Treatment
Bedwetting alarm
Although the exact mechanism of alarm therapy is not well understood, one of the possible mechanisms has been explained by classic conditioning theory. The child is woken by the bell in order to get up and complete voiding into the toilet. A more appropriate approach is an operant type of behavioral technique in which the child learns to suppress his/her bladder emptying during sleep [13]. Alarm therapy is associated with a significant increase in nocturnal bladder capacity in those children who become dry. It is has a response rate of 60% and the long-term success rate was reported as 43%. The Cochrane review by Glazener et al. [14] reported that nearly half of the children who persisted with a bedwetting alarm remained dry after treatment finished, compared to almost none remaining dry if no treatment was given. Although desmopressin may have a more immediate effect, alarms appear more effective in the long run and the evidence for supplementing alarm treatment with desmopressin was conflicting. Results using alarms were also better than those when using tricyclics, both during and after treatment.
Disruption of sleep for both parents and the child and the relatively long duration for obtaining the result of the treatment are common causes of discontinuation.