879-85.
Glazener 2004a
  • Glazener CMA, Evans JHC. Desmopressin for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD002112]
Glazener 2004b
  • Glazener CMA, Evans JHC, Peto R. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD002117]
Glazener 2004c
Glazener 2004d
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Glazener 2004e
  • Glazener CMA, Evans JHC, Peto RE. Complex behavioural and educational interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD004668]
Hagglof 1998
  • Hagglof B, Andren O, Bergstrom E. Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment. European Urology 1998;33(Suppl 3):16-9. [DOI: 10.1159/000052236]
Harbord 2006
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org. [: www.cochrane-handbook.org.]
Hirasing 1997
Hjalmas 2004
Houts 1983
Howe 1992
Huang 2011
Jarvelin 1989
Jarvelin 1990
  • Jarvelin MR, Huttunen NP, Seppanen J, Seppanen U, Moilanen I. Screening of urinary tract abnormalities among day and nightwetting children. Scandinavian Journal of Urology and Nephrology 1990;24(3):181-9. [MEDLINE: 91047829]
Jura 2011
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Koff 1995
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Krantz 1994
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Maizels 1993
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Mishne 1993
  • Mishne JM. Primary nocturnal enuresis: a psychodynamic clinical perspective. Child and Adolescent Social Work Journal 1993;10(6):469-95.
Moffatt 1989
Morgan 1970
  • Morgan R. The treatment of enuresis amongst child clients of a social services department. British Journal of Social Work 1970;9(2):217-31.
Morison 1998
  • Morison MJ. Parents' and young people's attitudes towards bedwetting and their influence on behaviour, including readiness to engage in and persist with treatment. British Journal of Urology 1998;81(Suppl 3):56-66.
Neveus 2006
  • Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The standardisation of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. Journal of Urology 2006;176(1):314-24. [DOI: 10.1016/S0022-5347(06)00305-3]
Norgaard 1993
Novello 1987
Peters 2006
Redsell 2001
Reed 1993
  • Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary nocturnal enuretic children. Proceedings of the National Conference on Chiropractic & Pediatrics. 1993:64-82.
Rutter 1973
  • Rutter M, Yule W, Graham P. Section V: Chapter 17 - Enuresis and behavioural deviance. Some epidemiological considerations. In: Kolvin I, MacKeith RC, Meadow SR editor(s). Bladder control and enuresis. London: William Heinemann Medical Books, 1973:137-47.
Shaffer 1977
  • Shaffer D. Enuresis. In: Rutter M, Hersov L editor(s). Child psychiatry: Modern approaches. Oxford: Blackwell Scientific Publications, 1977.
Sorotzkin 1984
Stewart 1975
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Theunis 2002
Von Gontard 2001
Von Gontard 2011a
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Warzak 1993
Warzak 1994
  • Warzak WJ, Friman PC. Current concepts in Pediatric Primary Nocturnal Enuresis. Child and Adolescent Social Work Journal 1994;11(6):507-23.
WHO 1992
  • WHO. Nonorganic enuresis. In: WHO editor(s). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: WHO, 1992.
Yeung 2004
Yeung 2008
Young 1972

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Glazener 2002
Glazener 2004f
  • Glazener CMA, Evans JHC. Simple behavioural and physical interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2004, Issue 2. [DOI: 10.1002/14651858.CD003637.pub2]
Lister-Sharp 1997
  • Lister-Sharp D, O'Meara S, Bradley M, Sheldon TA. A systematic review of the effectiveness of interventions for managing childhood nocturnal enuresis, CRD Report 11. York: NHS Centre for Reviews and Dissemination, University of York, 1997.