Behavioral Treatment

Behavioral therapy is unfortunately the least popular approach to enuresis – being employed by only about 10% of pediatricians. This is perhaps because it is very “labor intensive” – requiring frequent long visits, talking with the child over many months time. It works best when the child is old enough to care about and take “ownership” of the problem, AND when it is closely supervised by a pediatrician or behavioral psychologist trained in it’s use. The program should be something the child and I are working on together (with parental help), not something the parent and I (or the parent alone) are “doing to” the child. It is also not something a kid should be working on by themselves with parental “coaching”. Before I start a course of behavioral therapy, I like to see that the problem is bothering the child as much (or more) than it’s bothering the parent, and that the child is cognitively ready to go home and “work on a project” or “practice” something independently. A good guide: when a child is ready to start taking lessons to play a musical instrument, he’s probably also ready for behavioral bedwetting treatment. If you wait for these criteria to be met, the success rate of this approach within a year will be 60-80%, with a relapse rate of only 10-20%. If you don’t wait for these criteria to be met, you are setting yourself and the kid up for a frustrating experience.

Behavioral treatment programs for enuresis can include many components: star/ sticker charts or calendars linked to a positive reinforcement incentive, self hypnosis, biofeedback, stream interruption exercises,bladder stretching exercises, scheduled toileting, and bedwetting alarms all play a role. The particular mix and the particular pace & order of introduction of these measures is an art, not a science, and should be individualized for the particular patient by an experienced clinician.