Preliminary management focusing on behavioral modification and positive reinforcement is often helpful. Bladder training exercises are not recommended, because they have not been demonstrated to be effective. The only therapies proved to be effective are alarm therapy and treatment with desmopressin acetate or imipramine. Enuresis per se is not a surgically treated condition. Treatment is usually not recommended for children younger than 6 or 7 years.
Initial management includes the following:
Caring and patient parental attitude, acknowledging that the child has no control over the wetting
Behavioral modification with positive reinforcement
Explanation of the probable cause of the enuresis
Keen attention to establishing and maintaining a normal daytime voiding pattern, normal bowel pattern, and normal hydration
If following this approach for up to 3 months does not result in dryness, either alarm therapy or pharmacologic therapy should be considered.
Alarm therapy should be considered for every patient. Children with a reported deep sleep pattern and difficulties awakening may not have a successful outcome. If the child is still wet after a minimum of 3 months of consecutive use, alarm therapy may be discontinued and considered unsuccessful. Failure does not preclude future successful treatment once the child is older and more motivated.
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