Efficacy of alarm intervention in primary monosymptomatic nocturnal enuresis in children

Gourav Claudius, Jugesh Chhatwal, Inderpreet Sohi


Background: Enuresis affects about 15 to 20% of five year old children, and even up to 2% of young adults. The various treatment modalities used are behavioural therapy, alarm intervention and pharmacological therapy. Current evidences suggest that alarm intervention is preferable to other modalities of treatment. So a study was done to assess the efficacy of alarm interventions in primary monosymptomatic nocturnal enuresis in children.

Methods: A prospective study was done on children aged between 5-18 years with primary monosymptomatic nocturnal enuresis on a total of 62 children. An enuresis diary was maintained by parents. All children received alarm intervention for 12 weeks. A child remaining dry for two consecutive weeks was taken as a success. The subjects were followed up for 12 weeks, two or more wet night in 2 weeks period were taken as relapse. If child failed to become dry after 12 weeks of alarm intervention, intervention was continued for maximum of 6 months or till he became dry.

Results: Out of 62 children, majority were males and in the age group of 5-7 years. Family history of enuresis was present in 30.65% of children. A total of 74.19 % of subjects achieved dryness while failures were 25.8% and relapse was seen in 23.91 % during follow up. Significant improvement was noticed as early as 2 months after alarm intervention (p 0.00499) but maximum improvement was seen after 5 months (20 week). On follow up 23.91 % children had relapsed but the frequency of wet nights among these also was significantly low (mean wet nights 0.08/week). Even among failures there was a significant decrease in mean number of wet nights (from 4.24 wet nights/week to 1.85 wet nights/week).

Conclusions: Alarm treatment was an effective intervention for management of primary monosymptomatic nocturnal enuresis with high success and low relapse rate.


Primary nocturnal enuresis, Alarm intervention, Children

Full Text:



Ramakrishnan K. Evaluation and treatment of enuresis. American Family Physician. 2008;78:489-96.

Naitoh Y, Kawauchi A, Soh J, Kamoi K, Miki T. Health related quality of life for monosymptomatic enuretic children and their mothers. J Urol. 2012;188(5):1910-4.

Kanaheswari Y, Poulsaeman V, Chandran V. Self-esteem in 6- to 16-year-olds with monosymptomatic nocturnal enuresis. J Paediatr Child Health. 2012;48(10):178-82.

Deshpande AV, Caldwell PH, Sureshkumar P. Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics) Cochrane Database Syst Rev. 2012;12:12.

Goel KM, Thomson RB, Gibb EM, McAinsh TF. Evaluation of nine different types of enuresis alarms. Arch Dis Child. 1984;59(8):748-52.

Özgür BC, Özgür S, Doğan V, Örün UA. The efficacy of an enuresis alarm in monosymptomatic nocturnal enuresis, Singapore Med J. 2009;50(9):879-80.

Jensen IN, Kristensen G. Frequency of Nightly Wetting and the Eficiency of Alarm Treatment of Nocturnal Enuresis. Scand J Urol Nephrol. 2001;35:357-63.

Harari MD, Moulden A. Personal Practice. Nocturnal enuresis: what is happening? J Paediatr Chid Health. 2000;36:78-81.

Schaumburg HL, Rittig S, Djurhuus JC. No relationship between family history of enuresis and response to desmopressin. J Urol. 2001;166(6):2435-7.

Thomas N. A clinical study on efficacy of desmopressin in the treatment of primary nocturnal enuresis in children above 6 years of age. A thesis submitted for MD Pediatrics. Baba Farid University of health sciences Punjab India. 1998.

Pereira RF, Silvares EF, Braga PF. Behavioral alarm treatment for nocturnal enuresis. Int Braz J Urol. 2010;36(3):332-8.

McKendry BJ, Stewart DA, Khanna F, Netley C. Primary enuresis: relative success of three methods of treatment. Can Med Assoc J. 1975;113(10):935-55.

Devlin JB, Catharin C. Predicting treatment outcome in nocturnal enuresis. Arch Dis Child. 1990:65:1158-61.

Monda JM, Husmann DA. J Primary nocturnal enuresis: a comparison among observation, imipramine, desmopressin acetate and bed-wetting alarm systems. Urol. 1995;154(2):745-8.

Bollard J. A 2-year follow-up of bedwetters treated by dry-bed training and standard conditioning. Behav Res Ther. 1982;20(6):571-80.

Houts AC, Peterson JK, Whelan JP. Prevention of relapse in full spectrum home training for primary enuresis: A components analysis. Behaviour Therapy. 1986;17:462-9.

Werry JS, Cohrssen J. Enuresis - an etiologic and therapeutic study. Journal of Pediatrics. 1965;67(3):423-31.

Wille S. Comparison of desmopressin and enuresis alarm for nocturnal enuresis. Arch Dis Child. 1986;61(1):30-3.

Halliday S, Meadow SR, Berg I. Successful management of daytime enuresis using alarm procedures: a randomly controlled trial. Arch Dis Child. 1987;62(2):132-7.

Forsythe WI, Butler RJ. Fifty years of enuretic alarms. Arch Dis Child. 1989;64:879-85.