General Measures

• Use nonpharmacologic approaches as first line before prescribing medications (6)[A].
• Simple behavioral interventions (e.g., scheduled wakening, positive reinforcement, bladder training, diet changes)
• Enuresis alarms (bells or buzzers):
  • 66–70% success rate; must be used nightly for 3–4 months; offers cure; significant parental involvement; disruption of sleep for entire family

Issue for Referral

• Primary NE: Persistent enuresis despite nonpharmacologic and pharmacologic therapies
• Diurnal incontinence or nonmonosymptomatic enuresis with voiding dysfunction or underlying medical condition

Additional Therapies Individual psychotherapy, crisis intervention, and family therapy