In the treatment of enuresis, the enuresis alarm is the gold standard. NICE, ICCS, AAP — all international guidelines recognise it as first-line therapy. Effectiveness is 70–80%, with a relapse risk 3–4 times lower than medication-based treatment.

However, this device is still relatively unknown in many countries. In this article we explain how it works and how to use it correctly.

How Does It Work?

The device consists of two parts:

  • Sensor — attached to the child's underwear or to the bed, sensitive to moisture
  • Alarm unit — connected to the sensor by wire or wirelessly, emits an audible and/or vibrating signal

Mechanism: as soon as the child begins to urinate, the sensor detects moisture and activates the alarm. The sound wakes the child.

Why Does It Work? Classical Conditioning

The principle of Pavlovian conditioning is applied here:

  • Unconditioned stimulus: the alarm sound → unconditioned response: waking up
  • Conditioned stimulus: bladder filling (sensation)
  • Gradually formed connection: bladder filling → waking up

Over 8–12 weeks, the brain learns to recognise bladder signals — and the child begins to wake on their own, without the alarm.

Types of Devices

1. Mat type: A pad placed under the mattress. Protects the entire bed. Advantage: the sensor does not contact the child directly, more comfortable. Disadvantage: sometimes reacts less quickly.

2. Body-worn: Sensor attached to the underwear, alarm unit worn around the neck or wrist. Advantage: fast reaction. Disadvantage: can cause discomfort for the child.

3. Wireless: Sensor in the child's room, alarm unit in the parents' room. This allows the parent to assist as well. More expensive.

12-Week Protocol

Weeks 1–2: Adaptation

  • Teach the child how to connect the device
  • Joint preparation together before bed each evening
  • Protocol on activation: get up immediately → toilet → reconnect the device → back to bed
  • The child participates actively — they are not a passive subject

Weeks 3–6: Building the Effect

  • The number of activations typically decreases during this phase
  • On some nights the child wakes on their own, without the alarm
  • The number of dry nights begins to increase

Weeks 7–12: Consolidation

  • Goal — 14 consecutive dry nights
  • A fully dry morning is a small joyful moment (acknowledge it, but not an "event")
  • After a setback — no scolding; take the approach "this is part of the journey too"

Upon successful completion of treatment: after 14 consecutive dry nights the device is gradually discontinued — used every other night for 1 week, then stopped.

Practical Tips

  • The device should be in the child's room, not the parents'. Sometimes the child does not hear the alarm — so the parent must be nearby
  • Begin treatment with enthusiasm — give the child a sense of being "helped," not "punished"
  • Do not motivate the child with sweets and cakes — this creates behavioural dependency
  • The child should not change the bedding — this is perceived as punishment; the parent changes it, the child only helps (e.g. putting the dirty linen in the washing machine)
  • Don't be afraid to start again — for some children the first protocol doesn't work, but the second succeeds

Limitations and Obstacles

  • When the device doesn't work — it is usually errors in use (the child does not hear the signal after urinating, the parent is not helping)
  • Some children, due to deep sleep, cannot hear the alarm — in this case, parental assistance is essential
  • Relapse after completing treatment (in 15–20%) — resolved by a brief repeat course

Where to Buy the Device?

International manufacturers:

  • Wet-Stop, Malem (USA)
  • Anzacare DRI Sleeper (New Zealand)
  • Pjama (Sweden)

When receiving treatment at a clinic, the device is often loaned out and returned upon completion of treatment.