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Simple behavioural and physical interventions for nocturnal enuresis in children.
Cochrane Database Syst Rev 2002; (2):CD003637CD

Abstract

BACKGROUND

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Simple behavioural methods of treating bedwetting include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction.

OBJECTIVES

To assess the effects of simple behavioural interventions on nocturnal enuresis in children, and to compare these with other interventions.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group trials register. The reference list of a previous version of this review was also searched. Date of the most recent search: December 2001.

SELECTION CRITERIA

All randomised or quasi-randomised trials of simple behavioural interventions for nocturnal enuresis in children up to the age of 16. Trials focused solely on daytime wetting were excluded.

DATA COLLECTION AND ANALYSIS

In a previous version of this review, trials up to 1997 were independently assessed by two reviewers. Previous trials were re-assessed, and further trials were assessed for quality, and data were extracted by another reviewer.

MAIN RESULTS

Twelve reliable trials met the inclusion criteria, involving 748 children of whom 365 received a simple behavioural intervention. However, within each comparison each outcome was addressed by single trials only, precluding meta-analysis. In single small trials, reward systems (e.g. star charts), lifting and waking were each associated with significantly fewer wet nights, higher cure rates and lower relapse rates compared to controls. There was not enough evidence to evaluate retention control training (bladder training), whether compared with controls or dry bed training, or used as a supplement to alarms, or versus desmopressin. Cognitive therapy may have lower failure and relapse rates than star charts, but this finding was based on one small trial only. One small trial of poor quality suggested that star charts were initially less successful than amitriptyline but this difference did not persist after the treatments stopped.

REVIEWER'S CONCLUSIONS

Simple behavioural methods may be effective for some children, but further trials are needed, in particular in comparison with treatments known to be effective, such as desmopressin, tricyclic drugs and alarms. However, simple methods could be tried as first line therapy before considering alarms or drugs, because these alternative treatments may be more demanding and may have adverse effects.

Authors+Show Affiliations

Health Services Research Unit (Foresterhill Lea), University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD. c.glazener@abdn.ac.ukNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

12076495

Citation

Glazener, C M., and J H. Evans. "Simple Behavioural and Physical Interventions for Nocturnal Enuresis in Children." The Cochrane Database of Systematic Reviews, 2002, p. CD003637.
Glazener CM, Evans JH. Simple behavioural and physical interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2002.
Glazener, C. M., & Evans, J. H. (2002). Simple behavioural and physical interventions for nocturnal enuresis in children. The Cochrane Database of Systematic Reviews, (2), p. CD003637.
Glazener CM, Evans JH. Simple Behavioural and Physical Interventions for Nocturnal Enuresis in Children. Cochrane Database Syst Rev. 2002;(2)CD003637. PubMed PMID: 12076495.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Simple behavioural and physical interventions for nocturnal enuresis in children. AU - Glazener,C M, AU - Evans,J H, PY - 2002/6/22/pubmed PY - 2002/8/10/medline PY - 2002/6/22/entrez SP - CD003637 EP - CD003637 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Simple behavioural methods of treating bedwetting include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction. OBJECTIVES: To assess the effects of simple behavioural interventions on nocturnal enuresis in children, and to compare these with other interventions. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register. The reference list of a previous version of this review was also searched. Date of the most recent search: December 2001. SELECTION CRITERIA: All randomised or quasi-randomised trials of simple behavioural interventions for nocturnal enuresis in children up to the age of 16. Trials focused solely on daytime wetting were excluded. DATA COLLECTION AND ANALYSIS: In a previous version of this review, trials up to 1997 were independently assessed by two reviewers. Previous trials were re-assessed, and further trials were assessed for quality, and data were extracted by another reviewer. MAIN RESULTS: Twelve reliable trials met the inclusion criteria, involving 748 children of whom 365 received a simple behavioural intervention. However, within each comparison each outcome was addressed by single trials only, precluding meta-analysis. In single small trials, reward systems (e.g. star charts), lifting and waking were each associated with significantly fewer wet nights, higher cure rates and lower relapse rates compared to controls. There was not enough evidence to evaluate retention control training (bladder training), whether compared with controls or dry bed training, or used as a supplement to alarms, or versus desmopressin. Cognitive therapy may have lower failure and relapse rates than star charts, but this finding was based on one small trial only. One small trial of poor quality suggested that star charts were initially less successful than amitriptyline but this difference did not persist after the treatments stopped. REVIEWER'S CONCLUSIONS: Simple behavioural methods may be effective for some children, but further trials are needed, in particular in comparison with treatments known to be effective, such as desmopressin, tricyclic drugs and alarms. However, simple methods could be tried as first line therapy before considering alarms or drugs, because these alternative treatments may be more demanding and may have adverse effects. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/12076495/Simple_behavioural_and_physical_interventions_for_nocturnal_enuresis_in_children_ L2 - https://doi.org/10.1002/14651858.CD003637 DB - PRIME DP - Unbound Medicine ER -