Concomitant nonpharmacologic therapy in the treatment of primary nocturnal enuresis

Some 5 to 7 million children in the United States suffer from primary nocturnal enuresis (PNE). Although the majority of parents do not seek medical evaluation and treatment for their children with PNE, physicians usually prescribe pharmacotherapy for this condition. Several nonpharmacologic treatment modalities also are available, including bladder-stretching exercises, behavioral therapy, hypnotherapy, and elimination diets. Motivational counseling, another technique, should be a component of all PNE treatment programs. Although none of the methods offers effective resolution of nighttime incontinence in all children, combining methods increases the probability of treatment success and encourages compliance without risk to the child. Required in any program is the active participation of the patient and his or her family and the guidance, education, and reinforcement provided by the physician. Although the health-care professional may have to devote considerable time to help the patient, successful treatment may prevent the development of potentially serious psychosocial effects.