Intervention Review

Complementary and miscellaneous interventions for nocturnal enuresis in children

  1. Tao Huang1,*,
  2. Xu Shu2,
  3. Yu Shan Huang3,
  4. Daniel KL Cheuk4

Editorial Group: Cochrane Incontinence Group

Published Online: 7 DEC 2011

Assessed as up-to-date: 17 MAY 2011

DOI: 10.1002/14651858.CD005230.pub2


How to Cite

Huang T, Shu X, Huang YS, Cheuk DKL. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD005230. DOI: 10.1002/14651858.CD005230.pub2.

Author Information

  1. 1

    Jinggangshan University, Branch of Cooperative Research Center on Evidence-based Medicine of Ministry of Education, Department of Preventive Medicine, Ji'an, Jiangxi, China

  2. 2

    Nanchang University, The First Affiliated Hospital, Nanchang, Jiangxi, China

  3. 3

    Jinggangshan University, Centre for Evidence-Based Medicine, Ji'an, Jiangxi, China

  4. 4

    The University of Hong Kong, Queen Mary Hospital, Department of Pediatrics and Adolescent Medicine, Hong Kong SAR, China

*Tao Huang, Branch of Cooperative Research Center on Evidence-based Medicine of Ministry of Education, Department of Preventive Medicine, Jinggangshan University, 23 Jifu Road, Ji'an, Jiangxi, 343000, China. ht229@163.com.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 7 DEC 2011

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Abstract

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Background

Nocturnal 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.

Objectives

To assess the effects of complementary interventions and others such as surgery or diet on nocturnal enuresis in children, and to compare them with other interventions.

Search methods

We searched PubMed (1950 to June 2010), EMBASE (1980 to June 2010), the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) (1984 to June 2010), Chinese Biomedical Literature Database (CBM) (1975 to June 2010), China National Knowledge Infrastructure (CNKI) (1979 to June 2010), VIP database (1989 to June 2010), and the reference lists of relevant articles, all last searched 26 June 2010. No language restriction was used.

Selection criteria

All randomised or quasi-randomised trials of complementary and other miscellaneous interventions for nocturnal enuresis in children were included except those focused solely on daytime wetting. Comparison interventions could include no treatment, placebo or sham treatment, alarms, simple behavioural treatment, desmopressin, imipramine and miscellaneous other drugs and interventions.

Data collection and analysis

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

Main results

In 24 randomised controlled trials, 2334 children were studied, of whom 1283 received a complementary intervention. The quality of the trials was poor: 5 trials were quasi-randomised, 5 showed differences at baseline and 17 lacked follow up data.

The outcome was better after hypnosis than imipramine in one trial (relative risk (RR) for failure or relapse after stopping treatment 0.42, 95% confidence interval (CI) 0.23 to 0.78). Psychotherapy appeared to be better in terms of fewer children failing or relapsing than both alarm (RR 0.28, 95% CI 0.09 to 0.85) and rewards (RR 0.29, 95%CI 0.09 to 0.90) but this depended on data from only one trial. Medicinal herbs had better results than desmopressin in one trial (RR for failure or relapse after stopping treatment 0.35, 95% CI 0.14 to 0.85). Acupuncture had better results than sham control acupuncture (RR for failure or relapse after stopping treatment 0.67, 95% CI 0.48 to 0.94) in a further trial. Active chiropractic adjustment had better results than sham adjustment (RR for failure to improve 0.76, 95% CI 0.60 to 0.95). However, each of these findings came from small single trials, and must be verified in further trials. The findings for diet and faradization were unreliable, and there were no trials including homeopathy or surgery.

Authors' conclusions

There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects clearly reported.

 

Plain language summary

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Complementary treatments such as hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs for bedwetting in children

Night-time bedwetting is common in childhood, and can cause stigma, stress and inconvenience. Alarms offer the best chance of cure, and desmopressin may be used to reduce or stop wet nights during treatment. Simple behavioural methods such as rewards also help, especially as first line treatment. People often use complementary methods to treat their children, but the review of trials did not provide good evidence to support this. There was no reliable information comparing complementary methods with established effective methods such as alarms and desmopressin. Further research is needed.

 

Résumé simplifié

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Traitements complémentaires comme l’hypnose, la psychothérapie, l’acupuncture, la chiropractie et les plantes médicinales pour le traitement de l’incontinence nocturne chez les enfants

L’incontinence nocturne est courante pendant l’enfance et peut être source de stigmates, de stress et de gênes. Les réveils sont la meilleure solution pour palier ce problème et la desmopressine peut être utilisée pour atténuer ou arrêter l’incontinence nocturne pendant le traitement. De simples méthodes comportementales, comme des récompenses, peuvent également être efficaces, surtout pour un traitement de première intention. Les personnes utilisent fréquemment des méthodes complémentaires pour traiter leurs enfants, mais cette revue des essais ne fournissait aucune preuve probante pour corroborer cela. Aucune information fiable comparant des méthodes complémentaires à des méthodes effectives établies, comme les réveils et la desmopressine, n’était disponible. Des recherches supplémentaires doivent être effectuées.

Notes de traduction

Traduit par: French Cochrane Centre 1st January, 2012
Traduction financée par: Ministère du Travail, de l'Emploi et de la Santé Français

 

Plain language summary

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  3. Plain language summary
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Razne komplementarne intervencije za noćnu enurezu kod djece

Komplementarne terapije kao što su hipnoza, psihoterapija, akupunktura, kiropraktika i ljekovite trave za noćno mokrenje kod djece

Noćno mokrenje često je u djetinjstvu, i može uzrokovati neugodnosti u društvu i stres. Alarmi za noćno mokrenje pružaju najveću šansu za izlječenje, a lijek dezmopresin se također može koristiti za smanjenje ili prestanak noćnog mokrenja tijekom liječenja. Jednostavne bihevioralne metode, uključujući nagrade, također mogu pomoći, osobito kao liječenje prve linije. Ljudi često koriste komplementarne metode za liječenje svoje djece od noćnog mokrenja. Međutim, rezultati Cochrane sustavnog pregleda su pokazali za ne postoje čvrsti dokazi koji podupiru korištenje komplementarnih metoda za liječenje noćnog mokrenja kod djece. Nisu pronađene pouzdane informacije o usporedbi različitih komplementarnih metoda s konvencionalnim učinkovitim metodama kao što su alarmi za noćno mokrenje i lijek dezmopresin. Potrebna su daljnja istraživanja.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre