A 9-year-old with primary enuresis asks about treatment options. The family should be told which statement is true?

A 9-year-old with primary enuresis asks about treatment options. The family should be told which statement is true?

• A. The alarm is the safest therapy, but the relapse rate is about 10%
• B. Pharmacologic therapy has the lowest relapse rate
• C. Motivational therapy should be used after pharmacologic treatment
• D. Treatment should begin with bladder awareness training

Answer: (D)

Starting with bladder awareness training targets how the bladder functions and helps the child learn to recognize fullness, expand capacity, and develop regular voiding patterns. This noninvasive approach often includes keeping a bladder diary, establishing timed daytime voiding, and managing fluids and constipation if present. By normalizing bladder habits and improving bladder control, it lays a solid foundation for any later therapy, whether an alarm or medication is used. The other options—alarm therapy, pharmacologic treatment, or using motivational strategies only after other steps—are valuable but are typically added after building good bladder habits and voiding routines. So beginning with bladder awareness training is the best first step.

Starting with bladder awareness training targets how the bladder functions and helps the child learn to recognize fullness, expand capacity, and develop regular voiding patterns. This noninvasive approach often includes keeping a bladder diary, establishing timed daytime voiding, and managing fluids and constipation if present. By normalizing bladder habits and improving bladder control, it lays a solid foundation for any later therapy, whether an alarm or medication is used. The other options—alarm therapy, pharmacologic treatment, or using motivational strategies only after other steps—are valuable but are typically added after building good bladder habits and voiding routines. So beginning with bladder awareness training is the best first step.