Note: Nocturnal enuresis is not classified as a condition requiring treatment until the age of 6.
Therapy motivation and therapy evaluation (therapy is often lengthy; child-friendly reward systems, e.g., award stars for dry nights).
In nocturnal enuresis with additional daytime symptoms (monosymptomatic enuresis nocturna, non-MEN), daytime symptoms should be treated before nocturnal enuresis.
If fecal incontinence is present, it should be treated first.
Conventional non-surgical therapy methods
Standard durotherapy (basic therapy of nonorganic enuresis).
Information about the clinical picture
Drinking/meal plan:
Visit toilet when urge to urinate
Visit toilet in the morning and evening
Visit toilet before long journeys
In case of nocturnal enuresis → reduce evening fluid intake.
Fluid intake via the 7-cup rule (intake of age-appropriate amounts of fluid in 7 portions throughout the day).
Micturition/toilet training:
Regular toilet use (with reminder times if necessary).
Micturition schedules / calendar
Special urotherapy:
Sacral neuromodulation (SNM) for overactive bladder (OAB); surgical procedure that modulates motor innervation of the bladder).
Apparent behavioral therapy (AVT; e.g., bell pants) for monosymptomatic enuresis; in combination with dry bed training (DBT)/arousal training (reinforcing positive behavior: child receives a reward for standing up and actively cooperating), if appropriate [first-line agent; child and parents must agree]
Intermittent external/self-catheterization (in addition to urotherapy) for underactive bladder (formerly “lazy bladder”)
Repetitive sacral magnetic stimulation (rSMS) at the level of S2 (2nd sacral segment) – significantly improved monosymptomatic enuresis nocturna in a small randomized trial.
