A medical screening, including family history, toilet training history, a urine culture and urinalysis, can determine whether medical problems are the cause or a contributing factor to enuresis. A small percentage of children with enuresis have medical problems, such as urinary tract infections, and require specialized treatment. Children with daytime wetting problems, regardless of the presence or absence of nighttime wetting, have been shown to have medical problems at a rate higher than among children who wet only during sleep.
Many children outgrow enuresis without treatment. For those who do not, behavioral techniques have been shown to be effective. Behavioral treatments try to eliminate bedwetting by directly training the child to control bladder functions during the night. A device called the bell and pad is used in many behavioral treatment plans. Somewhere in the bed there is a pad with a sensor that detects wetness. At the first sign of wetness the sensor causes a bell to ring, waking the child. The child then gets up, runs to the bathroom, and urinates in the toilet. This system can be made more effective when combined with a system of positive and negative reinforcement. Cleanliness training, or having the child strip the bed, put on clean sheets and change his pajamas, increases the child's motivation to get up when he hears the bell. Bladder training exercises can help the child wait longer between trips to the bathroom. Parental attitude and motivation are basic to the success of these programs.
Depending on the severity, a child may benefit from medication, which may physically limit the amount of urine output or keep him dry.