Alarms better than medication for stopping bedwetting

Alarms that buzz, ring or light up when a child wets the bed are more effective at stopping bedwetting than medications like the drug commonly used to prevent urination, according to a new review of recent studies.

Among the 2,345 children enrolled in the studies, two-thirds of those who used an alarm stopped bedwetting for 14 straight days. About half of those children (55 percent) relapsed into bedwetting after quitting the alarm treatment, compared with 99 percent of children who received no bedwetting treatments.

“ On average, there were three fewer wet nights per week using the standard alarm,” compared with no alarm, conclude Dr. Cathryn Glazener of the University of Aberdeen in Scotland and colleagues in the review.

Children taking the drug desmopressin stopped bedwetting faster than those using the alarm system, but “there is no reliable evidence that the drugs are effective after treatment has stopped,” says Glazener.

Only 18 percent of children taking the drug stayed dry in the weeks after the therapy, compared with 67 percent of children using alarms, the researchers found.

Glazener and colleagues found some evidence that alarms are also better at treating bedwetting than tricyclic drugs, a group of antidepressant medications, but say more studies are needed to confirm this finding.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Nighttime bedwetting, or enuresis, affects 15 percent to 20 percent of 5-year-olds and 1 percent to 3 percent of teens, according to a 2003 report by the American Academy of Family Physicians.

Bedwetting is not physically harmful, but it can cause “stigma, stress and inconvenience” and increase the risk of emotional and physical abuse by disapproving parents, say the Cochrane reviewers.

" There is no doubt that bedwetting can impact the entire family dynamic," says Dr. Alan R. Greene, a pediatrician and clinical professor at Stanford University School of Medicine.

There are a variety of treatments for bedwetting, although most cases of enuresis eventually resolve themselves, Glazener explains.

“ Without treatment, about 15 percent bedwetting children become dry each year. However, it is not possible to predict which children will become dry spontaneously,” she says.

Glazener and colleagues analyzed 55 trials comparing the effectiveness of bedwetting alarms to several other therapies. In general, the studies were small, involving an average of 57 children, and “the quality of many trials was poor,” Glazener says.

Most of the alarms used in the studies made a buzzing or ringing noise, but alarms used in a 1964 study gave children small electric shocks. Some of the children were burned by the shocks, many were frightened of them and several parents refused to allow them to be used, say the researchers.

Glazener and colleagues found some, but insufficient, evidence to suggest that an immediate alarm was better than a delayed alarm or than one which woke the parents rather than the child.

They say that there is not enough evidence to determine whether alarms are a better therapy than other interventions like waking up a child during the night to use the toilet or using a reward system to encourage dry nights.

In several of the studies, researchers treated children with a combination of an alarm system and a drug like desmopressin, a strategy that may be especially useful for treating bedwetting over several months, according to Greene.

" We need to reinforce that long-term treatment options are available, which we should be especially considering when managing enuresis in older children for whom bedwetting has a major impact," he says.

The Cochrane reviewers also examined studies of complementary or alternative treatments for bedwetting, including hypnosis, chiropractic methods, acupuncture, psychotherapy and special diets. The complementary therapy studies were small, single trials of “dubious” quality, the reviewers found.

“ People often use complementary methods to treat their children, but the review of trials did not provide good evidence to support this,” Glazener says.