Nighttime Toilet Training

  • Rachel L. Goldin
  • Delilah Mendes de Gouveia
Part of the Autism and Child Psychopathology Series book series (ACPS)


Nighttime toilet training entails a much different set of methods and procedures than daytime toilet training. Daytime toilet training requires education and practice on enuresis and encopresis, while nighttime training typically only involves enuresis. Also, the length of time body waste must be retained at night is much longer than during the day. Thus, it should be no surprise that children are much younger when daytime continence is achieved. This chapter will discuss these issues in detail and will provide a review of the comment, empirically based methods for nighttime toilet training.


Nocturnal enuresis Bedwetting Nighttime toileting Intervention 


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.CrossRefGoogle Scholar
  2. Aikawa, T., Kasahara, T., & Uchiyama, M. (1998). The arginine-vasopressin secretion profile of children with primary nocturnal enuresis. European Urology, 33(3), 41–44.CrossRefPubMedGoogle Scholar
  3. Axelrod, M. I., Tornehl, C., & Fontanini-Axelrod, A. (2014). Enhanced response using a multicomponent urine alarm treatment for nocturnal enuresis. Journal for Specialists in Pediatric Nursing, 19, 172–182.CrossRefPubMedGoogle Scholar
  4. Azrin, N. H., Sneed, T. J., & Foxx, R. M. (1974). Dry-bed training: Rapid elimination of childhood enuresis. Behaviour Research and Therapy, 12(3), 147–156.CrossRefPubMedGoogle Scholar
  5. Azrin, N. H., & Thienes, P. M. (1978). Rapid elimination of enuresis by intensive learning without a conditioning apparatus. Behavior Therapy, 9(3), 342–354. Scholar
  6. Banerjee, S., Srivastav, A., & Palan, B. M. (1993). Hypnosis and self-hypnosis in the management of nocturnal enuresis: A comparative study with imipramine therapy. American Journal of Clinical Hypnosis, 36(2), 113–119.CrossRefPubMedGoogle Scholar
  7. Bollard, J., & Nettelbeck, T. (1981). A comparison of dry-bed training and standard urine-alarm conditioning treatment of childhood bedwetting. Behaviour Research and Therapy, 19(3), 215–226. Scholar
  8. Bower, W. F., & Diao, M. (2010). Acupuncture as a treatment for nocturnal enuresis. Autonomic Neuroscience, 157(1–2), 63–67. Scholar
  9. Bradbury, M., & Meadow, S. (1995). Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis. Acta Paediatrica, 84(9), 1014–1018. Scholar
  10. de Jonge, G. A. (1973). Epidemiology enuresis: A survey of the literature. In I. Kolvin, R. C. MacKeith, & S. R. Meadow (Eds.), Bladder control and enuresis - clinics in developmental Medicine (pp. 39–46). PA, Lippincott: Washington Square.Google Scholar
  11. DiBianco, J. M., Morley, C., & Al-Omar, O. (2014). Nocturnal enuresis: A topic review and institution experience. Avicenna journal of medicine, 4(4), 77.Google Scholar
  12. Edwards, S. D., & Spuvy, H. I. J. V. (1985). Hypnotherapy as a treatment for enuresis. Journal of Child Psychology and Psychiatry, 26(1), 161–170. Scholar
  13. Fergusson, D. M., Hons, H., Horwood, L. J., & Shannon, F. T. (1986). Factors related to the age of attainment of nocturnal bladder control: An 8-year longitudinal study. Pediatrics, 78(5), 884–890.PubMedGoogle Scholar
  14. Fielding, D. (1985). Factors associated with drop-out, relapse and failure in the conditioning treatment of nocturnal enuresis. Behavioural Psychotherapy, 13(3), 174–185.CrossRefGoogle Scholar
  15. Fitzwater, D., & Macknin, M. L. (1992). Risk/benefit ratio in enuresis therapy. Clinical Pediatrics, 31(5), 308–310.CrossRefPubMedGoogle Scholar
  16. Friman, P. C. (2008). Evidence-based therapies for enuresis end encopresis. In R. G. Steele, T. D. Elkin, & M. C. Roberts (Eds.), Handbook of evidence-based therapies for children and adolescents: Bridging science and practice (pp. 311–333). New York: Springer.CrossRefGoogle Scholar
  17. Fonseca, E. G., Bordallo, A. P., Garcia, P. K., Munhoz, C., & Silva, C. P. (2009). Lower urinary tract symptoms in enuretic and nonenurtic children. Journal of Urology, 182(4), 1978–1983.CrossRefPubMedGoogle Scholar
  18. Forsythe, W. I., & Redmond, A. (1974). Enuresis and spontaneous cure rate. Archives of Disease in Childhood, 49, 259–263.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Foxman, B., Valdez, R. B., & Brook, R. H. (1986). Childhood enuresis: Prevalence, perceived impact, and prescribed treatments. Pediatrics, 77(4), 482–487.Google Scholar
  20. Glazener, C. M. (2008). Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews, 1. Retrieved from
  21. Glazener, C. M. A., Evans, J. H. C., & Peto, R. E. (2005). Alarm interventions for nocturnal enuresis in children. The Cochrane Database of Systematic Reviews, 2, CD002911.Google Scholar
  22. Glazener, C. M., Evans, J. H., & Peto, R. E. (2004). Treating nocturnal enuresis in children: Review of evidence. Journal of Wound Ostomy & Continence Nursing, 31(4), 223–234.CrossRefGoogle Scholar
  23. Henrikson, N., & Peterson, S. (2013). Behavior treatment of bedwetting in an adolescent with autism. Journal of Developmental and Physical Disabilities, 25, 313–323.CrossRefGoogle Scholar
  24. Jarvelin, M. R., Huttunen, N. P., Seppanen, J., Seppanen, U., & Moilanen, I. (1990). Screening of urinary tract abnormalities among day and nightwetting children. Scandinavian Journal of Urology and Nephrology, 24(3), 181–189.CrossRefPubMedGoogle Scholar
  25. Kristensen, G., & Jensen, I. N. (2003). Meta-analyses of results of alarm treatment for nocturnal enuresis: Reporting practice, criteria and frequency of bedwetting. Scandinavian Journal of Urology and Nephrology, 37(3), 232–238.CrossRefPubMedGoogle Scholar
  26. Lovibond, S. H. (1963). The mechanism of conditioning treatment of enuresis. Behaviour Research and Therapy, 1, 17–21.CrossRefPubMedGoogle Scholar
  27. Mellon, M. W., & McGrath, M. L. (2000). Empirically supported treatments in Pediatric Psychology: Nocturnal enuresis. Journal of Pediatric Psychology, 25(4), 193–214. Scholar
  28. Meltzer, L. J., Johnson, C., Crosette, J., Ramos, M., & Mindell, J. A. (2010). Prevalence of diagnosed sleep disorders in pediatric primary care practices. Pediatrics, 125(6), 1410–1418.CrossRefGoogle Scholar
  29. Mowrer, O. H., & Mowrer, W. M. (1938). Enuresis—A method for its study and treatment. American Journal of Orthopsychiatry, 8(3), 436–459. Scholar
  30. Nettelbeck, T., & Langeluddecke, P. (1979). Dry-bed training without an enuresis machine. Behaviour Research and Therapy, 17(4), 403–404.CrossRefPubMedGoogle Scholar
  31. Neveus, T. (2011). Nocturnal enuresis - theoretic background and practical guidelines. Pediatric Nephrology, 26, 1207–1214.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Olness, K. (1975). The use of self-hypnosis in the treatment of childhood nocturnal enuresis. A report on forty patients. Clinical Pediatrics, 14(3), 273.CrossRefPubMedGoogle Scholar
  33. Oppel, W. C., Harper, P. A., & Vider, R. V. (1968). The age of attaining bladder control. Pediatrics, 42(4), 614–624.PubMedGoogle Scholar
  34. Page, M. E., & Valentino, R. J. (1994). Locus coeruleus activation by physiological challenges. Brain Research Bulletin, 35, 557–560.CrossRefPubMedGoogle Scholar
  35. Roche, E. F., Menon, A., Gill, D., & Hoey, H. (2005). Clinical presentation of type 1 diabetes. Pediatric Diabetes, 6, 75–78.CrossRefPubMedGoogle Scholar
  36. Ronen, T., Wozner, Y., & Rahav, G. (1992). Cognitive intervention in enuresis. Child & Family Behavior Therapy, 14(2), 1–14. Scholar
  37. Sukhai, R. N., Mol, J., & Harris, A. S. (1989). Combined therapy of enuresis alarm and desmopressin in the treatment of nocturnal enuresis. European Journal of Pediatrics, 148(5), 465–467.CrossRefPubMedGoogle Scholar
  38. Taylor, P. D., & Turner, R. K. (1975). A clinical trial of continuous, intermittent and overlearning “bell and pad” treatments for nocturnal enuresis. Behaviour Research and Therapy, 13(4), 281–293.CrossRefPubMedGoogle Scholar
  39. Tüzüner, F., Keçik, Y., Ozdemir, S., & Canakçi, N. (1989). Electro-acupuncture in the treatment of enuresis nocturna. Acupuncture & Electro-Therapeutics Research, 14(3–4), 211–215.CrossRefGoogle Scholar
  40. Warzak, W. J. (1993). Psychosocial implications of nocturnal enuresis. Clinical Pediatrics, 32(1), 38–40.CrossRefGoogle Scholar
  41. Watanabe, H., & Azuma, Y. (1989). A proposal for a classification system of enuresis based on overnight simultaneous monitoring of electroencephalography and cystometry. Sleep, 12, 257–264.PubMedGoogle Scholar
  42. Wille, S. (1994). Primary nocturnal enuresis in children. Background and treatment. Scandinavian Journal of Urology and Nephrology. Supplementum, 156, 1–48.PubMedGoogle Scholar
  43. Wille, S. O. R. E. N. (1986). Comparison of desmopressin and enuresis alarm for nocturnal enuresis. Archives of disease in childhood, 61(1), 30–33.Google Scholar
  44. Williams, P. G., Sears, L. L., & Allard, A. (2004). Sleep problems in children with autism. Journal of Sleep Research, 13, 265–268.CrossRefGoogle Scholar
  45. Yazbeck, S., Shick, E., & O'Regan, S. (1987). Relevance of constipation to enuresis, urinary tract infection, and reflux. A review. European Urology, 13, 318–321.PubMedGoogle Scholar
  46. Yeung, C. K., Sit, F. K., To, L. K, Chiu, H. N., Sihoe, J. D., & Wong, C. (2002). Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. British Journal of Urology, 90, 302–307.CrossRefGoogle Scholar
  47. Yeung, C. K., Sihoe, J. D., Sit, F. K., Bower, W. F., Sreedhar, B., & Lau, J. (2004). Characteristics of primary nocturnal enuresis in adults: An epidemiology study. British Journal of Urology, 93, 341–345.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Rachel L. Goldin
    • 1
  • Delilah Mendes de Gouveia
    • 2
  1. 1.Department of PsychiatryIndiana University School of MedicineIndianapolisUSA
  2. 2.The Emerge CenterBaton RougeUSA

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