What role do alarm therapy and pharmacological treatments play in the management of nocturnal enuresis?

Alarm therapy is considered the first-line treatment for children and young people whose bedwetting has not responded to advice on fluids, toileting, or reward systems, unless it is deemed undesirable or inappropriate by the child, young person, or their parents or carers ¹.

It involves setting and using an alarm to detect wetness and alert the child or young person, with response guidance provided to manage the alarm effectively

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Assessment of response to alarm treatment should be made by 4 weeks, with continued treatment if early signs of response are observed, such as smaller wet patches, waking to the alarm, or fewer wet nights

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Reassuringly, dry nights may be a late sign of response and can take weeks to achieve

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Pharmacological treatments, primarily desmopressin, are offered if alarm treatment is unsuccessful or unsuitable, especially in children over 7 years where rapid or short-term improvement is a priority or if an alarm is undesirable

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Desmopressin can be used in children aged 5 and over, with dose adjustments considered if there is no response after 1-2 weeks, and assessment at 4 weeks to determine continuation for up to 3 months based on signs of response

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If there is no response to initial desmopressin, combination therapy with an alarm and desmopressin or desmopressin alone can be considered, especially if there was a partial response to previous treatments

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