Simple behavioural and physical interventions for nocturnal enuresis in children


  • CMA Glazener,

    Senior Clinical Research Fellow, Corresponding author
    1. University of Aberdeen, Health Services Research Unit (Foresterhill Lea), Aberdeen, Scotland, UK
    • CMA Glazener, Senior Clinical Research Fellow, Health Services Research Unit (Foresterhill Lea), University of Aberdeen, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.

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  • JHC Evans



Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Simple behavioural methods of treating bedwetting include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction.


To assess the effects of simple behavioural interventions on nocturnal enuresis in children, and to compare these with other interventions.

Search strategy

We searched the Cochrane Incontinence Group trials register. The reference list of a previous version of this review was also searched. Date of the most recent search: December 2001.

Selection criteria

All randomised or quasi-randomised trials of simple behavioural interventions for nocturnal enuresis in children up to the age of 16. Trials focused solely on daytime wetting were excluded.

Data collection and analysis

In a previous version of this review, trials up to 1997 were independently assessed by two reviewers. Previous trials were re-assessed, and further trials were assessed for quality, and data were extracted by another reviewer.

Main results

Twelve reliable trials met the inclusion criteria, involving 748 children of whom 365 received a simple behavioural intervention. However, within each comparison each outcome was addressed by single trials only, precluding meta-analysis.

In single small trials, reward systems (e.g. star charts), lifting and waking were each associated with significantly fewer wet nights, higher cure rates and lower relapse rates compared to controls. There was not enough evidence to evaluate retention control training (bladder training), whether compared with controls or dry bed training, or used as a supplement to alarms, or versus desmopressin. Cognitive therapy may have lower failure and relapse rates than star charts, but this finding was based on one small trial only.

One small trial of poor quality suggested that star charts were initially less successful than amitriptyline but this difference did not persist after the treatments stopped.

Reviewer's conclusions

Simple behavioural methods may be effective for some children, but further trials are needed, in particular in comparison with treatments known to be effective, such as desmopressin, tricyclic drugs and alarms. However, simple methods could be tried as first line therapy before considering alarms or drugs, because these alternative treatments may be more demanding and may have adverse effects.

Plain language summary


Simple treatments such as rewarding dry nights and lifting may reduce night-time bedwetting in children, and they do not have adverse effects, but the evidence is weak.

Bedwetting (nocturnal enuresis) is a stressful condition that particularly affects young children. It is the involuntary loss of urine at night without an underlying disease as the cause. It can result in social problems, sibling teasing and lowered self esteem. Simple methods to help children gain control include star charts and other reward systems, fluid restriction, lifting and wakening. They are often used as a first attempt to control the problem before using drugs or alarms. The review of trials found very little evidence to show that these simple methods work, but also found no adverse effects on safety. More research is needed.