When bedwetting is caused by a medical problem, treatment depends on the specific diagnosis.
If your child has no specific medical problem causing him or her to wet the bed, but has never been dry at night, there are several treatment options:
Motivational therapy — Your doctor may suggest that you begin by trying a "token and reward system" to motivate your child to stop bedwetting. This typically involves using a colorful chart to keep track of your child's progress, with a gold star for every dry night. When the chart is filled, you can let your child select a treat. Many doctors encourage the use of three to six months of motivational therapy before trying other treatments.
Behavioral therapy — After age 8, your doctor may recommend behavioral therapy with an enuresis alarm. An enuresis alarm uses sounds or vibrations to wake a child who wets the bed or his or her underwear. In some cases, behavioral therapy is combined with motivational therapy to reinforce successful behavior by rewarding the child for dry nights.
Bladder training exercises — A few children with bedwetting respond to bladder-retention training. In this approach, the child is encouraged to hold his or her urine for longer and longer periods during the daytime.
Medications — Several medications are available to treat primary nocturnal enuresis, though these rarely are used first.
One of the safest and most commonly used medications for treating bedwetting is desmopressin acetate (Concentraid, DDAVP, Stimate), a synthetic drug that is similar to the body's natural antidiuretic hormone. The initial treatment usually lasts for three to six months.
If desmopressin is successful in keeping the child dry during this treatment period, the drug is tapered gradually and eventually stopped. Often the problem returns after the child has stopped taking the medication. Some children can use this medication to stay dry only when needed, such as when the child is away at summer camp or at a friend's sleepover party.
Combination therapy — In some children, a combination of medications and behavioral therapy will stop bedwetting when other treatments have failed.
Other options — Studies show that hypnosis, diet therapy (especially cutting out caffeine) and psychotherapy work in some cases.