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Treatment Options

Treatment for bedwetting typically does not begin until after the age of five – and then only if your child is emotionally upset about the issue and ready for change. If your child isn’t ready, treatment efforts can be ineffective.

Daytime incontinence is considered abnormal after the age of four.

If your child experiences normal urination patterns for an extended amount of time (more than six months) – and then regresses, that’s another sign they may be a candidate for our clinic.

Initial treatment at the clinic typically includes:
• Basic urotherapy
     o Timed voiding (emptying the bladder on a scheduled basis – every few hours – even if the urge to void is not present)
     o Double voiding (urinating twice in rapid succession to ensure complete bladder emptying)
     o Hydration
• Bowel management (Voiding Dysfunction is often associated with constipation)
• Extensive education, encompassing an explanation of the urinary system, behavior modification, and how to complete a voiding diary

Following this protocol resolves symptoms in about 45 percent of the patients we see.

If problems persist, we move to the next level of investigation, medication and therapy.

Advanced Studies include:
• Renal ultrasound
• Noninvasive urodynamics, which can entail voiding into a specially-designed cylinder that measures the constancy and speed of the urine stream
• Invasive urodynamics, which can involve catheterization in the bladder and rectum to measure pressures and evaluate function
• Voiding cystourethrogram (VCUG), a test that uses fluoroscopy to visualize a child's urinary tract and bladder and help diagnose vesicoureteral reflux

If we have to do an invasive test, we take great care to explain the procedure to you and your child.

In conjunction with escalating investigations for persistent dysfunctions are escalating treatment options, which may include:
• Anticholinergics – a class of drugs used to treat a variety of conditions, including gastrointestinal disorders, such as diarrhea, overactive bladder, and incontinence
• Alpha adrenergic blockers that relax the sphincter muscles
• Behavioral therapy
• Biofeedback, a type of physical therapy that teaches pelvic floor muscle coordination
• Parasacral TENS (transcutaneous electrical neural stimulation) to stimulate the sacral nerves and help prevent voiding accidents and relieve constipation
• Sacral neuromodulation – equated to a “bladder pacemaker” for older children with persistent issues
• Percutaneous Tibial Nerve Stimulation, which involves sending a nerve impulse to regulate control of bladder and pelvic floor muscles
• Bladder or sphincter Botox treatments